Published: 11/4/2002, Volume II2, No. 5800 Page 18 19
There is a widely held belief that the NHS and pharmaceutical companies view each other with suspicion tinged with loathing. A recent conference organised by the NHS Confederation boasted that it would offer the industry insights into the future of the health service. But did it go any way towards mending a notoriously tricky relationship?
Representatives from the drugs industry converged on London's Savoy Hotel just before Easter. At£1,410 for the two-day event, they clearly hoped that the great and good would offer useful pointers on how they could work more fruitfully with the NHS in the interests of the companies' balance sheets.
And patients too, of course.
Judged on the first day, the conference seemed to leave many delegates disappointed. The keynote presentation was by junior health minister Lord Hunt whose areas of responsibility include pharmaceuticals. He provided a more than adequate overview of the structural changes in the NHS. But some of those attending pointed out it was not the first time he had explored this territory.
Lord Hunt said that with the 'major change in the levers of power', primary care trusts would control the funding for pharmacy services. Health secretary Alan Milburn wants the industry to work closely with the Department of Health on the implementation of the national service frameworks, Lord Hunt noted.
He went on to explain that the new National Institute for Mental Health in England planned to meet pharmaceutical companies with an interest in mental health to set up a working group on areas of mutual interest. These collaborations were an important step forward, he stressed.
The delegates were keen to find out who the key decision makers in the new - allegedly decentralised - NHS were likely to be and to get to them quickly.
One was worried about how long the handover to PCTs would take. Lord Hunt said he 'preferred to work on the premise that PCTs are capable of taking on the responsibilities they are being given...' But the industry representatives doubted the ability of the new organisations to get up to speed quickly.One said: 'I am concerned there is no-one in place yet. They have not sorted themselves into a structure that is ready to do business.'He had no faith that that was likely to happen before 2004, when PCTs will hold 75 per cent of the NHS budget.
Another delegate recommended finding allies by focusing on the most developed of the new organisations. A number of PCTs, he said, had 'some had very strong leads in certain frameworks'.
Andy McKeon, head of the medicines, pharmacy and industry division of the DoH, seemed slightly confused when asked who would be the key contacts at the new strategic health authorities.
'It is too early to say... It will vary, ' was all he could say. 'They all have their different structures. I suspect it will depend on what you want to talk about. A lot of them will have a pharmaceutical or prescribing adviser.Or you may want to talk to the person who is dealing with the coronary heart disease framework.'
The advice from conference chair Alan Jones was to 'read the back pages of HSJ '.
Mr McKeon laid out the changes impacting on his area, including the roll-out of independent nurse prescribing, GPs delegating follow-up plans for patients to community pharmacists and pilots for the electronic transfer of prescriptions. But he left the industry to read between the lines.
Somewhat provocatively, Alan Maynard, professor of health economics at York University, gave a talk entitled Devolution and NHS Redisorganisation for Drug Dealers. The delegates didn't seem to mind that. But they must have been bothered by his pessimistic message that PCTs were 'untested' and would be 'supervised' by SHAs who 'may or may not be the flunkies of the four regional offices, whose role is to protect ministers'.
Did he offer the industry any comfort? 'There were no grounds for thinking the restructured NHS was going to be any different, ' he said, but added that the Commission for Health Improvement and the Audit Commission were coming through in their roles of reviewing framework implementation.
The greater emphasis on quantitative management and performance ratings might also be an opportunity, he felt.
Colette Edwards, manager in health advisory practice at PricewaterhouseCoopers, said that the better NHS organisations were working to five-year plans, but 'some were still stuck in the 12-month mentality'. She believes the pharmaceutical companies need to be 'more focused' about research and development so that their products fit in better with what the NHS needs.
In the pharmaceutical industry, demand drives supply while the opposite is true for the NHS. So are the two sides going to end up as 'bed partners' or will there be a 'clash of the Titans', Ms Edwards asked. One way forward was for businesses to get tied in to the service and financial frameworks:
'There is then the chance money will be there for a new drug.'
The industry came to the conference looking for more than crumbs from the table. As one deflated delegate told HSJ: 'It has not opened things up.'
So what does she believe has to happen next? 'There needs to be a clear direction from the centre that says as long as you have transparent relationships, you must look at the pharmaceutical industry as a partnership.
Then a lot of the fears among PCTs will go.'
Though feedback from the second day was more positive, it remains to be seen whether the event has brought the pharmaceutical companies and the DoH closer together or driven a wedge further between them. l Cash point: tapping the innovators National clinical director for primary care Dr David Colin-Thomé was asked how the industry might get access to the new primary care purse-string holders.One entry point might be primary care trust professional executive committees, he said.'Tap into the innovators', he recommended.
A new more quality-based GP contract might force the pace, he said.But he had no hesitation in lobbing grenades.The way the industry had 'attacked' the National Institute for Clinical Excellence had been 'unhelpful'.While he had nothing against Mondeos clogging up GPs'car parks, he emphasised that marketing could be 'through more mature partnerships'.
PCTs had been 'engaging with private organisations in developing services', Dr Colin-Thomé said.
Might not the industry be a funder for a national service framework roll-out, he wondered.He pushed on with optimism: 'A few years ago, some of you seemed to be thinking about helping with managed care models.'His words were met with stony silence.
Conference chair Alan Jones asked: 'What does the mature relationship consist of?'Dr ColinThomé told HSJ: 'There are ideas where the pharmaceutical industry could expand into being a funder - for example, they could fund PCTs.'
But what about probity? 'That would depend on the contract [with the PCT] saying they are not going to just recommend their own drugs... You need to have the failsafes without stopping innovation.'He said he was confident that mechanisms such as PCT networks were developing to ensure any emerging best practice with the pharmaceutical industry could be spread around.