PHA
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Aug u st
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2017
THE M E N TA L H E A LT H ISSUE
2017 Perception, Motivation and Satisfaction Survey How satisfied are you in your current role? Does your benefits package stack up? Are you looking for other opportunities? U N D E R S TA N D YO U R E M PLOYE E S Retaining your top performers is critical to your business success – do you know what they are thinking? The Pf People Survey asks your employees the questions you want the answers to. 26% of respondents in the 2016 Pf People Survey stated that they were looking to change companies in 2017. Gain powerful insight into your employees and industry by taking the 2017 Perception, Motivation and Satisfaction Survey. Call Hazel Lodge on 01462 476119 for more details.
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WELCOME
EDITOR
John Pinching john@pharmafield.co.uk A S S I S TA N T E D I T O R
Amy Schofield amy@pharmafield.co.uk ART DIRECTOR
Emma Warfield emma@pharmafield.co.uk COMMERCIAL DIRECTOR
Hazel Lodge hazel@pharmafield.co.uk SALES & MARKETING MANAGER
Rachel Cresswell rachel@pharmafield.co.uk FINANCIAL CONTROLLER
Fiona Beard finance@e4h.co.uk P f AWA R D S
Melanie Hamer melanie@e4h.co.uk PUBLISHER
Karl Hamer karl@e4h.co.uk pharmafield.co.uk e4h.co.uk @pharmafield @pharmajobsuk HEAD OFFICE
Spirella Building Bridge Road Letchworth Garden City Hertfordshire SG6 4ET United Kingdom Cover illustration by Alex Buccheri alexbuccheri.com The content of and information contained in this magazine are the opinions of the contributors and/or the authors of such content and/or information. Events4Healthcare accepts no responsibility or liability for any loss, cost, claim or expense arising from any reliance on such content or information. Users should independently verify such content or information before relying on it. The Publisher (Events4Healthcare) and its Directors shall not be responsible for any errors, omissions or inaccuracies within the publication, or within other sources that are referred to within the magazine. The Publisher provides the features and advertisements on an ‘as is’ basis, without warranties of any kind, either express or implied, including but not limited to implied warranties of merchantability or fi tness for a particular purpose, other than those warranties that are implied by and capable of exclusion, restriction, or modification under the laws applicable to this agreement.
T
Letter from the Editor
his month we talk quite openly about mental health. Indeed, we are dedicating much of the magazine to it. Discussing our difficulties and anxieties, as a normal part of British life, has not been easy. A decade ago we still lived in a ‘pull yourself together’ society where self-analysis, emotional well-being and matters of the mind were religiously neglected. Old habits die hard. Much has happened in recent years, however, to gradually change the make-up of a nation, through politics, the medical profession and even popular culture; notably music, cinema and television. Consequently, mental health has become part of the conversation, while people with mental health issues are, apparently, less marginalised. In our cover story, we ask how much progress has really been made, and if the panacea of parity with physical conditions can ever truly be reached. We will also focus on one of the most common mental health issues – depression; how well it is being treated, advances in diagnosis and what life is like for people with depression in the modern era. Our exclusive interviews include a chat with a Europe-roving pharma star, and coffee with a true hero of mental health. This dynamic pair both prove that desire and determination can go a long way in changing attitudes and lives. Meanwhile, we’ve sent our brave political correspondent into the wasteland of British Governance, our pharmacy columnist into medicines management and our NHS adventurer into the crevices of healthcare you didn’t even know existed. Also, we reveal the best 10 healthcare apps, what it takes to be a Pf Award Winner and who in industry is moving where. It’s great to have you on board,
No copying, distribution, adaptation, extraction, reutilisation or other exploitation (whether in electronic or other format and whether for commercial or non-commercial purposes) may take place except with the express permission of the Publisher and the copyright owner (if other than the Publisher). The information contained in this magazine and/or any accompanying brochure is intended for sales and marketing professionals within the healthcare industry, and not the medical profession or the general public.
Pf Magazine is published monthly. For a free U.K. subscription visit pharmafield.co.uk/subscribe.
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M AG A ZI N E | AU G U S T 2017 | 1
CONTENTS
03 08 14 15 16 18 20 22 25 26 30 32 34 36
MAGAZINE
N E WS
Bringing you this month’s essential headlines C OV E R S TO RY
Is mental illness finally being given parity? OPINION
David Thorne’s vision of primary care in the future F E AT U R E
Are smartphones taking over our lives? POLITICS
Alex Ledger ponders the new political landscape COFFEE BREAK
Kate Dale’s mission to transform mental health OPINION
Deborah Evans on medicine optimisation
August READER’S VOICE: I really enjoyed July’s Pf Magazine. The breadth of feature and opinion articles – from different perceptions on how biosimilars are changing, to considering the implications of directto-consumer advertising in the UK – have provided relevant perspectives on the pharma industry, which we regularly apply to our communications activities. Having just returned from the American Society of Clinical Oncology annual conference and seen first-hand just how different the US regulations are, one can’t help considering how the UK would react should things change over here. Coupled with the latest news, Pf Magazine provides a comprehensive overview of what’s happening in the industry, and helps me keep my finger on the pulse! Chrissie Hannah, Account Executive, Tonic Communications
Reading such an honest piece from Melanie Hamer, about her Dad’s pancreatic cancer (July Pf Magazine), really hit home to me – thanks for sharing it. My family went through a similar situation, in fact the dates were almost identical in terms of diagnosis. In Summer 2015 life just stopped. To put it into words takes courage and I’m sure it was tough to go back to that time, but I’m also sure it brought back wonderful memories of a “dignified” man. Fortunately, my Dad, a retired pharmaceutical rep, was able to receive the Whipple procedure and has made good progress. His incredibly positive attitude has astounded me, even through chemo, and I would love to inherit it as I get older. We should all stop to reflect more on what’s important in life. Colin Prentice, MD and owner, Prentice Associates
F E AT U R E
The most helpful selfcare apps on the market P H A R M ATA L E N T
What it takes to win a coveted Pf Award F E AT U R E
How modern Britain is dealing with depression
HAVE YOUR SAY: Are men talking more openly about their health? Has awareness about STIs improved in the last decade? What social responsibilities does industry have beyond treatment manufacturing? We’ll be covering these issues in the next Pf Magazine – want to contribute? GET IN TOUCH: hello@pharmafield.co.uk @pharmafield
@pharmajobsuk
Pf Magazine
MARKETING
Industry must start realising the potential of digital M OV E R S & S H A K E R S
Who is going where and why they are going there P H A R M ATA L E N T
Nathalie Moll’s inspirational tour of European pharma O N YO U R R A DA R
BE IN THE KNOW. To request a FREE print subscription for your workplace, or to sign up to our weekly newsletters for the essential headlines, Jobs of the Week, Pharmatalent and thought-provoking features, visit pharmafield.co.uk/subscribe This issue and all past issues of Pf Magazine can be viewed online at issuu.com/pfmagazine
A glance across the wider healthcare landscape
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P f N E WS : B R IN G IN G YOU TH I S M O NTH ' S E SS ENTI A L H E A D LIN E S
A N I M A L T H E R A PY
DIFFERENT STROKES for DIFFERENT FOLKS
Pf View: Industry is becoming increasingly open to the holistic approach and this is precisely the type of initiative it should be encouraging. How pharmaceuticals work in tandem with animal-based therapy would certainly make a fascinating study.
T R I A L DATA .
EMPLICITI ITSELF
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ristol-Myers Squibb has announced that treatment with Empliciti (elotuzumab) plus Revlimid (lenalidomide) and dexamethasone in patients with relapsed/refractory multiple myeloma (RRMM) continued to show effectiveness in the Phase III ELOQUENT-2 trial after four years of follow-up. The combination therapy demonstrated a sustained reduction in risk of disease progression and death of 29%, as well as a 50% relative improvement in progression-free survival rates. After the four-year period had elapsed, 21% of patients were still alive and disease-free, in contrast to the 14% of patients receiving Revlimid and dexamethasone (Ld) alone.
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he Royal College of Nursing (RCN) is to create the first ever nationwide protocol for animals in healthcare, encouraging more hospitals to explore animal therapy. The protocol, announced at an RCN public lecture on the subject, will provide an evidence-based criteria to enable hospitals and other healthcare settings to introduce animals into the care environment. The project was prompted by a recent RCN survey which found that, although the majority of respondents thought animals were hugely beneficial to patients, most nurses said animals were not allowed in their workplace. By following the RCN’s proposed new protocol, services will enable patients to reap the benefits that interaction with animals can bring, while ensuring the safety of patients, healthcare staff and the animals. The RCN survey found that nine out of 10 nurses believe that animals can improve the health of patients with depression and other mental health problems, and 60% said the presence of animals could speed patient recovery. The development of the new protocol will be led by RCN Professional Lead for Longterm Conditions and End-of-Life Care, Amanda Cheesley, with contributions from expert charities, nursing staff and a variety of healthcare organisations. Cheesley said: “There are so many myths about the dangers of animals in healthcare settings, however, most organisations are too concerned to try it. This protocol will help dispel fears by supporting hospitals to include animals in the care they deliver.”
Empliciti is an immunostimulatory antibody that specifically binds to SLAMF7, a glycoprotein, or a protein attached to a carbohydrate group, located at the cell-surface. SLAMF7 is found in myeloma cells and immune cell subsets. The findings were presented at the 22nd Congress of the European Hematology Association in Madrid, Spain, and represent the longest follow-up assessment of efficacy and safety of an immuno-oncology drug. Jonathan Leith, PhD, haematology development lead at Bristol-Myers Squibb, said: “The long-term efficacy data for Empliciti in patients with advanced multiple myeloma shows the combination of this immuno-oncology agent with standard Ld treatment can improve patient outcomes.”
M AG A ZI N E | AU G U S T 2017 | 3
Pf View: This shows flexibility and common sense from NICE that many of its fiercest critics will welcome. More importantly, it represents justice for the many thousands of people that will benefit from this correct decision.
BREAST CANCER.
U-turn triumph
N
ICE has announced a ‘new deal’ on Roche’s breast cancer drug Kadcyla (trastuzumab emtansine), meaning it can now be recommended for routine funding on the NHS. Kadcyla is currently funded through the Cancer Drugs Fund (CDF), but if there are no appeals against the new draft guidance, eligible patients will no longer have to apply for funding and the drug will be paid for in the normal way. Campaigners have called it a ‘monumental’ U-turn as, despite being approved by the NHS in Scotland, the life-extending drug was previously deemed too expensive for the UK. Roche has now reached a confidential deal with the NHS and reduced the cost of the drug, which previously cost £90,000 per patient. Kadcyla adds an average of
six months of life to women with HER2-positive tumours, a form of terminal breast cancer. Another important factor in the decision to recommend the drug was the committee’s agreement that it was appropriate to compare Kadcyla with Herceptin plus capecitabine. NICE had previously compared Kadcyla’s efficacy against a different combination of treatments. Herceptin plus capecitabine, however, is now considered standard treatment for people with advanced breast cancer. Professor Carole Longson MBE, Director of the centre for health technology evaluation at NICE, said: “Since we started reassessing the drugs available through the Cancer Drugs Fund, companies have responded positively and shown that they can offer good deals when it comes to pricing.”
