As a more integrated and networked system of decision-making takes root across the NHS, Oli Hudson looks at the key strategic and organisational challenges pharmaceutical companies will need to address

Organisational change can feel strangely abstract – until, of course, it becomes alarmingly real. That’s the feeling many in the NHS will be having at the moment as we start to see the tangible effects of the landscape being remoulded into the form envisaged by the government’s NHS Bill.

The accession of integrated care systems (ICSs) as the dominant organising structure within the NHS is now being reflected by the increasing amount of guidance documents, senior recruitment advertisements and system-level pledges being pushed out across the country.

Beneath them, provider collaboratives are also taking shape, encouraging greater collaboration and shared planning and resource management across multiple provider organisations – while an equivalent process has already taken place with Primary Care Networks joining general practice together at neighbourhood level.
But what difference does all of this make to the nuts and bolts of how industry does business with the NHS?

In this article, I want to look at three practical implications of these changes for commercial suppliers, illustrating some of the strategic and operational challenges that are emerging – and showing how pharmaceutical companies best meet them.

Intelligence-based assumptions

First, there’s a simple truth to bear in mind: these reforms, coupled with the ongoing efforts of managing an unprecedented backlog, mean that we can’t expect individual hospitals to be doing the same work they were doing before. What was ‘business as usual’ for a given hospital is now (in a lot of cases) ancient history.
For pharma, this means it is important to understand these new realities and to invest in the local intelligence needed to discover how different ICSs are responding to the key challenges of managing capacity and reducing waiting times.

Our Quantis data tool is a useful way of tracking how systems are approaching the decision of where it treats people. Indeed, we are about to launch a Patient Discovery white paper diving into this issue – because the results, as we’ve found, can be eye- opening.

In Norfolk and Waveney, for instance, we’ve noticed a clear pattern emerging in diabetes care. Of the three big acute providers within the ICS footprint, the biggest hospital is now getting more patients while the other two have recorded drops in activity. In addition, a high number of patients are being sent outside of the ICS footprint for specialist treatment in London.

What arises from this is a flavour of the strategy taken by a particular ICS: in this case, an effort to stop the smaller district general hospitals from doing specialist diabetes care, presumably so that they can focus on tackling the backlog. And with this, of course, comes practical insights that can drive your engagement and KAM approach.

This is just an illustration. But by mapping at scale, looking across different ICS footprints and digging down into different disease pathways, pharma companies can begin to develop robust, intelligence-based assumptions about how patient flows are being remoulded as a result of the current environment. It represents a critically important foundation for your own strategic planning.

Understanding clinical networks

A second challenge is keeping up with the movement of people and their influence across different decision-making points within a system. One of the established principles of ICSs, as set out in their Design Framework, is that of delegated authority – that is, ensuring power and decision-making is delegated down to the most appropriate level. What that means in practice is a complex layering of decision-making.

For example, formulary arrangements will vary from area to area, but in many parts of the country we are seeing decisions taken at both system (via ICSs) and place (via provider collaboratives) levels. That means that tracking and managing influencers becomes ever more intricate.

In the new NHS landscape, decisions are no longer insular or organisation-based. Clinical networks are fast-becoming the dominant decision-makers and collective decision-making, bound up in the new governance arrangements within a system, is the ‘new normal’. So how best to manage the right relationships in this emerging game of 3D chess?

Our Specialism XD database can offer a comprehensive database of information on clinicians’ interests of professional networks – you can quickly understand who the power players are in a given specialism and how they connect into the new decision-making arrangements within their area.

To operationalise this, you can link your key contacts into our Key Account Management tools to organise and plan your engagement and relationship management approaches. Together this can ensure that you’re connecting to the right people; that you understand the context in which they are working; and that you therefore tailor your offer in a way that best answers the challenges they are facing.

Optimising your commercial resources

The third and final area for pharma to consider is how it reorganises its own people and processes in response to the changes now happening in the NHS.
The risk for commercial suppliers is that they are configured to deal with the NHS as it was, not as it’s now become, with outdated territories and account teams mapped against rigid organisations rather than the more fluid networks of influencers and decision makers.

Organisations need to deal with the impact of these changes on issues like customer relationship management, how customers are grouped or segmented, how sales resource is targeted at system, place and neighbourhood levels, what kinds of targets are realistic at each of these levels and how different elements of the workforce are trained and organised to manage these new realities.

Specialist commercial optimisation support can help you dig down into the organisational issues that this new landscape creates in a way that brings together all of the themes we’ve discussed. There are several important elements to this (and we can help with all of them).

The first step includes benchmarking, diagnostics and customer mapping to understand what drives commercial success in the new commercial environment and how different localities may yield new or greater commercial potential.

The second step, based on this analysis, is a process of re- organising your resources to align with the target segments and territories you’ve prioritised. How do you best organise your field force at system-level, and how does that map down into relevant contact points within provider organisations?

And the third and final step is the development of more detailed engagement and bespoke call planning strategies, as well as advice on training and performance management. In other words, ensuring sales teams are equipped with the information and direction they need and are motivated to succeed.

Conclusion: opportunity knocks

Having described the challenges, it’s worth saying that the reforms also present some considerable opportunities for industry to partner with the NHS in different ways, and sometimes on a completely different scale. The recalibration of the NHS landscape focusing on collective decision-making to support population health should be something that the pharma industry welcomes because it allows commercial partnerships to paint on a far bigger canvas.

There’s also a greater willingness and urgency to embrace new ways of working within the NHS, including the use of technology and digitally enabled solutions to improve preventative services and support out of hospital care. Indeed, this is a moment when serious conversations are happening about many, if not all, care pathways to see if they can be improved and optimised for the future.

But in this environment, the organisations that will thrive are the ones that understand deeply the new context in which NHS decision makers are working, and are properly configured and equipped to provide their customers with a sound, evidence-based rationale for changing or improving the way they do things.

This demands bold thinking, strong organisation and access to the right data and evidence to shape your commercial approach. More than anything, it means industry recognising that it’s not just the NHS that will need to adapt to change. Pharma will have to do so too – and quickly.

Oli Hudson is content director at Wilmington Healthcare. Its Patient Discovery white paper will be published later in October. Visit