Pf Magazine Autumn 2021 by E4H Ltd

AUTUMN 2021

Importance of innovation Spin-offs as a strategy Market access environment PHARMAFIELD.CO.UK

COMING UP in the next Pf Magazine, published in December…

Year in review • Recruitment • Career plans • Industry updates And much more…

Our quarterly magazine covers the issues at the heart of the pharmaceutical sales and marketing environment, with a focus on relevant trends and industry updates.

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Hello.

elcome to the Autumn issue of Pf Magazine, which brings you the post-pandemic positives. We explore patient care, priorities for health and pharma to achieve the best outcomes for all, plus the challenges that lay ahead. Our cover story explores the patient pathway, post-Covid, as health transitions from crisis mode to business as usual. Following on from this, our therapy area focuses on ophthalmology. In January of this year, 604,4011 people were waiting for a first treatment in ophthalmology and our article on page 11 builds a strong case for an optimal glaucoma pathway. It is clear the concepts of collaboration and innovation weave their way through the features in this issue and are key drivers for success, moving forward. The Government recognises innovation as a way to build out of the pandemic, in its new 10-year strategy, the new UK Life Sciences Vision. Read about how the Academic Health Science Network (AHSN) has played a crucial role in the adoption and spread of innovation during the Covid-19 pandemic, on page 20. There has been a convergence of several major drivers of reform recently and the NHS is in the process of yet another fundamental reorganisation. The National Institute for Health and Care Excellence is also poised to undergo an overhaul of its methods and processes. Our article on page 14 examines the effect this is all having on the UK market access environment. Five years on from the UK’s vote to leave the EU, Claudia Rubin takes stock of what Brexit has meant for the life sciences industry, in her article on page 22. With a recent rise in pharma companies ‘spinning out’ from their parent company, we explore spin-offs as a strategic option and offer three ‘simple rules’ to review whether a spin-off could be the right option for you. Read the article on page 30. We also return with our regular career close-up feature which profiles Paul Steckler, Managing Director of Canopy Growth Corporation. I hope you enjoy reading this issue and if you would like to be involved in the Winter Pf Magazine, drop us a line at hello@pharmafield.co.uk

EDITOR

Emma Cooper emma.cooper@e4h.co.uk HEAD OF MARKETING OPERATIONS

Emma Morriss emma.morriss@pharmafield.co.uk CREATIVE DIRECTOR

Emma Warfield emma@e4h.co.uk MID WEIGHT DESIGNER

Sigrid Dalland sigrid@e4h.co.uk SENIOR EDITOR E4H

Amy Schofield amy@pharmafield.co.uk COMMERCIAL DIRECTOR

Hazel Lodge hazel@e4h.co.uk FINANCIAL CONTROLLER

Fiona Beard finance@e4h.co.uk Pf AWARDS

Melanie Hamer melanie@e4h.co.uk PUBLISHER

Karl Hamer karl@e4h.co.uk HEAD OFFICE

3 Waterloo Farm Courtyard, Stotfold Road Arlesey, Bedfordshire SG15 6XP United Kingdom NEWS DESK

newsdesk@pharmafield.co.uk

Reference: 1. NHS England https://tinyurl.com/rttdataJan21

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M AG A ZI N E | AU T U M N 202 1 | 1

Autumn HAVE YOUR SAY: If you’d like to share an idea for a feature or collaborate with us on a captivating advertorial, please get in touch. GET IN TOUCH: hello@pharmafield.co.uk

Contributors

@pharmafield

@pharmajobsuk

Pf Magazine

AMANDA BARRELL

MIKE PROCTOR

PROFESSOR GARY FORD

Amanda is a freelance health and medical education journalist, editor and copywriter. From crisis mode to business as usual, page 08

Mike is Non-Executive Chair at Conclusio. He has 45 years of experience gained within the NHS, half of which were spent in senior executive roles that included chief nurse, chief operating officer, deputy chief executive and chief executive. Mike joined Conclusio from his most recent role as interim chief operating officer at North Cumbria Trust. Building a case for an optimal glaucoma pathway, page 11

Professor Gary Ford is a consultant stroke physician and Chief Executive of Oxford AHSN. In 2021 he was appointed Chair of the AHSN Network, the innovation arm of the NHS. The importance of innovation, page 20

JOHNNY SKILLICORN-ASTON

Johnny is Communication and Engagement Consultant at Conclusio. He has 25-years’ experience in developing and delivering communication strategies for the public and private sectors and for civil society organisations. He has supported large-scale transformation projects within the NHS, and influenced, developed and delivered public consultation methodologies across the health sector. Johnny is co-author and editor of the London Community Pharmacy Strategy 2020. Building a case for an optimal glaucoma pathway, page 11

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NEIL GRUBERT

Neil has worked in global market access for the last 20 years. He spearheaded the development of Decision Resources Group’s market access business before becoming an independent consultant, trainer and writer. In 2019, he set up Future of Pharmaceutical Market Access, a forum to promote discussion and knowledge sharing in the international market access community. Market access in the UK, page 14

CLAUDIA RUBIN

Claudia is Senior Director at Newmarket Strategy. She has over a decade of experience supporting healthcare and life science organisations to navigate the NHS. A specialist in strategic planning and market access, her knowledge of the healthcare policy environment and the challenging pathways to product reimbursement, gives her unique expert insight. A look at the UK’s postBrexit route to market, page 22 OLI HUDSON

Oli is Content Director at Wilmington Healthcare. Brand planning, page 25

SAM GROVE

Sam is Client Service Implementation Manager, Healthcare Solutions at Star OUTiCO. Patient management in a digital world, page 26 EMMA MORRISS

Emma is Head of Marketing Operations at E4H. Improving the patient treatment pathway, page 28 PAUL RILEY

Paul is Medical Affairs Director at Glasshouse Health. He is an experienced medical affairs professional with expertise in bridging the gaps between healthcare companies, patients, and the medical community. Paul works with pharma companies and technology companies, and specialises in the evaluation and development of effective digital technology strategies and procurement planning. Parting company, page 30 MARK DAVIES