Quick doses M E R C K S H A R P and D O H M E ’s Keytruda accepted for inclusion in the Cancer Drugs Fund as a first-line lung cancer therapy. • E U S A P H A R M A announces positive CHMP opinion for marketing FOTIVDA (tivozanib) which manages patients with advanced renal cell carcinoma in EU plus Norway and Iceland.
10-year study shows that G S K’s Benlysta (belimumab) plus standard of care prolongs control of disease in patients with systemic lupus erythematosus. • S A N O F I and S A N O F I G E N Z Y M E announce EC marketing authorisation for Kevzara® (sarilumab) in combination with methotrexate for the treatment of rheumatoid arthritis.
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R O C H E ’s new Esbriet tablet formulation, approved in Europe for mild to moderate idiopathic pulmonary fibrosis, offers reduced pill burden. • The European Commission agrees to expand the use of N OVA R TI S’ Zykadia to include the first-line treatment of patients with advanced non-small cell lung cancer whose tumours are ALK-positive.
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ALZHEIMER’S. DISEASE.
DIRE DEMENTIA PREDICTION
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esearchers from University College London (UCL) have concluded that by 2040, there will be over 1.2 million people living with dementia in England and Wales, largely due to increased life expectancy. Their results, published in the BMJ, show that, although the incidence of dementia is falling, the overall prevalence is set to increase. Researchers used data from 18,000 men and women from the English Longitudinal Study of Ageing (ELSA). The study began in 2002 with the purpose of tracking the health of a representative sample of the population in England aged 50 and older. Participants were assessed in six waves from 2002 to 2013. At each wave, tests were carried out to assess memory, verbal fluency, numeracy function, and basic activities of daily living, for example getting in or out of bed, dressing and eating. Dementia was identified through the assessments, complemented by interviews with carers, or by doctor diagnosis. After accounting for the effect of dropout from the study, the team found the rate of dementia incidence went down by 2.7% per year between 2002 and 2013. Despite this decline in incidence, the research shows that overall prevalence of dementia is set to increase substantially, which is mainly attributed to increased life expectancy. Dr James Pickett, Head of Research at Alzheimer’s Society, said: “These latest estimates are yet another wake-up call that the current social care system – already on its knees from decades of underfunding – needs urgent attention from the Government if it is to cope with the inevitable massive increase in demand.”
BREAST CANCER
Faslodex flies The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has adopted a positive opinion recommending the marketing authorisation of AstraZeneca’s Faslodex (fulvestrant) for the treatment of hormone receptor-positive (HR+) locallyadvanced or metastatic breast cancer, for those who meet certain criteria. The CHMP recommendation is based on pivotal data from the Phase III FALCON trial, where Faslodex 500mg demonstrated superiority over anastrozole in the treating post-menopausal women who had not received prior hormonal-based medicine for HR+ breast cancer. The CHMP’s positive opinion will now be reviewed by the European Commission and the final decision will be applicable to all 28 EU member countries plus Iceland, Norway and Liechtenstein. In addition, Faslodex is being tested in combination with over 19 different medicines and is the only hormone medicine for advanced breast cancer that slows tumour growth by binding to and degrading the oestrogen receptor.
R H EU M ATO I D A R T H R I T I S
Rheum with a view A new survey into the effects of rheumatoid arthritis (RA) has shown that regardless of characteristic or country, its symptoms and how it makes people feel has a significant impact on their lives. The RA Matters survey, conducted by Eli Lilly and Company, showed that despite major advances in the treatment of RA, physical symptoms, such as fatigue and pain, continue to be the biggest barriers for people with RA in the workplace. They had difficulty using their hands, while daily activities were also impacted by the disease, with more than 60% of people with RA finding that it hindered their ability to exercise.
Meanwhile, 23% of people with RA reported that they had problems with daily routines, such as washing and personal care. Despite much progress in addressing the physical burden of RA, many people feel RA hinders their ambitions for the future. Clare Jacklin, Director of External Affairs, NRAS, UK, said: “The RA survey has provided a platform for people living with RA to voice what really matters to them. Life with RA should not be a compromise. It should be about taking control of this debilitating disease and not having your life defined by it.”
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EPILEPSY
‘A’ to Zebinix
NHS
NHS EXPRESS Patients with a learning disability, autism or both are set to benefit from over £10 million of investment by NHS England to help them lead more independent lives closer to friends and family. 14 local Transforming Care Partnerships will be supported by the funding to develop new, high-quality community services for people in their area. The Partnerships are made up of NHS organisations, local authorities and NHS England commissioners, working closely with people who use services, their families and providers. The funding will support services, among others, in Bradford, involving intensive support for children showing challenging behaviour. Meanwhile, in the South of England, there will be action to help people move from long-term inpatient care into more appropriate facilities, and in Berkshire funding will be available for a multi-disciplinary community service. Jane Cummings, Chief Nursing Officer for England and Chair of the Transforming Care Delivery Board, said: “We’ve already seen a 13% fall in the number of people inappropriately situated in inpatient settings across England.” The funding announcement is the latest tranche of up to £40 million being invested by the cross-system Transforming Care programme over 2015/16 – 2018/19.
Bial and Eisai have announced data from a Phase II study which showed that treatment with Zebinix ® (eslicarbazepine acetate) had no significantly negative impact on attention, information processing and working memory in children aged six to 16-years-old with focalonset epilepsy. Data was presented in an oral presentation at the EPNS Congress in Lyon, France. Eslicarbazepine acetate also demonstrated no statistically significant difference for secondary endpoints including continuity of attention, quality of working memory and speed of memory at the end of Part I.
Approximately 10.5m children and adolescents worldwide are estimated to have active epilepsy. Meanwhile, children with the condition may suffer from cognitive impairment and have impaired ability to learn. Ann Connolly, Registered Advanced Nurse Practitioner Epilepsy (Childhood), National Children’s Hospital, Adelaide and Meath Hospital, Dublin, Ireland, said: “These findings may indicate that eslicarbazepine acetate has no significant negative consequence on the neurocognitive capability of children. This is important as the treatment may help support normal learning and schooling.”
R CELL IMMUNOT H E R A PY.
MATES
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esearchers at the University of Southampton and La Jolla Institute for Allergy & Immunology, California, have discovered a new type of immune cell that could predict which lung cancer patients will benefit most from immunotherapy treatment. The scientists found that lung cancer patients with a substantial amount of memory T-cells in their tumour were 34% less likely to die. The study, funded by Cancer Research UK, also found that the cells’ behaviour played a key role, clustering together and residing in a particular tissue, in this case the cancer tissue, to protect the patient. These new T-cells also produce other molecules that attack the tumour, meaning the body’s immune system could be more likely to hunt out and destroy cancer cells. The T-cell could also potentially be used as a template to develop a vaccine to boost immunotherapy even more and help tackle one of the hardest to treat cancers. Professor Christian Ottensmeier, Cancer Research UK scientist at the University of Southampton, said: “These are hugely exciting results. For the first time we have a real indication of who might benefit from a particular drug before we make treatment decisions. The new findings are a big step towards making this exciting treatment much more predictable. Pf View: Understanding how the body’s own sophisticated defence systems operate in order to assist with lab-manufactured treatments; essentially combining ‘old tech’ and new innovation is a masterstroke.
N E WS FO CUS Looking at a notable story in sharp focus
Hit send: Doctors using Snapchat to share patient scans
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report from a panel of health and tech experts says that NHS doctors may be using Snapchat to send patient scans to each other. The panel, chaired by former Liberal Democrat MP, Dr Julian Huppert, said that using Snapchat or camera apps in this manner is a ‘clearly insecure, risky and non-auditable way of operating.’ The report, by DeepMind Health (DMH), which is owned by Alphabet, the parent company of Google, was commissioned for an annual independent review of the company’s work, which involves introducing and testing new technology for the NHS. Early in July, the Information Commissioner’s Office found that London’s Royal Free hospital failed to comply with the Data Protection Act when it handed over the personal data of 1.6 million patients to DMH. Dr Huppert said: “The digital revolution has largely bypassed the NHS, which, in 2017, still retains the dubious title of being the world’s largest purchaser of fax machines.
“Many records are insecure, paperbased systems which are unwieldy and difficult to use. Seeing the difference that technology makes in their own lives, clinicians are already manufacturing their own technical fixes. “They may use Snapchat to send scans from one clinician to another or camera apps to record particular details of patient information in a convenient format.” He went on to say that it was “difficult to criticise these individuals, given that this makes their job possible, however, this is clearly an insecure, risky and non-auditable way of operating, and cannot continue”. The panel included Richard Horton, Editor-in-Chief of the Lancet, Professor Donal O’Donoghue, Consultant Renal Physician at Salford Royal Hospital and Matthew Taylor, Chief Executive of the Royal Society for the Encouragement of Arts, Manufactures and Commerce.
E X P E R T A N A LYS I S
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JA M E S M U C K LOW Digital healthcare expert, PA Consulting Group The digital revolution is transforming every aspect of our lives, with affordable, powerful, easy-to-use technology available to almost everyone. That has made us very demanding consumers. We expect to be connected all the time, access huge amounts of data and for all that to be available at the touch of a button. Patients, health and social care professionals are no different and we need to focus on doing more to harness these new technologies in safe and appropriate ways to meet their needs.
D R K E N N Y L I V I N G S TO N E GP and Chief Medical Officer, ZoomDoc We need to probe into why doctors are resorting to Snapchat. I don’t think it stems from an urge to cut corners; rather it’s the technological bugbears they face. Doctors need to be careful. But as a doctor within the NHS, what I want more than ever, is a balance between the need for privacy and the understanding that doctors with a vested interest in patient recovery need to have quicker access to clinical notes, lab reports, x-rays and other files. The NHS is encumbered by layers of legacy systems that need to be consolidated in various departments so that information can be exchanged quicker and people can be treated swiftly.
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WORDS BY
John Pinching I L L U S T R AT I O N B Y
Alex Buccheri
H E A D R O O M
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COVER STORY
WE
HAVE
MAD E CO N S I D E R AB LE PRO G R E SS WITH
A WAY
LEIL A RE YBURN Mental Health Services Manager at Mind
M E NTAL
H E ALTH , B UT
THE CHARIT Y
TH E R E ’ S LO N G TO
G O.
M
ental illness and ‘Britishness’ have always been a toxic pairing. The combination of dark episodes, depression or anxiety, and a national identity built on a stiff-upper lip, has made our collective mental journey slow and difficult. Mental illness still makes us uncomfortable, and it has only been through considerable force that we have brought it into sharp focus and, more importantly, stared it down; often in our own mirror. Consequently, in 2017, we are a little more comfortable with what we see and, indeed, what we hear. In these passages, we confront our position on mental health and our experts ponder where we are in the great scheme of things. As a nation, have we really made progress and are we anywhere near reaching parity with physical conditions?
