David Fisher Commercial Director, ABPI PDIG Summer Conference 2008 dfisher@abpi.uk

1. David Fisher Commercial Director, ABPI PDIG Summer Conference 2008 dfisher@abpi.org.uk

2. Building Partnerships with the NHSPPRS Renegotiations

3. Ministerial Industry Strategy Group “There are a number of areas where increased dialogue and partnership between the NHS and industry would deliver significant benefits for Government, patients, industry and research.” • A more ‘mature’ relationship can be developed between the industry and the NHS (at both national and local levels) through joint working on areas of mutual interest and benefit.

4. Why do it?The NHS in 2008 - 2010 • National standards, local delivery • Professional networks and KOLs still important, but will increasingly ‘bump up’ against the local commissioning agenda • Less clinical / prescribing freedom for individual GPs or Pharmacists

5. The NHS of tomorrow.. • More contracted GPs – obliged to conform with local formularies (who writes these?) • More ‘corporate’ and better informed • More prescribers, but more controls

6. “Significant changes in the structure and measurement of the NHS, and particularly the introduction of a variety of Health Trusts and new business - orientated roles in the NHS, have meant that there are more complex channels to go through to sell a particular product. Managers in Trusts are increasingly focused on value for money when choosing medicines, which has an impact on what clinicians are guided to prescribe.” Carolyn Hunt, Head of Field Force Training and Development, Pfizer (Pf March 08)

7. Recommendations • DH Guidance specific to joint working • Best practice toolkit on joint working for NHS and industry managers (on DH and ABPI websites) • Promotion and dissemination of toolkit at key conferences and other forums GUIDANCE and TOOLKIT ABPI Training for industry managers initiating and implementing joint working projects Industry and NHS stakeholder training and support TRAINING • Build on ideas arising out of NHS Workshop September 2006 • Articulate the ‘win-win’ POTENTIAL PROJECTS

8. Joint Working Joint working between the pharmaceutical industry and the NHS refers to situations where, for the benefit of patients, organisations pool skills, experience and/or resources for the joint development and implementation of patient-centered projects and share a commitment to successful delivery. Joint working agreements and management arrangements are conducted in an open and transparent manner. Joint working differs from sponsorship, where pharmaceutical company(ies) simply provide funds for a specific event or work programme. JOINT WORKING DEFINITION

9. ABPI NHS Outreach Programme: What Is It? • Reaching out to NHS customers that do not talk to / engage with pharma (‘do not enter here’ policies) • Describing mutually beneficial ways of working to improve service / quality to patients • Introducing companies to new NHS customers • Facilitating joint working projects • Learning and sharing what works and how

10. NHS / Pharma Involvement • 32 out of 33 ‘difficult to access’ PCTs expressed an interest in working with the programme • 24 companies involved in N West • 25 companies involved in S West • 35 companies involved in East Mids

11. What it isn’t • ABPI constraining individual company activity (all are free to pursue their own agendas in parallel to outreach) • NHS customers seeing ‘working with pharma’ as ‘working through ABPI’ • ABPI ‘pooling’ pharma resources to offer to NHS customers

12. How do we do it? • Leg work and hard work • Establishing rapport and building trust (ABPI is broadly trusted by NHS customers) • Working through their priorities and then describing those that might be of interest to pharma • Joint working not sponsorship – both parties put something in and get something out • Agreeing the project design with pharma companies around the table thereby influencing outcomes, building rapport and trust

13. Challenges • Neither NHS customers nor pharma companies are ‘joined up’ • Communicating the programme is largely ‘bottom up’ • Establishing rapport and building trust and learning new behaviours • ABPI Code of Practice?

14. Outcomes to date • Programme well received by both NHS customers and pharma on the ground • Helping companies think through the learning need of their front line staff based on evidence (what they need to know, how they need to behave) • Asking NHS customers to promote the benefits of working with pharma (articles in the press, conference presentations)

15. Involving the right people with appropriate support? “Need more senior endorsement, from senior to middle management. The local people lack experience and skills to release the budgets and marketing skills”. “On the pharma side, by being a senior person, I was able to get the partnership agreement completed quickly, and I gained more from the project by knowing how to use the opportunity”. (Pharma)

16. Involving the right people with appropriate support? “HDM has a different meaning in different companies - some are specialist sales reps, hence pushing sales; others are more project based”. “The industry people are less experienced than the NHS people”. (Pharma)

17. “Sales reps may not be the most appropriate people. Not sure why they were chosen, or who else is available in the companies”. “It could have been helpful to bring in other expertise from within the pharma companies at certain times e.g. marketing”. “Were reps the right people to have on this team”? “When choosing reps, the companies should find out who would be best suited. Is it just the local rep who is being sent? This is not necessarily the best person. The same can be said for the PCT choice of person”. (NHS)

