Published: 02/12/2004, Volume II4, No. 5934 Page 23

In the week of the NICE conference, Alan Jones asks what role pharma companies will have in the management of long-term conditions

In the mid-1990s, several bold pharmaceutical companies set up disease-management operations to sell services to the NHS in chronic disease areas such as asthma and diabetes.

At their heart were IT programmes aimed at tackling the often-fragmented services provided for the treatment of these long-term conditions.

But with little government support the initiative died and the outfits were wound up. Now several pharmaceutical companies are again considering setting up similar operations. However, this time with warm government support they would likely do much better, in part because US-managed care is over here and most certainly over-hyped.

Who cannot be aware of the US Evercare and Kaiser pilots ongoing in England? But some may be less familiar with the Pfizer Health Solutions pilot being run with Haringey primary care trust in north London.

PHS is a wholly owned subsidiary of Pfizer, which has developed a large number of management of long-term conditions programmes in the US.

Haringey is using care management tools developed by PHS, but is keen to point out in a question and answer document that this is not 'healthcare privatisation by stealth'.

The document also states that Pfizer has no objectives from the partnership that relate to the use or endorsement of its products in the UK, nor does it provide or encourage any additional access to healthcare professionals by Pfizer reps.

And there is more: 'This innovative, technology-supported disease-management programme is a landmark pilot project within the NHS in terms of a partnership between the public and private sectors.' But other folk in PCT land may be less happy to use pharmaceutical companies in this way - after all, it is an American profit-making company.

What is most interesting is that under the previous Conservative government this kind of initiative stalled, but under a Labour government it is being encouraged. Clearly the view of this government is that plurality of provision is now a good thing.

There is even reference to working with pharmaceutical companies through the alternative provider medical services route in the NHS improvement plan.

Certainly, a major problem in reducing unplanned hospital admissions is knowing with any certainty who should be targeted, which is why the folk at UnitedHealth Group are so enthusiastic about their data collection products.

So, with the government now requiring greater innovation at local level, might we begin to see a range of initiatives from more joint working around management of long-term conditions and 'full' disease-management services (again) being provided by pharma but funded by PCTs?

PCTs will certainly have to actively refocus their minds on introducing more effective chronic-disease managment systems. And they may well consider using private sector partners to help them with this.

So has another opportunity arisen for companies to get back into disease management packages?

I am sure others will consider following in Pfizer's footsteps, but remember GSK, Novartis, Lilly and others all got their fingers badly burnt in the mid-'90s.

Alan Jones is an independent health policy analyst and managing consultant at AJC healthcare.