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ental health has been neglected for decades; by government, by public services and by society as a whole. As a result, mental health services have suffered huge underinvestment by comparison to physical healthcare services. We see the impact of this in people who do not get the help they need, when they need it, and in the distinct lack of investment in the prevention of mental health problems. In contrast, we have seen considerable change in public attitudes towards people with mental health problems over the last decade, with a 9.6% improvement (around 4.1m people) since our anti-stigma campaign, ‘Time to Change’, began in 2007.
Alongside efforts to decrease the stigma around mental health, initiatives like Mind’s ‘Find the Words’ campaign aimed to give people greater confidence in seeking support from their GP or primary healthcare provider. Now that stigma is starting to dissipate and more people are seeking help, it is vital that we have the funding and resources in place to cope with high demand. We are also a year into the Five Year Forward View for Mental Health, a robust and clear plan to start improving mental health services, which comes with an additional £1bn investment in mental health services by the end of 2020-21. We need to keep up the pressure to make sure these promises are fulfilled and that money reaches the frontline. The proof will ultimately be in the improved experiences of people accessing mental health services. Go to mind.org.uk
“Now that stigma is starting to dissipate it is vital that we have the resources in place to cope with the high demand”
T H E C O N F E D E R AT I O N
SE AN D UG G AN Mental Health Network Chief Executive, NHS Confederation
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here has been huge progress in the way mental health is talked about and recognised, with campaigns such as ‘Heads Together’ having a positive impact on tackling stigma. With greater awareness of mental health, however, comes extra pressure on services, which are already stretched. The Government has pledged to put mental health on a par with physical health, but this needs to be reflected in investment and the continued progress of the Five Year Forward View for Mental Health. Getting mental health services right will relieve pressure on other parts of the health system and we urge the Government to deliver on its promises and ensure mental health gets the equal status it deserves.
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T H E C A M PA I G N E R T H E P S YC H I AT R I S T
KENNY J O HN STO N
AND RE A S PAPAD O P OULOS
Founder of the CLASP Charity
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ental health has progressed positively in the last decade, though the road ahead is difficult if parity with physical conditions is ever going to be achieved. Part of the problem is the general public’s failure to realise the normality and variety of mental health difficulties, which we all encounter in our daily lives. The lack of support towards someone with a mental health issue remains different compared to the reaction towards an individual with a broken arm, cancer or a heart attack. Sadly, we still live in a society with a need for visible proof of an illness, before there is an acknowledgement. More people need to speak about their mental health experiences in order to engender normality, while empowering and inspiring others. The power of people speaking openly has been proved throughout history, assisting in ending negativity about different social aspects and illnesses, ending stigmas and
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T H E C O LU M N I S T
DAVID TH O RNE Pf Magazine Columnist and former mental health nurse
formulating parity across different races, religions and sexual orientations. A perfect example is cancer, which 40 years ago had a stigma due to the the low prospects of survival. Nowadays, there is early screening, effective medical treatment, support and information, while events such as ‘Race for Life’ enable unity. Normalising mental health will build positivity, showing there is no need to fear it. The more people speak, the more we can achieve as individuals and as a society. Mental health can find parity across society, institutions, employers and wider healthcare; but it needs to learn from cancer, the LGBT community and other social stigmas in order to achieve it. Go to claspcharity.com
“Normalising mental health will build positivity, showing there is no need to fear it”
ental health has progressed since I was a nurse in the 80’s but, sadly, far too little. It remains characterised by dichotomies – patient rights versus public protection, excellence alongside abuse and empathy for celebrities, but fear of ‘that guy on the bus’. The rhetoric is for mental health integration with mainstream healthcare, but psychiatrists and mental health nurses have helped to isolate themselves and their services through a sub-culture of lost confidence. Services are not designed for those most in need and the third sector is where positive practice invariably sits in addressing self-harm, substance misuse and crippling isolation.
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Consultant Psychiatrist at Avon and Wiltshire Mental Health Partnership NHS Trust
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or years Government mandates have pushed for parity of esteem between mental and physical health. Although NHS England has urged local CCGs to increase their funding for Mental Health Trusts, almost half have seen theirs drop. Trusts continue to be paid through block contracts, which don’t reflect the increases in demand, making them endure funding cuts in a disproportionate way. Mental health only receives 6% of the total UK health research funds and, as a result, many of the drugs used in the treatment of mental illness have not changed for the last 20 years. Patients with mental illness, therefore, continue to suffer inferior quality of life and fail to achieve functional recovery. Mental illness is much more difficult to diagnose and treat compared to physical illness, due to a lack of treatments which actually cure, rather than simply treat mental illness. Add to that a reluctance among patients to seek help and you have a big problem.
“Mental Health Trusts continue to be paid through block contracts that do not reflect the increases in demand for services” Inpatient treatment is helpful, but very expensive, and the number of NHS inpatient beds has significantly shrunk, opening opportunities for independent providers to charge vast amounts . Community services that provide support to people at risk are invaluable, but to ensure success in the longterm an upfront investment is necessary. In the meantime, inequality continues to widen, and for that to be corrected a political and societal change is needed which allows people to achieve their potential.
COVER STORY
M T H E PAT I E N T
IAN CART WRI G HT Diagnosed with depression 27 years ago
y journey into depression, like so many other people these days, was due to excessive stress at work. I worked in the outdoor event hire industry for many years, climbing through the ranks and eventually becoming a general manager. Stress for me was about seeking to be perfect, to be productive and not let anyone down. I became and still am a workaholic. For me, depression also has a physical element. During one meltdown, I slept all day and all night for weeks, with very little energy. My GP’s diagnosis was depression. Men don’t generally admit to it, but my road to recovery began when I eventually said: “I suffer from depression”.
“My road to recovery began when I eventually said, I suffer from depression”
TH E
THE PROFESSIONALS
D EB O R AH CARPENTER Psychotherapist, Nightingale Hospital
MEG AN J O HN STO NE Mental Health Nurse at an East London Foundation Trust
The diagnosis in 1990 paved the way for life as a Methodist Minister. During my seventeen years in the ministry I had three major breakdowns and the last one, in 2016, lead to my early retirement. Depression is like existing in a desert; a dry, dark, lonely, uncomfortable and debilitating experience. I did, however, discover many healing and refreshing streams of healing in my personal desert. This included help from my tremendous GP, taking medication and the use of talking therapy, because it is vital to be open about mental health. The NHS is wonderful, but I had to wait a long time for treatment and it finished early due to lack of funding. Fortunately, I have had incredible help from a range of other sources. A local mental health charity introduced me to compassion focused therapy, which has been amazing. My family and friends are also very supportive, encouraging me to go for walks, while volunteering at York Council for Voluntary Services has kept me active. If you are experiencing mental health problems, there is amazing help out there. It’s great to be feeling better, but it’s been a long journey back. Ian’s book ‘Healing Streams in the Desert’ is available at imagineprojects.co.uk
“The problem with mental health is that it’s not solely about funding, it’s about understanding what patient needs are and being able to provide necessary care on a consistent basis.” “It is not being given parity. If somebody has diabetes, they receive treatment almost instantly. In contrast, someone with depression could be waiting six months. There are constant cuts – our assertive outreach team is being discontinued and one of our rehab wards is being shut.”
FAC TS
MENTAL ILLNESS IS AMONG THE MAIN CAUSES OF
GLOBAL DISEASE burden worldwide •
1 IN 6 PEOPLE experience a mental health PROBLEM EVERY WEEK WORLDWIDE
• FEMALES AGED 16 TO 24 IN BRITAIN ARE 3 TIMES MORE LIKELY TO EXPERIENCE MENTAL HEALTH PROBLEMS THAN MALES •
7.8% of PEOPLE IN BRITAIN HAVE MIXED
anxiety and depression •
4-10% of PEOPLE WILL EXPERIENCE DEPRESSION IN THEIR LIFETIME • DEPRESSION CAUSES 1/5 OF DAYS LOST FROM WORK IN BRITAIN Source: Mental Health Foundation
M AG A ZI N E | AU G U S T 2017 | 1 1
ADVERTORIAL
INDUSTRY INSIGHT:
Mental health treatment experts Lundbeck on the challenges facing industry, healthcare and wider society.
D
epression is the leading cause of disability worldwide and a major contributor to the overall global burden of disease. In the UK, mental health problems represent the largest single cause of disability, with estimates showing that one in every six people of working age will experience a mental health problem over the course of a year, with anxiety and depression the most common. Despite this, depression consistently falls between the gaps in healthcare provision, as GPs struggle with workload and Mental Health Trusts prioritise more serious mental illnesses, due to funding cuts and a bed crisis. At present, mental health receives unprecedented political attention. Some might say, ‘about time too’. For several years, three words, ‘parity of esteem’ have been viewed as a mental health priority across the NHS, relative to physical health. Indeed, it has become the emblem embossed into national policies, documents, reports and indicators.
The change in policy has mainly been driven by the excellent work of the Mental Health Taskforce and the Five Year Forward View for Mental Health, but it might be argued that its recommendations have led to the overall focus shifting to more serious mental illnesses, such a schizophrenia, and less on depression. There may even be a view among the public, and some NHS services, that common mental illnesses like depression might be cured by commissioning more psychological therapies. While NICE are currently re-writing their guidelines on depression, in their last document, ‘Depression in adults: recognition and management’, they were clear that both psychological therapy and pharmacological therapy are useful in improving patient outcomes. Furthermore, it states that, for people whose depression doesn’t respond to either interventions, clinicians should combine treatments. NICE, in the spirit of the parity of esteem agenda, also undertook their first singletechnology appraisal of an antidepressant in 2015, approving vortioxetine as an option for treating major depressive episodes in adults
Making every day a better day for people affected by brain diseases.
Find out more about our culture at www.lundbeck.com/uk/about-us For career opportunities visit www.lundbeck.com/uk/careers
1 2 | PH A R M A FI EL D.CO.U K
“Depression consistently falls between the gaps in healthcare provision.” whose condition has responded inadequately to two antidepressants within the current episode. This clearly reaffirms the importance of pharmacological therapy for depression. Despite this positive psychological/ pharmacological guideline environment, and encouraging press around parity of esteem, it appears all too regularly in print that the patient on an antidepressant is part of a rising group of ill who are ‘overprescribed’ pharmacological therapies, despite NICE’s view on their effectiveness. Meanwhile, mental health professionals await the updated NICE clinical guidelines for depression, due for publication in January 2018, in the hope that they will help remove the stigma associated with mental illnesses like depression, and also encourage new effective treatments. Go to www.lundbeck.com References associated with this feature can be found in the online edition.
Since Together for Mental Wellbeing was established in 1879, we have believed that people with mental health issues have the right and the abilities to lead independent, fulfilling lives as part of their communities. What makes us stand out is that we put people at the centre of their own support – they set their own goals and are in control of how we work alongside them to achieve these. We focus on people’s strengths and believe everyone can and should be supported to live the life they want to lead, no matter how unwell they are or how complex their needs.