Mark is an NHS Consultant and Director of Res Consortium. He left clinical practice to take an MBA and now works extensively with pharma marketing teams supporting market access, brand strategy, commercial performance and partnership projects. Mark works with a team of digital specialists providing a range of dynamic digital applications to pharma and the NHS to improve patient outcomes. Parting company, page 30 EWAN CUTHBERTSON

Ewan is Head of Deployment Solutions Europe for Syneos Health. He has 25 years of experience as a commercial leader within the Medical Devices, Pharmaceuticals and Managed Care Sectors. Tech-enabled pharma marketing strategies, page 34

In this issue 04

ADVERTORIAL

An overview of the best bits recently published on www.pharmafield.co.uk

Patient management in a digital world

INDUSTRY ROUND-UP

A round up of the latest news, current collaborations and ones to watch in the industry

COVER STORY

From crisis mode to business as usual: Tracing a collaborative path to high quality care

THERAPY AREA

Building a case for an optimal glaucoma pathway

Paul is Managing Director, Europe, of Canopy Growth Corporation. Career close-up, page 36

INSIGHT

Improving the patient treatment pathway

INSIGHT

Parting company: Exploring spin-offs as a strategic option

MOVERS AND SHAKERS

Who’s moving where in the industry?

ADVERTORIAL

Tech-enabled pharma marketing strategies

Market access: How unprecedented change is presenting opportunities for pharma

CAREERS

INSIGHT

Pf talks to Paul Steckler, Managing Director of Canopy Growth Corporation

FEATURE

The importance of innovation: How the AHSN Network has played a crucial role in the adoption and spread of innovation during the pandemic

INSIGHT

A look at the UK’s post-Brexit route to market

ADVERTORIAL PAUL STECKLER

ICYMI

How will structural changes to the NHS landscape influence brand planning within pharma companies?

“To meet the challenges of Covid-era healthcare, patient pathways – from diagnostics to treatment, monitoring to follow-up – have been transformed” Amanda Barrell, page 08

ICYMI

PHARMAFIELD.CO.UK HAVE YOUR SAY

DO YOU HAVE AN OPINION YOU WANT TO SHARE? Get in touch to contribute thought leadership opinion pieces and add your voice to the conversation.

hello@pharmafield.co.uk

PF WEBINARS

MORE THAN JUST PRINT. In between your quarterly issues of Pf Magazine, you will find daily news, exclusive web articles and thought leadership opinion pieces on www.pharmafield.co.uk Take a look at some of the exclusive content you may have missed and the exciting things we’ve got coming up.

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Pharmafield and Star OUTiCO have partnered to bring you a free webinar series, exploring the real opportunity for pharma when it comes to the NHS recovery and beyond. The first webinar, in the series of three, looks at the key challenges and opportunities from an NHS stakeholder perspective and examines how pharma organisations can be the catalyst for making enduring and effective change. Watch the first webinar on-demand now and register your interest for the series by visiting the link below.

https://tinyurl.com/d5usvkwe

ICYMI

Pf TALKS TO.... SIMON NICHOLSON, MD OF ORGANON

It is long overdue, but women’s health has been having its moment in the spotlight and it feels like there could be a big shift on the horizon. It is timely, then, that Organon has recently launched; a global healthcare company formed through a spin-off from MSD, with the goal to make a better and healthier every day for every woman. Pf spoke to Simon Nicholson, Managing Director of Organon UK&ENI Cluster, to find out more about why this large-scale organisation with a start-up mentality could be a real driver for change. Turn to page 30 to read our article exploring spin-offs as a strategic option.

“With a specialist company like Organon, we now have the luxury of spending more time thinking, ‘how do these products really support women?’” SIMON NICHOLSON

FOUR ARTICLES NOT TO MISS THIS MONTH

A PANEL VIEW – HOW CAN PHARMA ENGAGE WITH A CHANGING NHS?

In an exclusive article for Pharmafield, Conclusio convened a panel of healthcare senior leaders to provide their view on the realities associated with a changing NHS and the opportunities for pharma to engage as a partner.

SETTING THE SCENE: SARCOMA DIAGNOSIS AND TREATMENT

To mark Sarcoma Awareness Month and the tenth anniversary of the bone and soft tissue cancer charity, Sarcoma UK, the charity reflects on its progress, celebrates its achievements and looks ahead to a future where everyone affected by sarcoma cancer has the treatment, care and support they need.

As the Health and Care Bill begins its passage through parliament, Oli Hudson, Content Director at Wilmington Healthcare, looks at five critical changes resulting from these reforms that will define the way industry engages with the NHS in the future.

James Wells, UK International Freight Manager at Aramex, explores the transferable practices that automotive manufacturers follow, and how they could deliver real benefits to the healthcare sector.

NEGOTIATING THE CHANGING NHS LANDSCAPE: FIVE CRITICAL SHIFTS THE PHARMA INDUSTRY MUST EMBRACE

FROM PORCHES TO PACEMAKERS: WHAT HEALTHCARE CAN LEARN FROM AUTOMOTIVE SUPPLY CHAINS

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Ones to watch Start-ups that have caught our attention

HERTILITY HEALTH Hertility Health is a new women’s health start-up providing accessible and tailored diagnostics in women’s health and nextgeneration advancements through at-home testing. It aims to help women be proactive, not reactive, about their health by offering a triage system of affordable and accessible testing, working with leading world experts to provide personalised care pathways and connecting women with professional experts and clinics. The start-up has raised £4.2million in seed funding, led by LocalGlobe. www.hertilityhealth.com

ECOUTAI Exciting start-up Ecoutai brings to the market a deep understanding of the commercial applications of conversational AI technology in life science. Ecoutai launches in January 2022 with a truly innovative technology solution that addresses the historical challenges of physician engagement, particularly compounded by Covid-19. State-of-the-art avatars and unique conversational AI technology combine to enable healthcare professionals to access deep and broad conversations about pharmaceutical brands on demand. enquiries@ecoutai.net

APRICITY Born to challenge the current fertility treatment, Apricity is the world’s first virtual fertility clinic, designed to empower women and put them at the centre of their treatment. With a mobile app to help patients visualise their journey and prepare them for each stage of treatment, the team of data scientists, data engineers, developers and clinicians believe they can deliver a better fertility experience through AI. www.apricity.life

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Above: Hertility Health’s Dr Natalie Getreu, Dr Helen O’Neill and Deirdre O’Neill.