18. What’s in it for Pharma? By working with the NHS to improve the quality and quantity of care provided …… • E.g. through provision of high quality education programmes to ensure staff are adequately trained to diagnose and treat patients; by helping to increase access and capacity of services etc….. ….will ultimately result in more modern medicines being appropriately prescribed and used properly by patients

19. Joint Working at a Local LevelThe Happy Hearts and INFORCE Projects

20. Happy Hearts CVD Risk Identification and Management in Deprived Communities

21. Nottingham City • 325,000 registered population • 7th most deprived LA in England • Just over half of residents live in areas ranked within the 10% most deprived nationally (IMD2004) • A city with low life expectancy • a 13-year difference for men: St. Ann’s (69) compared to Wollaton (82) • 34% due to premature deaths from Cardiovascular Disease (CVD) • 50% due to smoking • Need to narrow the inequality gap: • Between Nottingham and England average • Between least and most deprived areas in Nottingham

22. Premature (<75) CVD deaths: Nottingham and England Nottingham’s death rate is considerably higher than the England rate

23. We can impact on 86% of CVD risk factors • Deprivation • poor housing and education • Lifestyle factors • Smoking: 34% cf. to 24% in England - 90,000 people in Nottingham smoke! • Low levels of physical activity – over 180,000 people need to exercise more • Poor diet and nutrition – only 1 in 5 people eat5 or more portions of fruit and vegetables each day • Access to primary care • esp. to cholesterol and blood pressure-lowering treatments, and smoking cessation services • Support for lifestyle factor change

24. ‘Happy Hearts’ • Targeted in areas of deprivation where CVD death rate is worst ( 13 Practices) • Identifying people with >20% risk of developing CVD • 2 year project • Specially trained HealthCare Assistants • Specialist software to identify patients • Invitation to attend full health check • Supporting them to make healthier lifestyle choices • Referral for medical / pharmaceutical intervention as required. • Ongoing follow up and support

25. What did Industry bring? • Funding! • Business acumen and model development • Evaluation • Defining objectives and measures of success • Marketing • GPs and other stakeholders • Patients • Increased Management Capacity ( for PCT) • Communications lead for whole project • Launch Meeting • Monitoring and evaluation support software • Governance • ABPI support on developing and implementing clear governance arrangements

26. What did the NHS bring? • Strategic fit with Health Improvement work • Organisational buy-in • maintains top priority for the work • Opportunity to roll out and model with other disease areas • Epidemiological and clinical input • Buy-in from PEC and LMC

27. Project Materials Surgery Poster Patient Treatment Folder Patient Invitation Patient Info Leaflet Media Campaign

28. Where are we now? • Launched to patients Dec 2007 • 12 month period patient identification and management • Evaluation phase Dec 2008 • Project write up and publication • HSJ and HSC awards submission • Significant interest from other NHS organisations and DH • Example of good practice within DH toolkit • Launch of second PCT / Industry Project

29. INFORCE Industry and Nottingham NHS Focus on Reducing COPD Exacerbations

30. INFORCE • Aims to reduce number of unnecessary admissions to hospital for COPD exacerbation • Partnership between NUHT, NCPCT and Pharmaceutical Industry via ABPI Outreach programme • 5 Companies ( different to Happy Hearts Members) • Audit of all COPD admissions between Nov 2007 and March 2008 • Identify commonalities in treatment prior to admission • NICE Guidelines benchmark • Review COPD care pathway accordingly • Re audit 12 months later The INFORCE project has been developed in collaboration with and jointly funded by the ABPI Outreach project team whose members are the pharmaceutical companies: AstraZeneca, Boehringer Ingelheim, GSK, Nycomed and Pfizer. The ABPI is the Association of the British Pharmaceutical Industry.

31. Process • Development of business case and proposal to industry facilitated by ABPI • Steering committee with equal membership from all stakeholders • Working Groups equal membership • Communications, Audit, Implementation, Evaluation • Jointly chaired • Equal funding PCT and Industry ( £30k each) • COPD audit nurse via Ashfield In2focus • Audit in process, Results due July 2008 • Wider stakeholder consultation re potential service / pathway changes / improvements • Implementation of changes Sep 2008 AND Re audit Sept 2009 The INFORCE project has been developed in collaboration with and jointly funded by the ABPI Outreach project team whose members are the pharmaceutical companies: AstraZeneca, Boehringer Ingelheim, GSK, Nycomed and Pfizer. The ABPI is the Association of the British Pharmaceutical Industry.

32. Governance • Before project starts: • Clearly defined and agreed objectives • What's in it for both sides – must be a win / win • What each party is to contribute • Process • Expected outcomes • Exit strategy • Written agreement signed and agreed by all parties • ABPI code requirements • Funding process clearly defined

33. Challenges • Funding and Partnership Agreements • Internal company compliance • Sign off procedures and timelines • Project timelines • Diaries and meetings • Stakeholder Input • Ability • Commitment • Influence • Cultural and organisational differences

34. Would we do it again?

35. Definitely!! Yes!!