We see beyond diagnoses and approach people as whole individuals with a range of circumstances and needs: social, emotional, physical, spiritual and economic. Each individual we work with influences and shapes the support they and others receive from us. We value people’s lived experience of mental distress and believe this makes them the experts in what works best for them. We work with approximately 4,000 people every month in around 70 locations and our services include support in the community, accommodation-based support, advocacy and criminal justice services.
For more information, visit www.together-uk.org
Registered Charity No. 211091. Registered Company No. 463505
OPINION
Back to the future The current approach to primary care is toast – pharma, this is your chance.
F WORDS BY
David Thorne
ew things seem to be as unchanging as a GP surgery, and there is a fair chance you’re reading this thinking that yours has hardly changed since you registered. So, when I say that multiple tipping points suggest that primary care will radically alter, then you may not believe me. I work with two GP federations in very different areas. Yesterday, at one board meeting, we discussed a nursing workforce review, which revealed the majority of our nurses are aged over 51 and 29% are over 56. Last week, in the other city, yet another practice ‘handed the keys back’ and announced its closure. Ultimately, the future belongs to places like Encompass in Kent. This facility is a superb example of integrated out-of-hospital care made viable by scale; replicating leadership, a coherent strategy linked to a clear vision and data to build the plan. The truth is that the traditional primary care model is already an anachronism, and only complacency, wishful thinking and nostalgia stand in disagreement. We have GPs consulting 80-100 patients a day and our nurse headcount is twice the whole-time equivalent. It’s the same with admin staff and not far different for GPs.
Overheads of all kinds follow inefficient cottage industry approaches, while many practices pursue Quality and Outcomes Framework (QOF) rewards or enhanced service income, without understanding the cost of delivery and, therefore, the margins. Few practices are run as businesses, based upon accurate income and expenditure. Indeed, this is a potentially productive area for pharma that too few companies address. Primary care is disintegrating, so industry should seriously consider supporting practices in modern business execution. Margins are actually incredibly narrow and I’m learning the costs to a practice of routine secondary care activity are significant in tipping them to loss. I don’t mean the admission cost to the CCG that is paid to the hospital, but the associated costs to the actual practice of referral, follow up and diagnostics. Unpicking this makes or breaks a practice, as does the necessary efficiency to avoid a loss from chasing QOF or flu vaccination targets.
“The future belongs to places like Encompass in Kent. This facility is a superb example of integrated out-of-hospital care” Pharma value proposition models tend to ignore practice costs and budget impact models are much more detailed around CCG admission costs. Field staff generally over-estimate the value of things like QOF and cannot place finances into context, as practice finance barely features in training courses. In the final analysis, industry could work closer with practices and federations to collect, interpret and act upon data. Managing new models of primary care we so badly need is something pharma can and should be compelled to do. David Thorne is Chair, Washington Community Healthcare and Non-Executive Director, City and Vale GP Alliance. Go to blueriverconsulting.co.uk
IRRITATING QOF The QOF is a 13-year-old, periodically updated system, still in use today. It’s a way of gauging and rewarding general practice performance against criteria in several disease areas, such as heart conditions, diabetes, mental health and cancer. QOF is part of the General Medical Services contract and is also designed to identify areas of improvement.
1 4 | PH A R M A FI EL D.CO.U K
F E AT U R E WORDS BY
Amy Schofield
Can just having your smartphone in reach cause ‘brain drain’? Don’t believe the hype: health headlines dissected TH E S TO RY
TH E R E S U LT S
Most us of couldn’t imagine life without smartphones. How would we cope if we couldn’t check the weather first thing, chat to a mate in Australia or LOL at videos of kittens falling off things? But beware – dependence on this hyperconnectivity comes at a cost. Could the mere presence of your smartphone significantly reduce your cognitive capability, even when it’s not on? According to a new study, your device could be surreptitiously draining your brain power. Researchers from the McCombs School of Business, at The University of Texas at Austin, have been fully concentrating on getting some answers.
In Experiment 1, the researchers found that participants with their phones in another room significantly outperformed those with their phones on the desk, and also slightly outperformed the subjects whose phones were kept in a pocket or bag. The results of Experiment 2 showed that the subjects with the most dependence on their phones performed worse compared with those who were less dependent, but only when they kept their smartphones on the desk or in their pocket or bag.
TH E R E S E A RC H Previous research into the consequences associated with smartphones focussed on how people’s interactions with their devices can both facilitate and interrupt off-screen performance. For the new study, researchers noted how people ‘are constantly surrounded by potentially meaningful information; however, their ability to use this information is consistently constrained by cognitive systems that are capable of attending to and processing only a small amount of the information available at any given time’. The scientists conducted two experiments, involving a total of almost 800 undergraduates. During the first, participants sat at a computer and took a series of tests that required full concentration, to measure cognitive capacity. They were then randomly instructed to place their smartphones, turned to silent, either face down on the desk, in their pocket or in another room. Experiment 2 looked at how much a person’s self-reported smartphone dependence affected cognitive capacity. Subjects performed the same tests as group 1, however, some were told to turn their phones off.
FACTS&STATS
TH E D E A L McCombs Assistant Professor Adrian Ward and his colleagues found that it was immaterial whether a participant’s smartphone was on or off, or whether it was lying face up or face down on the desk. Having a smartphone within sight or within easy reach reduces a person’s ability to focus and perform tasks because part of their brain is actively working to not pick up or use the phone. Prof. Ward concluded: “It’s not that participants were distracted because they were getting notifications on their phones. The mere presence of a smartphone was enough to reduce their cognitive capacity.”
W HAT TH E PR E S S SA I D : “Having a smartphone in reach reduces brainpower even when switched off” Independent.co.uk; “Why your phone is a ‘brain drain’ even when it’s off” Menshealth.com; “Having your mobile within arm’s reach reduces brainpower even if the device is turned off” Dailymail.co.uk
SMARTPHONE USERS INTERACT WITH THEIR PHONES AN AVERAGE OF
85 times a day*
91% of people never leave home without their phones**
46% of users say they COULDN’T LIVE
without their smartphones*** *
Perlow 2012; Andrews et al. 2015; dscout 2016 ** Deutsche Telekom 2012 *** Pew Research Center 2015
M AG A ZI N E | AU G U S T 2017 | 15
Overdrawn What exactly is CEP and can pharma help?
W
WORDS BY
Alex Ledger
“There is a chance for pharma companies to help generate savings, whether in the cost of treatments or through system efficiencies” 16 | PH A R M A FI EL D.CO.U K
e are all aware of the severe financial straits the health and care system currently finds itself in. According to figures from NHS Improvement the provider deficit for 2016/17 was £791m, and this is set to be repeated this year with the King’s Fund recently forecasting a near £500m provider overspend. With no substantial new money on the horizon from Government, and all political attention focussed on Brexit, and the passing of the ‘Great Repeal Bill’, the NHS will continue to feel an ever-tightening squeeze on its resources. One such mechanism that has become more high profile over the last month is the new Capped Expenditure Process, or CEP. CEP is another double-act intervention by NHS England and NHS Improvement. These are the bodies in England with responsibility for overseeing the commissioner and provider sectors and, importantly, the bodies which negotiate provider reimbursement via the tariff. It is the latest in a series of measures introduced by NHS central agencies to bring down spend in line with its budgetary allocations.
Simply put, CEP is a spending cap targeted at specific areas of the country deemed to be financially out of control. It is designed to contain high levels of spending, while bringing under its scope whole health economies, including both commissioners and providers in the region. Earlier this year, CEP areas were asked to review their current financial plans and come back with bold proposals that would bring spending back in line with budget allocations. They were asked by NHS England and NHS Improvement to consider controversial interventions and ‘think the unthinkable’ over the nature of the care they deliver to reduce local spend. It is reported that the original instruction to CEP areas stipulated that revised plans and proposals for cost-saving measures should not compromise patient safety and CEP plans should be consistent with the rights set out in the NHS Constitution, and protect patient choice. The revised financial plans submitted in May 2017, through the CEP, were due to be reviewed by National Directors of NHS England and NHS Improvement. Details of the revised plans, however, are still not in the public domain, but it is likely that many of the areas have produced revised plans that come far closer to closing the financial gaps they face.
BAC K L A S H FRO M TH E N H S Trusts under the CEP programme have openly criticised the plans. NHS Providers, the body that represents the NHS provider sector, has stated that: “Trusts are concerned that these targets can only be realised in full by cutting or reconfiguring services in ways that are neither realistic nor reasonable.” It also added that, “Some of the proposals could challenge fundamental expectations shared by NHS staff and the public about what the health service is there to provide.” As a result, according to the Health Service Journal, NHS Improvement has since agreed to nearly halve the savings targets sought through CEP from an initial target of £470m, down to required savings of £250m, although there remain significant concerns about the risks involved in delivering these. The Guardian reported that Shadow Health Secretary Jonathan Ashworth MP has openly criticised CEP, by saying: “The capped expenditure process is in total chaos. The government are refusing to answer questions about it and Jeremy Hunt is trying to shirk responsibility for this scheme, which will see hundreds of millions of pounds cut from health budgets.”
POLITICS
RESPONSE TIME
PHA R MA TO H E LP M E E T TH E C A P ? To date, dialogue between central NHS bodies and those areas under CEP measures have taken place largely behind closed doors. It is undoubtedly a missed opportunity that industry has not been approached to explore how it might contribute towards meeting these ambitious savings targets. Industry already provides financial support to the cashstrapped NHS through a unique agreement in the PPRS whereby it underwrites growth in the country’s medicines bill over and above agreed limits. Many companies, however, are seeking to do more with the NHS and have offers specifically designed to help deliver returns. There is a chance for pharma companies to help generate savings, whether in the cost of treatments or through system efficiencies, to support the achievement of financial targets in hard-hit areas, without compromising patient care. NHS England’s new Commercial Unit is still being formed, but has started to move into second gear. It now needs to look outward and engage in new types of discussions with industry. There is a clear opportunity for the NHS to benefit from pharma’s ideas and partnerships. Such collaborations would help generate headroom in specific health economies, so that some of the ‘unthinkable’ measures can remain ‘unthought’ and patients living in certain parts of the country will not receive a lower quality of care compared with others.
Suggested measures include:
• Reducing spend on non-urgent work • Reducing levels of planned elective care currently outsourced to non-NHS providers • Restricting access to services, with IVF specifically called out • Stopping funding for some low value treatments, and seeking to delay or avoid funding some treatments newly approved by NICE • Closing wards and operating theatres to reduce staff and operational costs, where it will not impact on emergency care services • Closing hospital sites • Selling property and surplus land.
Alex Ledger is Deputy Managing Director at Decideum – the views expressed here are entirely his own. Go to decideum.com
BEING WATCHED So far 14 areas have been listed where future financial plans are deemed unaffordable.
1.
2.
3.
4.
5.
6.
7.
Bristol, South Gloucestershire & North Somerset
Cambridgeshire & Peterborough
Cheshire: Eastern, Vale Royal & South
Cornwall
Devon
Morecambe Bay
Northumberland
North Central London
North Lincolnshire
North West London
South East London
8.
