We were recently asked to conduct some research on partnership working between the National Health Service (NHS) in the UK and the pharma industry, by the PharmaTimes for a feature article. It threw up some fascinating insights on current challenges and a potential new partnering model. As part of the article we completed the Q&A below with the magazine. If you’d like more detail on our findings, please get in touch at info@strategicnorth.com.
What do you think is the main challenge for successful joint working?
Mindset – current ambition levels are too low. Both sides lack a deep understanding of what a partnership could look like and what each side would be willing to commit to. These assumptions and misperceptions often stop successful joint working in its tracks. There is little encouragement for long-term partnership, just one-off projects and so that frames people’s expectations.
In a nutshell, how would you describe pharma and the NHS’ views of joint working?
It mostly sits in the ‘too hard’ box. The NHS, see the potential benefit but are highly risk averse, which is accentuated by issues related to industry trust and transparency. The industry also sees the benefit, but the approval processes required (especially when multiple companies are involved which is the NHS preference) means it is incredibly hard to initiate and implement, and many people feel the current guidance actually makes joint working harder.
Are you surprised that the NHS is still concerned about pharma’s commercial motives despite some good examples of successes? Why/why not?
Not wanting to be evasive but yes and no! There are many examples of good practice but awareness of these is low, and so has not had the impact they could have. Plus the industry has not helped its cause with some of its historical practices. But let us be clear, as a CCG Commissioner said to us “There has been bad behaviour on both sides which has tarnished the idea of joint working”.
Can pharma provide more than just a product in a joint working partnership? Why/why not?
A very interesting question and dynamic. The issue is almost the opposite scenario where it is difficult for the industry to link joint working to a product. It is the only industry we can think of where this is the case. However our research actually showed that many people in the NHS would be happy to include product endorsement as part of a new type of partnership. For example they would be comfortable to incentivise use of product in class (in agreed therapeutic areas), and communicate an endorsed joint message in return for commitments from the pharma company. We are sure this would surprise a lot of people.
Do you think joint working is biased in favour of the NHS? Are you surprised this is how many in pharma think about joint working?
To a degree. Many in the NHS demand a lot from the pharma ‘partner’ but give little in return. However, our model showed that both parties are willing to commit to a reasonable and significant level of partnership across the criteria, and in many cases this was way beyond current frameworks, understanding and expectations of NHS/pharma joint working. But without understanding the opportunities and barriers, it is impossible to move to a different model.
Why does past and historical interactions have to influence joint working now?
They do because it is human nature. The concerns we refer to above are based on many, many years of experience which cannot be changed overnight. They may be based on historical events, but the perceptions and concerns remain deeply held, and influence current actions.
Are you surprised pharma are prepared to contribute more in terms of resource so it is an unequal distribution? What does this say about pharma and its view of joint working?
No, and we don’t think that should necessarily change. The guidelines state the need to share resources but that has caused confusion and been a sticking point for joint working. Pharma understand that they have more available money and resources (time, etc.) than the NHS, and therefore do not mind an unequal distribution. The NHS feel that sharing resources changes the nature of the project, because they believe they will have to spend money that they do not have, but that does not have to be the case. It is should be more about shared commitment and equal resource.
It probably says that pharma has been too willing to invest in different areas, and to meet too many demands as a ‘foot in the door’, as opposed to considering what truly brings value to their own organization, the NHS and most importantly the patient.
Do you think NHS people who are more open-minded will help push joint working forward or are there too many issues?
We think they certainly can. There are some change management concepts which are highly relevant here; firstly ‘rallying the herd’, where people will imitate good practice and in a risk-averse NHS seeing these examples will encourage people to do the same. Secondly, ‘following the bright spots’, where highlighting and recognising the success stories encourages others to pick up the baton. As a CCG Chair said to us “We need to reframe the opportunities and benefits of joint working, not only that it is something ok to do, but we should proactively encourage it, as there are many benefits to the collaboration”.
Are there any other comments regarding the findings you would like to make?
We think it relates to the mind-set issue. The expectations on both sides are incredibly low and short-termist, and focusing on the guidelines and regulations (which people do) will not fundamentally change this situation. Developing true long-term joint working partnerships requires a total reframing of what is required in terms of commitment on both sides. Our model showed that both sides are willing to commit beyond current expectations on a number of levels: exclusivity, access, product endorsement, promotional behaviours, information sharing and joint planning. Far from being a conflict of interest, the NHS respondents described this new model of partnership as more joined up, more patient and outcomes focused, more efficient and more open and honest, which can only be positive for the NHS and industry alike.