INDUSTRY ROUND -UP

PR & COMMUNICATIONS

COLLABORATION CORNER The National Institute for Health and Care Excellence (NICE) and the Academic Health Science Network (AHSN) have announced a two-year agreement to support the use of the best evidence-based healthcare in the NHS to improve the lives of patients. The agreement outlines priority areas of work that the collaboration will focus on, including addressing market challenges for digital innovation, shaping and generating real world evidence, and supporting innovators into the healthcare system. Expert teams from NICE and the AHSN Network will meet regularly throughout the year to develop a programme of work to deliver these priorities. Turn to page 20 to read our exclusive article from Professor Gary Ford, Chair of the AHSN Network, Chief Executive of Oxford AHSN and non-executive director for NICE.

MERGERS & ACQUISITIONS

NICE AND THE ACADEMIC HEALTH SCIENCE NETWORK

OPEN Health has announced the acquisition of North West UK-based medical communications agency Spirit. A statement from OPEN Health stated that integrating the Spirit business with the OPEN Health Group will strengthen global resources and offer a broad range of services, including high-quality scientific communications. In terms of scale, the acquisition means OPEN Health will now consist of more than 850 people in 15 locations across six different countries including the USA, UK, The Netherlands, Germany, India and China. PHARMA

Bioscript, the full-service pharmaceutical communications company, has announced two strategic acquisitions that strengthen and extend its integrated service offering. Fortis Pharma Consulting, a London-based specialist in medical affairs services, brings industry-side expertise to complement Bioscript’s scientific heritage. The acquisition builds on Bioscript’s existing services in refining and articulating a product’s value at launch, with specialist skills in medical education, expert engagement and strategic consultancy. The addition of Valid Insight, an award-winning specialist market access consultancy, introduces deep knowledge of value strategy, international payer evidence requirements and value communication.

ONCOLOGY

VACCINES

PHARMACY

Panthera has accelerated its move into running oncology trials, as part of its partnership with Rutherford Health. Panthera’s partnership with Rutherford not only provides four top oncology sites spread across the UK but also access to oncologists across each of the four regions, who cover a broad range of cancers. Matt Cooper, General Manager Oncology at Panthera commented: “We have had great interest from the industry with our innovative new cancer trial model. Particularly as we have been able to continue to operate safely by putting in place rigorous procedures. Our model provides much needed additional capacity and capability into oncology trials in the UK, especially at a time when trials have been adversely affected by the pandemic.”

Terumo Blood and Cell Technologies, a medical device company specialising in a portfolio of technology, software and services for blood component collection, therapeutic apheresis and cellular technologies, and PhotonPharma, a cancer immunotherapy developer, have established a memorandum of understanding (MOU) for collaboration to develop Innocell, a novel tumour specific immunotherapy (a therapeutic vaccine) for solid tumour malignancies, including breast cancer. To help in the cancer immunotherapy development process, PhotonPharma is using Terumo’s Mirasol(R) Pathogen Reduction Technology (PRT) in the manufacturing process, which can help improve the speed to market and benefit patients quicker.

Cegedim Healthcare Solutions has announced a new partnership with GIG Retail, to deliver consumer-focused in-store advertising campaigns for pharmacies through Cegedim’s ‘Pharmacy Display’ solution. Based on advanced retail data insights provided by GIG Retail, community pharmacies across the UK will benefit from more visually appealing digital campaigns – both evergreen and seasonal; enhanced involvement with NHS Health and wellbeing initiatives; and elevated promotion for pharmaceutical manufacturers’ over-thecounter (OTC) medicines. The collaboration will allow for curated, fresh and eye-catching content that is updated throughout the year, and produced by an expert team of pharmacy specialists, content marketers, journalists and motion designers.

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FROM CRISIS MODE TO BUSINESS AS USUAL: Tracing a collaborative path to high quality care

Faced with the monumental challenge of Covid-19, health and social care staff moved into crisis mode, reorganising, recalibrating, and realigning to meet the demands of a pandemic-struck nation. But what impact did this have on the shape of patient pathways, and what can we learn from the tragedy of the last 18 months? WORDS BY Amanda

Barrell

ore joined-up working, fewer outpatient appointments, and right first-time diagnostics and care have been among the NHS’ ambitions for some time. Yet despite multiple national policy documents and countless local initiatives, progress has been slow – until now. United behind a common purpose and an urgent need, professionals from across the health and social care ecosystem have worked together to streamline pathways. But what next?

C H A L L E NG I NG T I M E S At the start of the pandemic, a combination of infection control measures and the need to divert resources – including staff – to the front line rendered business as usual untenable. It called for drastic change. Dr Nav Chana, medical director of the National Association of Primary Care and south London GP, said: “For some people with long-term conditions, monitoring in secondary care stopped.

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“These people were unable to access investigations or scheduled specialist care. This created not only physical, but also mental health and social challenges.” It also laid bare the NHS’ pre-existing staffing issues, said independent healthcare consultant, Sue Thomas. “Specialist staff being deployed to the frontline has had a significant impact on patients,” she said. “Many clinicians have been working single-handedly to keep their services afloat.” All this was compounded by a drop in presentations and emergency admissions, driven as much by people not wanting to bother their healthcare teams as it was by fear of SARS-CoV-2. This perfect storm of pressures disrupted pathways across the whole spectrum of care, with serious consequences for outcomes. “Although the impact of heart attacks and strokes is significant, a lot of people with neurological problems, for example, experience frequent urinary tract infections. What has been happening to them if they have not been seeking help?” asked Sue. “Glaucoma is another area of concern. An eye problem might sound a low-key issue compared to cancer, but if people are not diagnosed and receive the required eye drops, they can lose their sight.”