9. 10. 11. 12. 13. 14. Staffordshire
Surrey & Sussex
Vale of York & Scarborough & Ryedale
M AG A ZI N E | AU G U S T 2017 | 17
MIND & T
he link between mental and physical health is inseparable, but for decades the two have been divided by the labyrinthine complications of service delivery. This is a situation that Kate Dale, Physical Health Project Lead at Bradford District Care NHS Foundation Trust, was unwilling to let continue.
JP spends an unforgettable Coffee Break with pioneer of integrated health Kate Dale
What is your background, Kate? I’ve been a mental health nurse for 40 years and, during the last 14, I have been concentrating on getting mental health patients a better deal in terms of their physical health. Over the years, we have focussed too much on segregating physical health from mental health, rather than treating the whole person. I’ve been campaigning for better overall care because these patients are dying up to 25 years younger than the general population. Suicide only accounts for 1% of that figure; people are mainly dying prematurely from natural causes, including cardiovascular disease, diabetes and respiratory failure. Tell me what you’re doing about it? The project I led developed an electronic template for SystmOne and EMIS for Primary Care and RIO for secondary care. These systems are designed to guide clinicians through a systematic physical health review appropriate for people with serious mental illness. We have a shared care agreement between local primary and secondary care, and the emphasis is for baseline and early monitoring, following the prescribing of anti-psychotic medication.
“I can go to bed knowing that somewhere down the line people will start to live longer, healthier and happier lives.” 18 | PH A R M A FI EL D.CO.U K
BODY INTERVIEW BY
COFFEE BRE AK
John Pinching
“It is time to wake up, share responsibilities across healthcare and start looking after the physical health of people with serious mental illness.” What has emerged from the project? It is time to wake up, share responsibilities across healthcare and start looking after the physical health of people with serious mental illness. I set out to do this in Bradford, but never imagined it would be rolled out regionally and nationally. Now I’m ready and willing to help anyone to push it out even further. What are the biggest challenges of an integrated system? Patients with serious mental illness are currently entitled to an annual physical health check at their GP surgery, but when we’re prescribing antipsychotic treatment in secondary care, we need a handle on the physical health as well. Medications often lead to an increased appetite, weight gain and a risk of diabetes. We need to get people more active and selfaware; enabling them to go for a walk and feel better about themselves. Weight management is one of the hardest things in the world to combat, but when you have a mental health problem it becomes much harder.
What have been the significant changes to mental health care since you started? I walked up the driveway of an asylum for my first job in 1979 and, believe it or not, there were 450 beds, 600 nurses and industrial therapy was still happening. The physical health of patients was actually very good and they were checked regularly. On the downside, however, we used to reward patients with cigarettes for good behaviour. After the old models of care disappeared, I witnessed community care evolving, and in the 1990s worked towards becoming a community psychiatric nurse. During that time ‘mental health risks’ became a priority; the pressure to keep people well, safe and out of hospital grew, and so did the divide between mental and physical health.
very supportive in recent times and it’s getting vital messages out there. It’s through pharma that much of my good work has come to fruition.
When did you start focussing on the link between mental and physical health? I took part in a Leeds Partnership Foundation Trust national pilot in 2003 and it involved physically health-checking an entire caseload of people I worked with. The outcomes were astonishing – people had been walking around with undiagnosed diabetes or borderline conditions. We were able to change their lifestyles and reverse the situation, and that’s where my passion began.
Your passion for changing the system is really admirable. I’ve been like a dog with a bone, I wouldn’t let go and I probably drove people around the bend, but at least I can go to sleep knowing that somewhere down the line people will start to live longer, healthier and happier lives. I’ve worked one-to-one with patients over the years and there’s nothing more rewarding than to see people recover, move on and gather some self-worth.
What’s your relationship with pharma? The industry has improved massively. A pharma company sponsored the original pilot in 2003. There were people who thought it was inappropriate but, I thought, if the funding was used positively, it didn’t matter where it came from. Pharma companies have been
How is society shifting its attitude? Years ago, my mother developed Alzheimer’s disease, when she was only 58. She had been very popular and always had a house full of friends, but when she became ill they nearly all disappeared. People didn’t know how to deal with it. The young Royals, William and Harry, have talked about their own issues and that’s had a massive impact, particularly around men’s mental health. By talking about the difficulties they had dealing with their mother’s death, they are reducing stigma and giving people confidence to open up.
What record would you choose for the soundtrack of your life? ‘Angels’, by Robbie Williams. It’s your last supper, what are you having? Piri piri chicken. I’m going to Portugal in a couple of weeks. How delightful. Goodbye Kate. Bye John.
M AG A ZI N E | AU G U S T 2017 | 19
STILL GETTING WASTED? Medicines optimisation is beginning to blossom but challenges remain.
WORDS BY
2 0 | PH A R M A FI EL D.CO.U K
Deborah Evans
I
n these times of escalating demands on NHS resources, and with medicines being the most common therapeutic intervention for patients, we must all do more to help patients, the public and society get the best outcomes and value from them. Whatever our role, healthcare professionals, managers, patients and the pharmaceutical industry need to work collaboratively to improve the quality of medicines use. From patients receiving insufficient information about their medicines to the vast number of hospital admissions caused by the adverse effects of medicines which could have been prevented, we simply must do better. In 2012, good practice guidance for all healthcare professionals in England on medicines optimisation was issued by the Royal Pharmaceutical Society and supported by the Royal College of General Practitioners, Royal College of Nursing and NHS England. This vital document, together with NICE’s own guidance on medicines optimisation, described a compelling partnership between patients and the health professionals that care for them. Important principles were defined that could revolutionise medicines use, ensuring that the right patients get the right choice of medicine, at the right time. By focussing on patients and their experiences, the goal was to help them improve their outcomes, take their medicines correctly, avoid taking unnecessary medicines, reduce wastage of medicines and improve medicines safety. But has anything really changed since the principles were launched or are we seeing a continued focus on reducing prescribing costs without broader consideration for the principles and, critically, patient needs? In my opinion, there has been some progress to embed medicines optimisation as part of a systems-approach, but there is much more that could be done in practice; policy has not reached the coal-face. If we are going to truly embrace the concept of medicines optimisation and realise the true value medicines bring, then we must move from concept to practice. Whether prescribing, dispensing, administering or taking medicines, there is more work to be done.
OPINION
“The industry is an integral part of the solution, by supporting a collaborative approach and ensuring easily accessible information”
“There has been some progress to embed medicines optimisation as part of a systemsapproach, but policy has not reached the coal-face”
PILLS
NATI O NAL C HAM PI O N S As medicines experts, pharmacists have an important leadership role, regardless of their sector, in championing the principles of medicines optimisation. This means delivering outstanding clinical and medicines use reviews, engaging with other healthcare professionals and ensuring the patient is at the centre of any decision-making about their care. Pharmacists are beginning to embrace the concept in practice, but how do we extend this intra and inter-professionally? The industry is an integral part of the solution, by supporting a collaborative approach and ensuring easily accessible information with an evidence-base that is relevant and practical. The guidance sees the industry as having ‘a key role to play in medicines optimisation through transparent and value-for-money partnerships with the NHS that help secure better outcomes for patients’. Let’s unite to make sure this truly works for the benefit of all patients.
MULTIPLYING
NHS SPENT
£16.8BN on meds in 2015-16
8% INCREASE on 2014-15 spend
AC TI O N S TATI O N S: H OW M E D I C I N E S O P TI M I SATI O N I S B E I N G E M B E D D E D HS England is committed to the N establishment of four Regional Medicines Optimisation Committees (RMOCs), operating together as part of a single system to eliminate duplication of activities when reviewing evidence. • Reduction of unwarranted variation and increasing value through medicines optimisation is a crucial element of NHS RightCare’s innovation work. • Medicines optimisation is a key activity within the Academic Healthcare Science Networks (AHSNs) and the Medicines Optimisation Dashboard has gained traction in identifying best practice and where improvement is needed. •
We are seeing a shift in emphasis from the medicines management focus on product choice and its cost, to maximising patient benefits from the use of medicines; for example, the adoption of direct oral anticoagulant medicines as an alternative to warfarin. • C ommunity pharmacy is engaged in two key medicines optimisation services – Medicines Use Reviews and New Medicines Service. • N HS England has launched the clinical pharmacists in GP practice programme committing over £100m of investment to support an extra 1500 clinical pharmacists to work in general practice by 2020/21. •
ESTIMATED
£300M 30-50% ANNUAL MEDICINES WASTE
NOT TAKEN BY PATIENTS AS PRESCRIBED
5-20% HOSPITAL ADMISSIONS LINKED TO
medicines harm
Deborah Evans is managing director of Pharmacy Complete, a specialist consultancy and training company enabling a healthier future for pharmacy. Go to pharmacycomplete.org or email deborah@pharmacycomplete.org. Special thanks to Elizabeth Butterfield, Chair Primary Care Pharmacist Association for her assistance in compiling this piece.
M AG A ZI N E | AU G U S T 2017 | 2 1
If the app fits FO
Apps are used by millions to monitor their bodies, habits and health – here’s our high 10. R
T I EN T S PA
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3
4
5
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M E NTA L H E A LTH
BREAST CANCER
TYPE 1 D I A B E TE S
CO P D
H E A LTH A S S E S S M E NT
MEDICINES ADHERENCE
Thrive Feel Stress Free, free (in app purchases available) Developed in the UK by consultant psychiatrists and psychologists, this evidence-based app proactively manages stress, anxiety and depression by keeping track of the user’s mood over time. This fully ICO-registered programme trains users in ‘self-soothing’ techniques, such as meditation and deep muscle relaxation to help them cope better in stressful situations. It also features a ‘thought trainer’ programme based on cognitive behavioural therapy techniques. thrive.uk.com
OWise, free The first app to be approved and listed in the NHS Apps Library, the OWise breast cancer app is suitable for use by breast cancer patients, during and after their treatment. It helps patients keep track of their treatment and wellbeing by recording levels of fatigue, appetite, pain and other aspects of their health. In turn this indicates trends and can provide users with a personalised list of questions for their doctor appointments. owise.uk
mumoActive, free Suitable for both adults and children with type 1 diabetes, and featured in the NHS Apps Library, mumoActive is a secure app that allows users to track their values, such as blood sugar, carbohydrates and insulin. The data is then collated into easy-to-understand graphs which patients can share with their doctor, carer or family to help them decide whether to test, exercise, eat or take insulin in order to best manage their diabetes. apps.beta.nhs.uk
myCOPD, free as an NHS service in some areas or a £20 lifetime licence. This NHS-approved app helps people with chronic obstructive pulmonary disease (COPD) to manage their condition. It can be used to perfect inhaler techniques, improve breathing, reduce exacerbations and track medication. It also allows clinicians to remotely check in with patients. myCOPD has been shown to correct 98% of inhaler errors without other clinical intervention, resulting in an improvement in quality of life. mymhealth.com
Quealth, free Quealth allows users to assess their risk of developing the five most common lifestyle-driven diseases: dementia, cardiovascular disease, type 2 diabetes, six forms of cancer and COPD. It uses answers to questions, assisted by live data from wearable trackers and mobile phones, to assess and score health risk status and guides users in improving their lifestyle and behaviour to reduce risk and help prevent the development of the conditions. quealth.co
Healthera, free Developed by three Cambridge-graduate entrepreneurs, the Healthera app is a smart medicine diary for patients which analyses their medicine-taking pattern, records their concerns and helps them gain their pharmacist or doctor’s attention when irregular medicine-taking occurs. It interprets the medicine’s name and instructions found on prescription labels into a schedule, then turns it into a QR code that is printed on the label, allowing patients to add the schedule to their phone’s calendar. healthera.co.uk
2 2 | PH A R M A FI EL D.CO.U K
F E AT U R E
FO
A
study has revealed that patients with advanced breast or lung cancer who entered symptoms into a smartphone app lived over five months longer than expected. The trial of 766 patients found that those who updated doctors about pain levels in real time missed fewer chemotherapy sessions and were more active. Health apps have become a pivotal part of the self-care revolution, with millions being downloaded every day. Here are 10 of the best.