C OV ER S TO RY

T H E PAT H T O SOLU T IONS To meet the challenges of Covid-era healthcare, patient pathways – from diagnostics to treatment, monitoring to follow-up – have been transformed. A large part of this has been attributed to the use of technology to conduct remote consultations, facilitate multi-disciplinary meetings, and enable the sharing of data. “We must never gloss over the great hardship a nd loss many people have experienced during the pandemic, but there have been some positives. For some people, remote access has been a positive thing,” said Dr Chana, whose general practice went from assessing 20% of people remotely to 80% in the space of just three days. Thomas agreed, saying that some people appreciated the convenience of virtual appointments, but adding that technology was only part of the answer. “The point is that it has enabled an increase in collaboration between primary and secondary care. It seems to have improved team working, and enabled people to contact each other more easily,” she said. This increased clinical integration has been a force for good in terms of ensuring patients are referred in a timely and appropriate manner, said Dr Chana. “There has been this general feeling that we are all in this together, whichever silo or sector you are in. It brushed some of the bureaucracy that sometimes gets in the way of providing quality care, especially for those really complex cases,” he said.

“I was able to directly reach out to consulting colleagues, and we could talk about particular investigations, rather than sending letters to each other. We have not worked like this for decades.” Cross-speciality working has enabled teams to build new pathways that straddle traditional silos, with the patient at the centre. The result is fewer outpatient appointments, more multidisciplinary team (MDT) working, and a greater focus on population level health, agreed Thomas and Dr Chana.

ST R E A M L I N E D PAT H WAY S R E DUC E DE M A N D Attention is now turning to what happens next, as the NHS moves to deal with the next wave of infections while also tackling burgeoning waiting lists. Dr Claire Colebourn, consultant medical intensivist at Oxford University Hospitals and president of the British Society of Echocardiography (BSE), said thousands of people were currently waiting for an echocardiogram – a problem that is repeated across the diagnostic landscape. “Backlogs are measuring at 12–15 weeks against the standard of six weeks for an outpatient echo referral in some areas. Work rates have been elongated by necessary PPE and room cleaning, staff who had to isolate or have had Covid, and also staff have been shielding. Many patients also did not attend their appointment because of fears of going to a clinical area,” she told Pf Magazine. “On top of that, there are many more people who need scans because they have had Covid and now have chronic shortness of breath.”

T OP 5 TA K E AWAY S

1. Perfect storm of pressures disrupted pathways across the whole spectrum of care. 2. Patient pathways, from diagnostics to treatment, monitoring to follow-up, have been transformed. 3. Technology and data sharing has increased collaboration between primary and secondary care. 4. Cross-speciality working has enabled teams to build new pathways that straddle traditional silos. 5. Triage is the name of the game.

“

I was able to directly reach out to consulting colleagues, and we could talk about particular investigations, rather than sending letters to each other. We have not worked like this for decades

”

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C OV ER S TO RY

Echocardiography, she explained, has a workforce shortage of around 20%, meaning demand was, as in many specialities, outstripping supply long before the pandemic. BSE’s solution, in keeping with the collaborative ethos of the last 18 months, involves working with primary and secondary care colleagues to ensure referrals are appropriate. “Triage is the absolute name of the game,” said Dr Colebourn. “To streamline requests, we are asking people to triage using our new national guidance and, where necessary, recontact the referrer to make sure that person really needs an echo. “If we can identify people who do not need an echo, we can relieve weight from the system. It’s also about reprioritising to maintain patient safety for those who really do need this test urgently.” Along with the triage guidelines, the BSE has also sent primary care providers posters explaining the clinical where echo is not required. This provides clinicians with the backing they need to prevent over-requesting. The BSE has also published a position statement, which sets out a range of time – and resource-saving initiatives designed to streamline services, on its website.

C OL L A B OR AT E T O C R E AT E N E W, OU TC OM E B O O ST I NG PAT H WAY S Collaborative networks have extended further than primary and secondary care, said Dr Chana, pointing to a project designed to tackle the glaring health inequalities brought into sharp focus by Covid-19. “In one area of London, we are seeing a great collaboration between secondary care, the voluntary sector, social care, and primary care, who have got a leadership group together,” he said. “The aim is to use data sources to identify vulnerable communities with unmet need, and build targeted schemes that would improve their health and wellbeing, while also reducing demand on a variety of services.”

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T H E BIG G E R PIC T U R E Overall, the pandemic has focused people’s attention on the importance of comprehensive pathways – and how they can help the NHS achieve its overall aims. “Many services have been delivering care for a long time without having or realising the implications of a defined pathway. My hope is that all of the changes we have seen will make people realise that there are better ways to deliver care, and produce better outcomes as a result,” said Thomas. In MS, for example, new therapies are coming online all the time, but many require cross-specialty involvement. “You might need an ophthalmology assessment after three months of being on a new treatment, for example. But if the service does not have access to ophthalmology because of waiting lists, it can’t implement the pathway,” she said. “Teams need to understand all the steps of the pathway and build their services around them collaboratively.”

G R A SP T H E N E T T L E OF MOM E N T U M Necessity, as Dr Colebourn said, was the mother of invention during the pandemic, and the last year or so has borne witness to something of a transformation in the way care is organised and delivered. Maintaining that momentum will not only push down waiting lists, it will also help the NHS achieve its long-stated goal of doing more with less. Said Dr Colebourn: “We need to look at any way of working more efficiently that protects patient safety. I want the person in front of me to need to be there and for their service to be as streamlined as possible. “It is vital that people are in the right part of any pathway at the right time.” Amanda Barrell is a freelance health and medical education journalist, editor and copywriter.

THERAPY AREA

Eyes on the prize Building a case for an optimal glaucoma pathway

ack in January 2019, Richard Whittington, then assistant director of commissioning, now chief executive of Local Optical Committee Support Unit, wrote a blog for the NHS England (NHSE) website. Entitled Creating a Community of Care on Eye Health,1 it made interesting reading then and resonates as firmly now during these challenging times for the NHS. In January 2021, 604,4012 people were waiting for a first treatment in ophthalmology, 230,872 have waited more than 18 weeks3 and 48,703 have waited more than a year4 . Richard’s central point was that optical professionals are a key asset in protecting and transforming the health outcomes of citizens; assessing someone’s ocular function and acuity can discover more than just a need for spectacles. Hitherto undiagnosed disease can be detected, and an earlier intervention will bring better outcomes. Certainly, now is the time to ensure the experts are given a platform to drive change across a whole system of care.

WORDS BY

Johnny Skillicorn-Aston & Mike Proctor

COLLABORATION

Despite this, optical clinicians and their teams are often neglected in the scheme of multi-disciplinary team working and fail to be recognised as front-line healthcare professionals (HCPs); a phenomenon experienced by other groups of HCPs. Optical professionals, working in the community, do so largely on the same streets as another health and social asset that has often faced status issues. Community pharmacy, just as optical professionals do more than sell spectacles, does more than dispense pills. Yet, while it has had to struggle to assert its place, it is now instrumental in the system leadership that is demanded as a result of the NHS Long Term Plan and the spawning of integrated care systems (ICSs). In London, Local Pharmaceutical Committees (LPCs) have driven forward a community pharmacy strategy, which determines a new service offer5. There is significant value to be drawn down through an integrated care pathway, where community optometrists are working handin-glove with consultant ophthalmologists. However, relationships between any coprofessionals only prosper where dialogue is supported that drives parity of esteem across all health professionals involved in the achieving of better outcomes for patients.

There is significant value to be drawn down through an integrated care pathway, where community optometrists are working hand-in-glove with consultant ophthalmologists

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The recently published Government White Paper, Integration and innovation: working together to improve health and social care for all6, is a ‘blueprint’ for: “stripping away unnecessary legislative bureaucracy, empowering local leaders and services and tackling health inequalities.”7 This builds on the NHS’s Long Term Plan8 proposals and is set to accelerate the rate of integration across the NHS, making the case – as stated in the White Paper: “…for joining up and integrating care around people rather than around institutional silos – care that focuses not just on treating particular conditions, but also on lifestyles, on healthy behaviours, prevention and helping people live more independent lives for longer. We need the different parts of our health and care system to work together to provide high quality health and care, so that we live longer, healthier, active and more independent lives.” This person-centred focus extends its lens into the working approaches and arrangements for, and between, HCPs. Dividing lines being painted out of the picture, walls coming down and silos being opened up; admirable and much needed actions but inter-health professional status has to be assured too. True shared decision making on how to plan, build, deliver and measure optimum care requires all the care professionals involved to view each other as equals.

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START AT THE BEGINNING

What are the implications and pointers in this for the optical health community? Finding a common cause is a good starting point. In the current climate of Covid-19 restrictions, the associated impacts on health and wellbeing in the population, and the consequences for our health systems, looking at a care pathway that is under strain is a good jumping-off point. Glaucoma as a group of eye conditions is one of the most common causes of blindness worldwide9. In the UK about 2% of the population over 40 have the condition and by 2035, the number of people living with glaucoma in the UK is expected to increase by 44%.10 While much of the diagnosis of glaucoma in the pathway resides in secondary care, there is a growing consensus that more of the risk stratification and management needs to be done in the community. For many years there have been designs to expand the provision of care in local communities. The NHS Long Term Plan set objectives for that with outof-hospital models and an overarching plan to avoid admissions. Issues that were once barriers to getting services out of Trusts and into the community, have started to fall. It provides an opportunity for optical clinicians and their teams to unite around an issue and assert their place in a glaucoma optimal care pathway.

Though the barriers might be lower, culture, custom and practice can be stubborn agents to remove. However, things have shifted. The financial regime has been turned on its head, block contracts are altering the motivations of hospital leaders. Covid-19 has necessitated reduced hospital footfalls and many of those resistant to change, have been persuaded to align. The development of ICSs has accelerated joined up working. An important emerging development is the place of accountability; incentive and sanction are now at system level. All this shows good prevailing conditions to steer optimal care through the community. Given that waiting lists for glaucoma treatment might very well be keeping a lot of Trust CEOs awake at night, this presents another opportunity to state the case for community care. It is clear that there is a powerful body of evidence for galvanising the strength of offer in community optometry in delivering within an optimal glaucoma care pathway. From diagnosis to follow-up care, care in community settings will provide a better experience for patients, strengthen the role of community optical clinicians and better serve the objectives of integrated care. The recent NHSX allocation of £8.5m funding across England’s seven NHS regions11 for technologies that allow hospital ophthalmologists to access records, referrals and diagnostic images

THERAPY AREA

We need an optimal care pathway to collect the data to help address unmet need and inequalities through interventions that are based on shared decision making between patients and HCPs alike

from high street optometrists, will bring community optometrists within real-time reach of secondary care clinicians and support the sharing of diagnostic images and streamline referrals. This will allow optometrists to consult with clinicians in real-time, share diagnostic images, and refer patients to hospital, forming part of a much-needed infrastructure for optimising integrated glaucoma care in the community. While there is not a register of people who might be good candidates for better outcomes from an optimal care pathway to support unmet need, the focus must remain on not precipitating inequalities in prescribing of glaucoma medications. We need an optimal care pathway to collect the data to help address unmet need and inequalities through interventions that are based on shared decision making between patients and HCPs alike. Pharma companies like AbbVie are starting to engage with these challenges and see themselves as potential partners of the NHS in a purposive approach to addressing these kinds of challenges. Changes in the NHS landscape, the delivery of care and the Covid-19 pandemic have taught many things to all those engaged in providing quality patient care. A clear opportunity to act exists; everyone needs to change their mind-set and demonstrate a commitment to work

in partnership across the whole healthcare system. Adopting shared goals that move us away from silo leadership and thinking and deliver more positive outcomes rather than just more barriers. Mike Proctor is NonExecutive Chair & Johnny Skillicorn-Aston is Communication and Engagement Consultant at Conclusio. Go to www.conclusio.org.uk