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HC
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WELL CONNECTED
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A S TH M A
P R E G N A N CY
D O C TO R CO N S U LTATI O N S
LIVER DISEASE
MyAsthma, free GSK’s MyAsthma app has been developed in collaboration with HCPs to put patients in control of their asthma. Users can track their condition by using the Asthma Control Test; monitor potential triggers, store their peak flow record and share information with their GP to help them understand their condition in more detail. MyAsthma is also one of the first examples of an app that is classified as a class 1 medical device. myasthma.com
Ask the Midwife, from 99p for one question to a £24.99 per month subscription Run by registered midwives, this online advice service for expectant mums allows users to get a quick response to any questions they have about pregnancy, birth and beyond from an experienced midwife. The ASK Service allows users to ask one question and get one answer from a registered midwife via the app’s messaging service, while the CHAT Service is a real-time, fast response messaging service where users can request a conversation with a registered midwife. askthemidwife.co.uk
ZoomDoc, app is free, appointments start at £99 for a 25-minute consultation ZoomDoc aims to remove barriers between GPs and patients by offering a 24/7 UK-wide ‘GP on Demand’ service. After registering with the service via the smartphone app, patients can choose a local GP to visit them. Patients initially receive a phone consultation from a GP within 60 seconds and then, if required, a home visit within 60 minutes. zoomdoc.com
Predictive calculator to help HCPs identify patients at risk of liver disease The University Hospital Southampton NHS Foundation Trust (UHS) has developed an app that helps GPs to assess a patient’s risk of liver disease using a traffic light test based on the results of assays carried out by the UHS. Results so far show that the app has helped to demonstrate that for alcohol related liver disease, feeding back an amber or red traffic light result doubles the number of patients who are drinking safely a year later. geneticapps.co.uk
Note: The tools / apps covered in this article are not endorsed by Pf or E4H and are not intended to be a substitute for a consultation with a healthcare professional.
THE GLOBAL MARKET FOR DIGITAL HEALTH WAS WORTH
£23BN IN 2014 AND IS EXPECTED TO
DOUBLE BY 2018 THE UK MARKET SIZE FOR DIGITAL HEALTH IS
expected to grow to
£2.9BN BY 2018
35% THE MHEALTH APPS MARKET IS PREDICTED TO GROW AT
IN THE UK & 49% GLOBALLY FROM 2014-18
Source: ‘Digital Health in the UK: An industry study for the Office of Life Sciences’, produced by Monitor Deloitte
M AG A ZI N E | AU G U S T 2017 | 2 3
ADVERTORIAL
RETURN TO LIFE: Otsuka and Lundbeck want people with schizophrenia to achieve their aspirations. This article has been sponsored by Otsuka and Lundbeck and has had input from Otsuka and Lundbeck into the editorial content.
Otsuka and Lundbeck – two companies with a rich CNS heritage, have formed a global alliance to focus on delivering up to five innovative psychiatric and neuroscience products.
2 4 | PH A R M A FI EL D.CO.U K
O
tsuka and Lundbeck’s ‘Head Start’ initiative is a practical, educational and motivational programme, in development, which is designed to give people with schizophrenia (PWS) a head start in their quest to make sense of their experiences, rationalise their choices and return to functionality. It is hoped that the programme, which is being piloted in two mental health trusts, will yield a cultural change for a community that is too often alienated and for a condition that is often misunderstood. PATIENT FIRST NICE guidelines highlight the importance of an integrated approach to promote the best possible recovery for PWS. The pioneering Head Start scheme is designed to be delivered through holistic modules, in mental health trusts (MHTs). It has been co-created by a Steering Committee of mental health experts, people with schizophrenia and a leading mental health charity. Working with MHTs, Head Start will identify appropriate patients and frontline staff to participate in the programme (30-40 patients per MHT). In addition, one-day coaching workshops will take place at each Trust, forming a specific collaborative approach which brings all members of the front line team together to embrace and commit to Head Start for their patient population and the goals of their Trust. Front-line staff, including the lead psychiatrist, will also be briefed on approach to evaluation measures that will be provided by PWS ahead of Head Start commencing. OPUK/0717/COMS/1058 - July 2017
POSITIVE CHANGE Head Start is a flexible resource that empowers PWS, is individually tailored to meet each patient’s needs and drives rediscovery. Another key aim is to work with the MHTs to help them achieve their individual goals for improving mental health care in their community. One of the most important aspects of carrying out the modules is to firmly establish mutually agreeable goals, while setting time scales for achieving them. Above all the modules must allow PWS space for creative expression, independent thought, positive affirmations and tips to stay on track with their rediscovery. For Head Start coaches, a series of downloadable workbooks will help guide PWS who feel they have a lack of skills or confidence, to achieving a task or goal. Ultimately, the long-term aim is to to track progress and share success for the PWS and the Mental Health team at each trust. “Meaningful, effective involvement can transform people’s lives, improve the quality and efficiency of services and develop the resilience of communities. If commissioners and clinicians really listen to us, respect us and treat us as equals, then our experience of services will improve,” concluded the Chief Executive of a National Survivor User Network. The Alliance of Otsuka and Lundbeck is committed to supporting and providing value to patients beyond the delivery of medicines, working as a partner with traditional mental health care structures, supporting and enabling patients by creating patient-centred and service-led solutions. We believe in going above and beyond the standard role of industry and provide a truly holistic commitment to mental health services and patients.
P H A R M ATA L E N T
What does a
WINNER look like?
We ask past winners and judges of the Pf Awards what it takes to win a Secondary Care Specialist Award? WORDS BY
J
John Pinching
ust what does it take to be the best? Winning a Pf Award is the ultimate accolade for individuals working in the pharmaceutical sales industry who want to test themselves against their peers and demonstrate how they perform under pressure. Since 2001 the awards have become widely recognised as the definitive achievement for representatives operating in the areas of sales and medtech. Winning a Pf Award represents a major career highlight and Pf Award winners go on to scale ever greater heights in our highly-competitive industry. This year, we’re introducing two entirely new Pf Award categories – The Best Newcomer Award and The Cross Functional Team Award – bringing the total number of categories up to 15. Entries open in September. Go to pfawards.co.uk and take your first step to finding out what it really means to be a winner, just like Shane Elder, winner of the 2009 New Hospital Representative Award (now Secondary Care Specialist Award).
JUDGE
WINNER
Annie Dingley
Shane Elder
Regular Pf Awards Judge
2009 New Hospital Representative Award
CHALLENGE
ASSESSMENT
The main challenge when entering the awards is managing and using your emotions productively. Our emotions and thoughts determine our behaviour – what we do, what we say and how we say it. If you feel anxious or excited, it has the potential to sabotage your call. This is something I see regularly when coaching in the field and is the biggest factor in inconsistent performance.
To be successful I believe it is important that you are not only delivering results for the company you represent, but you are also fully committed to your own personal development. Having a well-rounded set of competencies that you consistently perform well against, will definitely help you stand out.
P R E PA R AT I O N
Spend some time before the Pf Awards identifying what you are feeling before and during calls, what prompts those emotions, how it impacts on your behaviour and the outcomes you get. To excel in the New Representative category you need to be human! Aim to have a peer-to-peer conversation and understand the challenge from the customers’ point of view. WINNING
The key to winning an award is to create emotional urgency for the customer to do something differently for the patient. Use questions to understand the ideal outcome for the specific patient or patient group. Also, control the impulse to jump in with the solution before fully exploring the current situation. FUTURE
Winning a Pf Award is like a seal of approval. Within your organisation you will be sought out for extra projects, secondments and promotion. On a CV it is a short cut to interview.
P R E PA R AT I O N
You should aim to have fun. If you are relaxed on the day, the assessors will get the chance to know you. Take time to understand the process, speak with candidates who have experience and enter the process with confidence, as you are there on merit. You should expect to meet lots of wonderful and talented peers from different organisations so take the time to say hello. WINNING
Winning a Pf Award can act as a real catalyst for your career. Just being nominated shows that what you do matters. Winning an award is a real accolade which your company will recognise, and it stays with you as you move forward on your chosen career path. AMBITION
I was fortunate enough to be given my first Regional Business Manager opportunity two weeks after winning – my career goal was always to work in a leadership position. I have now worked in a variety of national management roles across sales and market access. The Pf Award still sits in my office at home as a reminder.
H AV E YO U G O T W H AT I T TA K E S ? V I S I T P FAWA R D S . C O . U K T O F I N D O U T M O R E M AG A ZI N E | AU G U S T 2017 | 2 5
From the
DARKNESS
of SIGNS DEPRESSION Long periods of
LOW MOOD FEELING HOPELESS & HELPLESS
TIREDNESS
& LACK OF ENERGY NO PLEASURE FROM ENJOYABLE ACTIVITIES
A third of us suffer from depression, but does stigma stop many seeking help?
Loss of self-confidence & esteem LACK OF INTEREST IN SEX
WITHDRAWING
FROM PEOPLE
CHANGES IN SLEEPING PATTERNS
Changes in appetite HARD TO CONCENTRATE
PREOCCUPATION with NEGATIVE THOUGHTS
Thoughts of self-harm
THOUGHTS
ABOUT SUICIDE. Source: sane.org.uk
When Prince Harry confessed, with searing honesty, to the depression he developed in the years following the death of his mother, Princess Diana, people sat up and took notice. It opened up a new conversation about depression and mental health, but it also left many wondering why the stigma around the condition continues to exist. Sufferers still feel unable to share the truth about how they are feeling, with family, friends and employers, perhaps because of a lack of understanding around how serious clinical depression can be. According to the mental health charity Mind, approximately 1 in 4 people in the UK will experience a mental health problem each year. Of these, 3.3 in 100 people are suffering from depression. Although depression is more common in women than men, rates of suicide among young men are rising, while rates of depression and anxiety among young people have increased by 70% over the past 25 years. The World Health Organisation says that, “if we don’t act urgently, by 2030 depression will be the leading illness globally”.