References 1. NHSE Blog: Creating a community of care on eye health. Richard Whittington https://www.england.nhs.uk/blog/creating-a-communityof-care-on-eye-health/ 2,3,4. NHS England https://tinyurl.com/rttdataJan21 5. London Community Pharmacy: Our offer to London Pharmacy Strategy 2020 https://psnc.org.uk/pharmacylondon/wp-content/ uploads/sites/112/2020/09/Offer-to-London.pdf 6. Government White Paper, Integration and innovation: working together to improve health and social care for all https://www.gov.uk/ government/publications/working-together-to-improve-health-andsocial-care-for-all 7. https://www.gov.uk/government/news/blueprint-launched-for-nhsand-social-care-reform-following – pandemic 8. NHSE Long Term Plan https://www.longtermplan.nhs.uk/ 9. https://www.moorfields.nhs.uk/condition/glaucoma#:~:text=In%20 England%2C%20about%20480%2C000%20people,have%20 chronic%20open%2Dangle%20glaucoma 10. Increase in incidence of Glaucoma to 2035 https://glaucoma.uk/ about-glaucoma/ 11. https://www.nhsx.nhs.uk/blogs/transforming-eye-care-servicesthrough-better-connectivity/

M AG A ZI N E | AU T U M N 202 1 | 13

M A R K E T AC C E S S in the UK

How unprecedented change is presenting opportunities for pharma WORDS BY Neil

he UK market access environment faces a time of change – the result of the convergence of several major drivers of reform. The Covid-19 pandemic will reinforce trends that were already taking place. The NHS in England is in the process of yet another fundamental reorganisation. Brexit has precipitated significant adjustments to the UK regulatory system. The National Institute for Health and Care Excellence (NICE) is poised to undergo an overhaul of its methods and processes. In addition, the government has recently published a Vision for Life Sciences that seeks to improve collaboration between different stakeholder groups in the healthcare ecosystem. For its part, pharma will need to be more adaptable than ever to adjust to this fast-changing environment. REPERCUSSIONS OF THE PANDEMIC

The pandemic has undoubtedly had a dramatic impact on the NHS over the last 18 months, and it will be a catalyst for lasting change in the healthcare system. Experience

Grubert

with telemedicine, combined with the growth of digital health technology, will accelerate a pre-existing trend to move care out of the inpatient setting where possible. For example, the NHS has indicated that initial funding of £160 million to substitute 50 ‘COVID-friendly’ cancer therapies – oral drugs and more tolerable treatments – for traditional chemotherapy in hospital could be maintained until March 2022. Of course, the government will soon have to deal with the enormous cost of dealing with Covid-19 and its consequences. Pharma is understandably anxious that it could be a prime target for cost containment. However, the pandemic has enhanced the industry’s reputation and powerfully demonstrated the importance of investing in healthcare. The human cost of the pandemic is, of course, enormous. Delays in the diagnosis and/or treatment of some diseases – especially cancers – will harm the prognosis for many patients and have implications for their therapeutic options. It will be interesting to see if treatment algorithms might be relaxed to take account of these

“

delays. The NHS will also have to deal with the challenges of ‘long COVID’ and an increase in mental illness. THE SHIFT TO INTEGRATED CARE

The Health and Care Bill will introduce the latest in a long line of reforms of the NHS in England. At its heart is a shift towards integrated care – breaking down the barriers between healthcare and social care to improve population health. The 106 clinical commissioning groups (CCGs) are expected to be merged into 42 integrated care systems (ICSs) by April 2022. Pharma will have to adapt to new decision makers, including influencers in social care. The scope and composition of area prescribing committees may change. Some hospitals have been directed by NHS England to form hospital groups, with potentially significant implications for procurement. Each ICS is expected to have a ‘single pot’ of money for commissioning, primary care budgets and specialised commissioning, diminishing the financial independence of individual hospitals.

The pandemic has enhanced the industry's reputation and powerfully demonstrated the importance of investing in healthcare

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”

INSIGHT

Hospital reimbursement will move away from the current activity-based approach to ‘blended payments’ that combine a fixed sum based on the costs of delivering a specific level of activity with a variable component for certain elective activities. Many high-priced drugs are expected to be purchased by ICSs based on cost and volume, but NHS England (NHSE) has suggested that blended contracts and local negotiation could be used for biologics to make providers more aware of the cost of these drugs. Most specialised services will no longer be commissioned by NHSE but by ICSs or groups of ICSs.

IMPACT OF BREXIT ON THE REGULATORY ENVIRONMENT

Following the UK’s departure from the EU, the Medicines and Healthcare products Regulatory Authority (MHRA) now has exclusive responsibility for licensing medicines. However, the UK government has elected to join two international regulatory alliances to expedite the approval of new drugs. The Access Consortium brings together the regulatory agencies of the UK, Australia, Canada, Singapore and Switzerland, which hope to be ‘regulators of choice’ for the launch of new drugs. Project Orbis – an alliance

of the UK, the US, Canada, Australia, Switzerland, Singapore and Brazil – has a narrower focus, on oncology drugs. The first result of Project Orbis was the MHRA’s approval of a label extension for AstraZeneca’s Tagrisso three weeks before the European Commission granted the same authorisation. MAJOR CHANGES AT NICE

Twenty-two years on from its formation, NICE sees a need for major changes to its methods and processes. The reforms are scheduled to be finalised by November 2021 and implemented in January 2022.

KEY PROPOSALS FOR POTENTIAL CHANGES AT NICE

• Replace the current modifier for life-extending treatments at the end of life with a broader disease severity measure. • Potentially terminate guidance development if the base-case incremental cost-effectiveness ratio (ICER) is too high. • Accept a greater degree of uncertainty and risk in some circumstances.

Gillian Leng, NICE’s Chief Executive, believes the most significant proposed change to NICE’s methods will be the adoption of a wider range of modifiers. Addressing uncertainty will also be very important because of plans to accelerate access and broaden funding for some innovative medicines. The institute’s recently-published Strategy 2021–2026 notes that “there will be an increased push for integrated guidelines that extend across the health, social care and public health interface. They will need to have a stronger focus on prevention and reducing health inequalities, particularly in key priority areas including the ageing population with increasing co-morbidities and the underlying risk factors driving growth in noncommunicable diseases.”

• Fund interventions with greatest benefits and disinvest from low-value/ ineffective technologies.

• Encourage fast-track appraisal for drugs entering established therapeutic classes.

• Be more receptive to real-world evidence, particularly for cutting-edge technologies.

• Streamline the evaluation of drugs with multiple indications.

• Allow one-off treatments to be classified as highly specialised technologies (with a much higher costeffectiveness threshold).

GOVERNMENT’S LIFE SCIENCES VISION

In July 2021, the government published its Life Sciences Vision. Its stated ambition is to “make the UK the best place in the world to discover, develop, test, trial, launch and adopt new treatments and technologies, by creating a forward-thinking commercial environment where the NHS can strike flagship deals and where proven, clinically and cost-effective innovations are rapidly adopted and spread across the country to bolster the health of the nation, deliver greater value for the taxpayer and stimulate economic growth.” The NHS Commercial Framework for New Medicines will play a key role in fulfilling this ambition. It is intended to “encourage faster market entry for new treatments and support uptake and adoption where these medicines are priced fairly and responsibly.”

• Move from HTA to health technology management, with “living guidelines”. • Involve patients in the selection of outcomes measures.

NICE TO WORK MORE CLOSELY WITH ACADEMIC HEALTH SCIENCE NETWORKS

NICE has formed a new collaboration with England’s 15 regional Academic Health Science Networks (AHSNs) to "support the use of the best evidence-based healthcare in the NHS to improve the lives of patients." The two-year agreement will promote the development of the Accelerated Access Collaborative’s National Innovation Service, which aims to create a single front door for innovators. The goal is to speed up the adoption of innovative health interventions (including digital health technology) throughout the NHS and to generate real-world evidence to underpin NICE recommendations. Closer partnership between industry and the NHS is a key objective of the AHSNs. M AG A ZI N E | AU T U M N 202 1 | 15

NHSE is particularly interested in exploring opportunities for ‘smart deals’ that offer companies market access within weeks (or sometimes days) of marketing authorisation in return for a substantial discount and a commitment to collect real-world evidence (RWE) for evaluation by NICE. Novartis’s Kymriah, Mayzent and Zolgensma, and Kite’s Tecartus, are examples of drugs that have benefited from such deals. The government has also pledged to establish an Innovative Medicines Fund modelled on the existing Cancer Drugs Fund (CDF). Reimbursement would be contingent on the collection of RWE. Funding of £500 million per year has been mentioned, though it is not clear whether that figure would be in addition to the £340 million allocated to the CDF or would subsume the CDF.

“

The government sees the value of an innovative pharmaceutical industry in the UK and wants to ensure the country is attractive to manufacturers from around the world

” A further initiative to expedite access to novel therapies is the Innovative Licensing and Access Pathway (ILAP), which will give companies the opportunity of very early engagement

– potentially at the pre-clinical stage – with key players in the UK healthcare system, including the MHRA, NICE, the Scottish Medicines Consortium (SMC) and NHSE.

Table 1. NHS COMMERCIAL FRAMEWORK FOR NEW MEDICINES OUTLINES TERMS FOR MANAGED ENTRY

Type of scheme

Key features

Simple patient access schemes (PASs)

• Always the preferred option: faster access because of minimal administrative burden. • Fixed price or percentage discount applicable to all indications (no blended or indication-specific pricing).

Complex patient access schemes

• Considered only with a strong rationale for their use and clear explanation of how risks will be shared. • Details are not confidential (to ensure value to NHS is achieved).

Commercial access agreements (CAAs)

• Option for technologies with an ICER of less than £20,000 per QALY or where a product launch would be particularly challenging or commercially unviable. • Examples include budget caps, price-volume agreements, cost sharing, stop-start criteria, and outcomes-based agreements/payment by results.

Managed access agreements (MAAs)

• Considered for drugs that are plausible candidates for routine commissioning but subject to uncertainty. • Data collection is combined with a PAS (simple or complex) or a CAA. • Key requirement for approval of an MAA is feasibility of collecting relevant health outcomes. • To date, MAAs have generally been used in the Cancer Drugs Fund or for highly specialised technologies, but they need not be limited to these programmes. • Statutory funding requirement (NHS coverage within 90 days of NICE approval) does not apply to MAAs.

Budget impact schemes

• For drugs with a potential net budget impact of more than £20 million in any of the first three years on the market, the NHS will engage in commercial discussions to reduce the cost.

INSIGHT

Table 2. ACTIONS TO BE CONSIDERED IN RESPONSE TO CHANGES IN ACCESS CONDITIONS

Products

Potential actions

Drugs already on the market

• Capitalise on funding for ‘COVID-friendly’ cancer therapies and make the case for permanent reimbursement of these products. • Advocate relaxation of therapeutic algorithms to offset the impact of delays in diagnosis and treatment of patients as a result of the pandemic.

Drugs approaching launch

• Be ready to adapt to changes in NICE’s methods and processes. • Investigate the potential of the forthcoming Innovative Medicines Fund. • Explore opportunities for ‘smart deals’ and other managed entry agreements.

Drugs in early development

• Consider the potential of the Innovative Licensing and Access Pathway to accelerate access to a new drug that meets the criteria.

Portfolio

• Prepare for new customer relationships in the changing NHS landscape in England. • Allow for the possibility of increases in cost containment. • Contribute to the dialogue about priority disease areas identified in the Life Sciences Vision.

Outlook and implications for pharma The UK’s dynamic access environment will undoubtedly present challenges to the pharmaceutical industry, but it also offers some exciting opportunities.

In the wake of the pandemic, vaccines and treatments for infectious diseases will inevitably benefit from increased support. Therapies for chronic, highprevalence, non-communicable diseases will also receive greater attention. Boris Johnson has specifically mentioned the need to tackle obesity. The Life Sciences Vision goes further, identifying treatments for neurodegenerative disorders, cancer immunotherapies, novel vaccines, cardiometabolic therapies, treatments for multi-system ageing and therapies for mental illness as priorities for funding. Given that budgets are finite, other medicines – possibly including orphan drugs – may face more challenging access conditions. The combination of the pandemic and the reorganisation of the NHS in England will accelerate the shift in care for many conditions out of the hospital setting, though the management of some diseases