2 6 | PH A R M A FI EL D.CO.U K
F E AT U R E
C AU S E A N D E F F E C T Depression isn’t always caused by any single factor, but several triggers: •S ocial – loneliness and isolation, losing your job, divorce, bereavement •P sychological – a traumatic experience from childhood, family issues •P hysical – illnesses such as glandular fever, side effects of some medications •G enetics – certain people may be genetically predisposed to depression.
C A S E S T U DY:
G EO RG I NA LLOYD
I TR E ATM E NT S FO R D E P R E S S I O N A NTI D E P R E S S A NT S These medicines treat the symptoms of depression by acting on chemicals in the brain that lift mood. They include: •S elective serotonin reuptake inhibitors (SSRIs) – the most widely prescribed, these include Fluoxetine (brand name Prozac), citalopram (Cipramil), paroxetine (Seroxat) and sertraline (Lustral). •S erotonin-noradrenaline reuptake inhibitors (SNRIs) – similar to SSRIs, these include duloxetine (Cymbalta and Yentreve) and venlafaxine (Efexor). •N oradrenaline and specific serotonergic antidepressants (NASSAs) – the most prescribed of these in the UK is mirtazapine (Zispin). •T ricyclic antidepressants (TCAs) – older types of antidepressant, they may be prescribed to people who have failed to respond to other medications, or those with OCD or bipolar disorder. They include amitriptyline (Tryptizol), clomipramine (Anafranil) and imipramine (Tofranil). TA L K I N G TH E R A P I E S Used alone or in combination with antidepressants, talking therapies aim to help patients to recognise factors that might be causing their depression, and find ways to cope. They include counselling and cognitive behavioural therapy, and referrals are normally made by the patient’s GP, but waiting lists are long. Patients can also consult charities such as Sane for information on free or low–cost counselling, or pay for private therapists or counsellors. Go to sane.org.uk
have always been a high-achiever and put myself under continuous pressure to succeed. I have a fear of failure, due to the demands which I place on myself. I strive for perfection. Academically, I did well at university before going on to become a lecturer. After a successful two years I gave up this career and applied to become a police officer. While waiting for intake, I spent time gaining further experience as a pharmaceutical representative. Early in 2015, I went though IVF treatment and, unfortunately, things did not work out. Instead of my partner and I dealing with it, talking things through and grieving, we both ploughed ourselves into work. I became obsessive about exercise and began taking part in cycling events and triathlons as I knew I could do well and get a sense of achievement and selfworth. They were a distraction from the hurt and pain I was going through. I didn’t want to drop the professional image. Yes, there were external pressures, but it was the internal pressure I put on myself which became my downfall. I did not want to show any sign of weakness, so I just hid how I was really feeling.
My relationship ended a week before Christmas 2015. I did not want to see or speak to anyone and spent Christmas on my own, as I didn’t want to face the world. It was a work colleague I had confided in that saved my life on Christmas Eve, as I had serious thoughts of ending it all. In work, I still presented myself as ‘happy smiley George’. I did not want people to know how broken I was, but at the end of March 2016 I sought help from my doctor. Everything came out and I sobbed for 30 minutes. I remember arguing with the GP who told me not to go to work the following day. I wanted to as I didn't want to be seen as a failure or weak. It was midday when I finally said to my line manager that I had to leave. That was 15 months ago. I have had fantastic support from my GP and workplace. I completed a 10-week mindfulness programme organised through work and some local courses on managing depression and stress through the NHS. Taking part in the BBC 1 documentary Mind over Marathon encouraged me to talk and forced me to be open with family and friends. My puppy, Olly, has also been a saviour. He has been brilliant for me; I now have responsibilities and he keeps me grounded. There is still a massive disparity with physical health. Thankfully, with all of the positive work being done to support mental health and with all of the well– known faces speaking out about their battles, the shift is happening, but there is still a long way to go. Follow Georgie’s story at depresseddetective.com and on Twitter @georgie_lloyd
S E L F– C A R E
Joining self–help groups, where patients meet others in similar situations, can help people cope with their depression. Good self–care, including eating healthily, exercising and asking family and friends for support can aid recovery.
M AG A ZI N E | AU G U S T 2017 | 2 7
F E AT U R E H E L P I S O U T TH E R E
“I was brought up thinking that antidepressants were addictive and should not be used”
No one should suffer in silence from depression, and there are many organisations which provide support, advice or empathy, without judgement or discrimination.
C A S E S T U DY:
Go to mind.org.uk, samaritans.org, justonelook.org, depressionuk.org, supportline.org.uk. There are also a number of brilliant platforms which allow peer-to-peer interaction. Go to depressionalliance.org, turn2me.org, friendsinneed.co.uk, headstogether.org.uk
LI SA B ROWN I N G
M
y depression began in September 2009 when my daughter (22 months old at the time) was diagnosed with cerebral palsy just two days before I was due to have my son by C-section. When my son was born I felt he was just in the way of me trying to learn about my daughter’s condition and how I could help her. I had no feelings for my son and just went through the motions. It was a terrible time. I also blamed myself for my daughter’s disability, becoming very tearful, angry and panicky when I left the house. My husband urged me to see the doctor, but I was brought up thinking that antidepressants were addictive and that depression was not a ‘thing’. In November 2009 I woke at 2am and went to buy a frozen turkey for Christmas and presents for the children. I had decided I should get in my car and drive off somewhere, but first needed to be sure the children would have a nice Christmas. I felt I was bad for them and they would be better off if I were not around. In the car park I sat there sobbing, then decided I needed help, so went home and woke my husband.
The next day I saw the doctor, who prescribed antidepressants. I felt better after a few months of these, combined with getting help for my daughter, and took them for the following two and a half years. We emigrated to Australia, however, and I started slipping back into the dark hole and was unable to scramble out. We returned to the UK six months later and I fell pregnant with my third child. I could not take medication due to the pregnancy, but my depression seemed to level out. My GP advised walking and this really helped – I was worried about postnatal depression and was monitored, but everything seemed okay. Six months later my stepfather was diagnosed with a terminal brain tumour and both my husband and I were made redundant. I was falling back into that hole and immediately sought help. I was put back onto the same medication I took in 2010 and have been taking this ever since. I still walk often and this lifts my mood. I always advise anyone who has depression to seek medical advice from a GP and talk, talk, talk as much as possible to someone they trust.
NUMBER’S UP
1 in 6
IN ENGLAND,
PEOPLE REPORT EXPERIENCING A COMMON
MENTAL HEALTH
PROBLEM SUCH AS DEPRESSION & ANXIETY IN ANY GIVEN WEEK
1 in 4
Each year, approximately
people in the UK WILL EXPERIENCE A MENTAL HEALTH PROBLEM mind.org.uk
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e n ffer to P ei fM ns i d e ex t aga ba zin w ck e e b co i n a re a d e r ve r fo s rd r F RE et a il s
A DVA N C E YO U R T H I N K I N G
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E
DIGITAL MARKETING
The rise of
3 0 | PH A R M A FI EL D.CO.U K
Social media is a prerequisite for most businesses, but how has the historically reticent pharma industry been adapting?
GRAEME SMITH Managing Partner, Fortis Pharma Consulting
T
he highly–regulated nature of the pharma industry has led to a very cautious approach to using social media, but those companies who have been willing to invest in this new approach have found that it has given them a competitive edge over traditional digital marketing techniques. PERILS OF PUBLIC I NTE R AC TI O N Among the major challenges to a pharma company kickstarting its first social media marketing campaign is the need to convince stakeholders and introduce new internal processes. One concern that can be overcome in well-designed campaigns, but is naturally very powerful, is the possibility that comments from the public interacting with social media campaigns may lead to compliance issues. C AU TI O U S LY CO N F I D E NT As pharma gains more confidence in using social media tools, we think that industry will be bolder in the content that is distributed. Sometimes the caution of internal regulatory departments can lead to ‘vanilla’ messaging on social media, but so long as we keep to our obligations to communicate accurate information appropriate for the target audience, there is plenty of potential for stronger messaging.
“The benefits of social media can be worth the effort of effecting change” S M A R T TH I N K I N G We emphasise to our clients that the benefits of social media can be worth the effort of effecting change, especially as the barriers to future campaigns are typically much lower once a successful campaign has been run. Key to the success of these campaigns is the ability to tailor content to the right audience at the right time. Social media marketing fits much more intuitively and less intrusively into an HCP’s daily routine compared with ‘traditional’ digital marketing. For example, email shots can be seen as unwelcome harassment, and generally come at a much higher cost per click than newer social media approaches. A smart digital campaign can take this concept further by integrating aspects of both social and traditional digital approaches in a way that is intuitive for the target HCP. Go to fortispharma.com
MARKETING
CHRIS FINCH Managing Director, earthware
M
ost pharma companies use social media channels to broadcast content rather than converse with their audience. Typically, this follows two themes; broadcasting corporate news including regulatory approvals, appointments and disease awareness, and releasing other notable items, such as the latest data from congresses or stats on epidemiology. Unlike many other industries, there is little attempt to use social media as a platform for conversation. This is primarily a result of the regulatory challenges faced by the industry. There is still little in the way of true innovation in digital marketing across pharma. For most companies, having an e-detail, brand website and corporate twitter account ticks the digital boxes. Digital remains an afterthought of the marketing plan after the exhibition stands, symposia and patient leaflets have been ordered.
TR U S T I S S U E S There are a couple of key issues that reduce the impact pharma can have over digital channels. Firstly, social media users are used to engaging in conversation and debate. Pharma’s inability to engage in this way means their social media presence is far less engaging for patients and doctors than other content providers. Secondly, there remains a distrust of industry. Deloittes’s report on pharma's adoption of social media* highlights the challenge, with 75% of doctors surveyed indicating a lack of trust in pharma. Pharma companies should consider partnering with third parties who are trusted by their target audience. Partnering with professional bodies or third party networks offers great opportunities for industry to provide access to clinical data and insights which their partners are not able to deliver on their own.
F E A R O F TH E K N OW N The risk of not adhering to industry codes of practice means there is an inherent fear of digital channels and, in particular, social media. With most companies requiring approval of all external communications it is very difficult for pharma to converse over social media and certainly not with the immediacy that users demand.
H C P E N G AG E M E NT The rise in popularity of platforms such as doctors.net.uk, Medscape, Epocrates and Sermo indicate that like any consumer, HCPs are using digital platforms to engage with the content they want. In addition, HCPs are increasingly using digital platforms as a way of receiving medical education, whether via webinars, or new platforms like twitter’s Periscope. Tools like
Skype are also being used increasingly by HCPs in their day-to-day working, including conducting MDT meetings with remote colleagues or even patient consultations**. As the traditional access to HCPs continues to increase in difficulty, perhaps a mix of online and face-to-face conversations will enable pharma reps to be more efficient. W H E R E TH E J O U R N E Y B E G I N S Listening is key to developing digital solutions that meet the needs of HCPs and patients. Social listening, for example, by searching the web to see what’s being said about your company or products is a great way to gather insight and there are many free tools out there to get you started, such as Google Alerts***. Speaking to HCPs and patients and asking them to describe the patient journey and mapping out the challenges and gains at each point helps identify where solutions are needed. Co-create solutions with HCPs and patients rather than stopping at co-design. Co-creation means involvement at each step of the process as you design, prototype, test and refine solutions. Start small, get something out there and learn as you go. Go to earthware.co.uk http://blogs.deloitte.com/centerforhealthsolutions/ pharma-adoption-of-social-media-a-prescription-forphysician-engagement/ **http://www.pulsetoday.co.uk/ home/finance-and-practice-life-news/patients-givethumbs-up-to-gp-skype-pilot/20009161.article *** https://www.google.com/alerts *
M AG A ZI N E | AU G U S T 2017 | 3 1
P H A R M ATA L E N T
MOVERS & SHAKERS
CELIA INGHAM CLARK
DOUGLAS S. INGRAM
NHS Improvement has appointed Celia Ingham Clark as its new National Patient Safety Director. Clark’s position is interim for six months until a permanent replacement is found; she will also continue in her current role as Medical Director for Clinical Effectiveness at NHS England.
Sarepta Therapeutics has named Douglas S. Ingram as President and Chief Executive Officer. He has 20 years’ of experience and will serve on the company’s board of directors. “Sarepta has shown leadership in the treatment of Duchene muscular dystrophy and brought hope to children and their families,” said Ingram.
Pf GR ADUATE OF THE MONTH Here we feature an outstanding graduate who is making their mark in the industry. NAME: Laura Coley COMPANY: QuintilesIMS ROLE: Sales Representative (Project Team) UNIVERSITY DEGREE: BSc Sociology; 1st (Hons) LAURA SAYS: “QuintilesIMS has supported me with a great foundation for my career. After hiring me as a new graduate in its internal HR department, the company supported my development and application into a Sales Role with one of its strategic partners. After being with them for eight months, I have now secured a role with a stronger account management focus in the Project Sales Team. QuintilesIMS has consistently supported my development with my long-term career goals in mind. Additionally, I have found its employee engagement crucial to my development and success to date.”
GEORGIA GRAY
WHO’S GOING WHERE AND WHY THEY’RE GOING THERE. WORDS BY
2017 Pf Award Winner, Georgia Gray, has been appointed by Johnson & Johnson Vision Care as Account Manager. She previously worked for Forte Ltd. “I have taken on an exciting new opportunity with Johnson and Johnson vision care. It’s a new challenge for me and something I’m excited to get stuck into,” Georgia enthused.
Winner
Rachel Cresswell
3 2 | PH A R M A FI EL D.CO.U K
KNOW A RISING STAR WHO DESERVES A MENTION? RACHEL@PHARMAFIELD.CO.UK
LARS PETER BRUNSE
Ferring Pharmaceuticals has appointed Lars Peter Brunse to the Ferring Executive Board. Lars Peter Brunse joined Ferring as Associate Director Technical Operations in 2000 and was rapidly promoted to Senior Vice President, Technical Operations and Logistics. He has led the expansion of Ferring’s manufacturing capability and extended the company’s product supply network.
CHRIS POSNER
LEO Pharma has unveiled Chris Posner as Executive Vice President Region US and President & CEO, LEO Pharma, Inc. Chris joins from R-Pharm US, a specialty pharmaceutical start-up company focused on oncology and chronic immune diseases.
IN BRIEF Biogen has appointed CATHERINE STEELE as Senior Vice President of Corporate Affairs. MATTHEW GANTZ has been
become CEO of OxThera.
DR DESIREE LUTHMAN
Verona Pharma has announced Desiree Luthman as Vice President, Regulatory Affairs. Jan-Anders Karlsson, CEO of Verona Pharma, said: “Desiree has an accomplished track record of working closely with the FDA and EMA on behalf of international healthcare companies to achieve key regulatory milestones.”
Avant Diagnostics has made PHILIPPE GOIX President and CEO.
M AG A ZI N E | AU G U S T 2017 | 3 3
P H A R M ATA L E N T
“You have to remember that what we do is critical to the health of patients – our contribution to society is to help people live longer and healthier lives”
What do you do? I was appointed Director General of the European Federation of Pharmaceutical Industries and Associations (EFPIA) in 2017, having previously worked as Secretary General of EuropaBio, the European Association for Bioindustries. My role involves working with the team and member companies, and associations, to create the best possible environment for the research, development and production of treatments for patients.
health and food sustainability. I went on to study biotechnology at St. Andrews University in Scotland and, when I decided not to go into pure research, I went to do a stage at the European Commission, in order to get acquainted with European institutions, and understood that I could contribute by enabling an environment that allowed researchers and industry to discover and develop solutions to address major challenges.
How did you get into pharma? Growing up, I moved around quite a lot in Europe and beyond. I began developing an interest in science during my teenage years, when I was living in Morocco, and became passionate about sustainable development. I wanted to understand how things worked and biotech allowed me to explore at a molecular level. I also established how things could be harnessed to increase
What happened next? A job in the European crop protection industry, covering their biotech dossiers and other files for three-and-a-half years and, following that, a move to the European Association for Bioindustries (EuropaBio) in 1999, responsible for government affairs. I then moved to Italy and worked for the biotech industry for a further four years, before returning to EuropaBio on strategic
The EFPIA’s Nathalie Moll on making a positive difference through passion. INTERVIEW BY
Amy Schofield
3 4 | PH A R M A FI EL D.CO.U K
HELP YOUR CAREER
SOAR
with PharmaJobs. policy, as their first Healthcare Director. I then led the EuropaBio agricultural team between 2006 and 2009 and was promoted to Secretary General in 2010. I was appointed Director General of EFPIA in April this year.
“The most important asset is when your occupation is aligned with your values.”
What are you most passionate about? The science and solutions that industries large and small come up with, and the idea of contributing to helping people. I have been incredibly fortunate to work in industries that include huge numbers of brilliant people who are passionate about what they do and also great fun to work with. I enjoy the challenge of addressing misconceptions or misunderstandings about biotech or pharma, and discussing these vital subjects with people dedicated to getting it right and making a positive difference one way or another.
How is EFPIA embracing the growth of digital for future success? Our member companies are engaged in building digital platforms to ensure we can effectively gather and analyse both existing ‘big data’ and the real world data generated in actual clinical settings. In addition, we are engaged in a series of collaborative efforts with other sectors, such as digital and regulatory, working in areas like the electronic common technical document for medicines authorisation submissions. We also work on e-health initiatives involving patientreported outcomes and health apps.
Which character traits and talents have been instrumental to your success? The most important asset is when your occupation is aligned with your values. If you are passionate about what you do, this will translate into the drive you need to achieve results. It ensures you have those reservoirs of resilience you need in life to go through challenging times, and will mean you have the capacity to celebrate results. Passion and care would be the two traits I would choose above all others, while nothing can really be achieved if you’re not part of a team.
How is EFPIA preparing for the UK exiting the EU? Our major focus at this point is on ensuring regulatory continuity between the EU and the UK, and avoiding any disruption in the supply of medicines to patients on both sides of the Channel at any time. We are insisting on the need for an early decision on the future location of the European Medicines Agency, which is fundamental to ensuring this continuity. It is also important that both sides arrive at a mutually acceptable trade deal that does not impede patient access to medicines in either market.
What’s the best piece of careers advice you’ve ever been given? Your job is only part of your day. You need to treat it as such and make sure you balance it with the other elements in your life; care for your family, care for your community and care for yourself. You can’t pour from an empty teapot.
What advice would you give to a person entering the pharma industry now? We are entering a challenging period, and you have to remember that what we do is critical to the health of patients – our contribution to society is to help people live longer, and healthier lives. Above all, be proud of what the industry has to offer. Go to efpia.eu
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M AG A ZI N E | AU G U S T 2017 | 3 5
O N YOU R R A DA R
AOB BAC K T WE ET THE WORD ON CYBER STREET S O M E T H I N G TO S AY ? @Pharmafield
Lundbeck @Lundbeck
Patience, passion & persistence – Key elements to improve lives of people affected by #psychiatric & #neurological disorders #1voicesummit RC of Psychiatrists @rcpsych
Mental health “doesn’t have parity” when it comes to funding. Staff confirm on BBC’s #Hospital TogetherMentalHealth @TogetherMW
So many people live in fear of disclosing #mentalhealth issues at work. That fear makes those issues worse.
BE PREP-ARED
ANTIBIOTICS PRESCRIBED
In the spirit of Dallas Buyers Club protagonist, Ron Woodroof, PReP activism website iwantprepnow.co.uk advices people on how to acquire the treatment. The site notes that it can be legally bought online and that, under current laws, users are allowed to import a certain amount of PReP for personal use. It also provides a link to Dynamix International, where cheaper generic versions of the treatment can be purchased.
Mutant superbugs beware, Fresenius Kabi has put two new production lines for antibiotics into operation at its futuristic plant in Santiago de Besteiros, Portugal. A magnificent new 65,000-square-foot building will be used to produce penicillin for intravenous administration. Meanwhile, about 80 new jobs are being created at the facility and the total investment is about €17 million.
DOCTOR WHO? Online doctors, such as pushdoctor.co.uk and netdoctor.co.uk are paving the way for a new culture in general practice. Fed up with waiting rooms, endless delays and the unavailability of appointments, British people are increasingly turning to digital platforms which offer appointments with a qualified GP in a matter of minutes, for as little as £15. Pushdoctor already has a television commercial, hinting at a direct-to-consumer future for healthcare.
Reuters Health @Reuters_Health
Antidepressants in pregnancy not tied to intellectual disability in kids Mind @MindCharity
New data from @NHSEngland shows that 6 out of 10 clinics are missing talking therapy access targets Health Fast Forward @Health_FF
Studies show more doctors are using apps to help manage #chronicdisease Berci Meskó, MD, PhD @Berci
Many believe VR has a bright future in the entertainment / gaming industry, but also healthcare. What do you think about VR? DepressedDetective @georgie_lloyd
Definitely the best decision I have made. Talking out about #mentalhealth #depression #personality NICE @NICEcomms
We’re starting to assess digital therapies that can help treat anxiety or depression.
3 6 | PH A R M A FI EL D.CO.U K
Rixathon & Erelzi M A D E BY: Sandoz The global leader in biosimilars has announced the UK availability of Rixathon and Erelzi, to treat patients with specific blood cancers and a range of inflammatory conditions. Rixathon will be accessible to patients with non-Hodgkin’s lymphoma, while Erelzi treats conditions such as rheumatoid arthritis. A P P R OV E D M E D I C I N E of the M O N T H
SOMETHING THAT SHOULD BE ON OUR R ADAR? R ACHEL@PHARMAFIELD.CO.UK
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11 S E P T E M B E R 2 0 1 7
New models of primary care provision Essential knowledge for pharma professionals The traditional division of primary care, hospitals and patient community services has become a barrier to coordinated patient care, and general practice is facing higher demand and pressures than ever before. Dr James Kingsland OBE reviews previous and current reforms – what can we learn from them? What does the future of primary care look like?
Live Q&A with Dr James Kingsland OBE & Michael Sobanja
parallelle arning.co.uk
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