will inevitably remain the preserve of secondary care and may even be limited to a few tertiary centres of excellence. Pharmaceutical companies may have to adapt their portfolios, recognising the increasing importance of oral and subcutaneous formulations. They will certainly need to develop a more holistic view of care pathways – to engage with a wider range of decision makers and show the value they can offer across the continuum of care. The UK has long had the reputation of being ‘low and slow’ for the uptake of new medicines. However, the 2019 Voluntary Scheme for Branded Medicines Pricing and Access set a target for the UK to be in the upper quartile of comparable countries for uptake by June 2021. That goal may not have been achieved, but the Life Sciences Vision does suggest that the government sees the value of an innovative pharmaceutical

industry in the UK and wants to ensure the country is attractive to manufacturers from around the world. Historically, the NHS – especially at local level – has often seemed wary of partnerships with the industry, but this situation does appear to be changing. Sir Simon Stevens, the outgoing Chief Executive of NHS England, has said: “When drug companies play ball with the NHS, taxpayers get a fair deal and patients get cutting-edge treatments.” The industry will naturally want to ensure that the rules of the game are clear, the playing field is level and the goalposts are not moved mid-match. There are, of course, no guarantees, but the outlook for access in the UK does seem more promising than it has in a long time. Companies need to act now to ensure that they are ready to make the most of current and future opportunities. Neil Grubert is an independent consultant, trainer and writer. M AG A ZI N E | AU T U M N 202 1 | 17

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The importance of innovation WORDS BY

Professor Gary Ford

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INNOVATION IN HEALTHCARE HAS BEEN ESSENTIAL TO THE NHS COVID-19 RESPONSE. THE GOVERNMENT’S NEW VISION FOR UK LIFE SCIENCES ALSO RECOGNISES ITS IMPORTANCE IN BUILDING OUT OF THE PANDEMIC. AS THE INNOVATION ARM OF THE NHS, HOW HAS THE ACADEMIC HEALTH SCIENCE NETWORK (AHSN NETWORK) BEEN CENTRAL TO THIS?

F E AT U R E

As a clinical academic and NHS stroke physician, I’ve dedicated my career to the spread and adoption of innovation

asked with supporting the adoption and spread of innovation across the health and care system, the AHSN Network has played a crucial role. During the pandemic, we pivoted our existing work programmes and redirected our support to the NHS response, working closely with health and care, and industry partners to facilitate the spread and adoption of technology in new clinical pathways. CORONAVIRUS RESPONSE

During the first wave of the pandemic, we came together with industry partners to quickly find alternatives to face-toface appointments and supported local healthcare services to accelerate the roll-out and uptake of online patient triage and remote consultations in GP practices. This helped control infection rates by supporting social distancing and protecting vulnerable groups and staff, as well as helping manage workforce pressures. During the second wave, we built on this knowledge to further support frontline services with spread and adoption of remote patient monitoring. AHSNs supported the roll-out of in-home oximetry devices with the ‘COVID Oximetry at Home’ initiative1, a care pathway that uses oximetry (measuring blood oxygen levels) to monitor and identify rapid patient deterioration at home. This approach has been linked to reduced mortality, shorter stays in hospital, and fewer patients requiring intensive care admission and ventilation. It’s now recommended by the World Health Organisation (WHO) as part of a package of care2 .

FROM THE BOTTOM UP

LOOKING FORWARD

As a clinical academic and NHS stroke physician, I’ve dedicated my career to the spread and adoption of innovation. I’ve seen first-hand the vital role that new stroke care pathways and therapies have played in improving patient care and outcomes. But I also recognise that spreading change across the NHS can be a slow process. Seeing the importance of rapidly acting on evidence and research brought me to the AHSN Network when it was conceptualised in 2013. I wanted to see the benefits of research getting to patients quicker and help the NHS adopt evidencebased treatments more rapidly. When I completed my training in geriatrics and clinical pharmacology in the early 1990s, there wasn’t any co-ordinated stroke care, or an evidence-base in acute or rehabilitation stroke care to inform best care delivery. I established an acute stroke unit and rehabilitation ward and began undertaking research with potential novel treatments. It’s now clear that the evidencebase created in the 1990s and 2000s on the prevention and acute treatment of stroke has had a substantial impact in reducing death and disability across the NHS. Working with the North Eastern Ambulance service, I developed a rapid ambulance protocol to enable people with a suspected stroke to be taken to our specialist unit, bypassing hospitals without dedicated teams. We also developed the Face Arm Speech Test (FAST) to help paramedics diagnose stroke, which is now used around the world to increase awareness of the warning signs of stroke. These early service innovations became key elements of the subsequent English stroke strategy. Using a ‘bottom up’ approach where new models of service delivery are developed and evaluated, then rolled out more widely with clinical leadership support is a core element of how the AHSN Network spreads innovation across the NHS. It was key to our coronavirus response and will be vital as we support the NHS to build out of the pandemic.

Building out of the pandemic, the NHS will need to work in different ways. Patient backlog and major workforce capacity challenges will need to be managed through maximising opportunities for patients to self-manage conditions and receive remote support. As an AHSN Network we need to identify, evaluate and maximise these approaches, which can often provide better outcomes than traditional methods involving face-toface appointments in primary care. Drawing on experience from the ‘COVID Oximetry at Home’ pathway, we are working on a programme to help primary care teams manage large numbers of people with hypertension. In blood pressure monitoring we’re seeing self-management with guidance and support from primary care showing better blood pressure control than through traditional routes. It’s about empowering people with their own care and ensuring support from healthcare professionals is there when needed. In Oxford AHSN, we’re looking at how we can use the opportunities that arise when people attend coronavirus vaccination clinics to undertake cardiovascular health checks, as this presents a unique opportunity to see nearly all adults. The Network is using a similar approach to deliver a pilot to screen all children across England during their routine immunisation appointment for elevated cholesterol levels and early diagnosis of familial hypercholesterolaemia, as part of our Lipid Management and Familial Hypercholesterolaemia national programme³. There’s a need and a willingness of the NHS to adopt new ways of working to deliver high-quality care. We’re committed to supporting this challenge through the adoption and spread of world-class research and innovation. Professor Gary Ford is Chair of the AHSN Network and Chief Executive of Oxford AHSN. References 1.https://www.ahsnnetwork.com/covid-oximetry 2. https://www.who.int/publications/i/item/WHO-2019-nCoVclinical-2021-1 3. https://www.ahsnnetwork.com/about-academic-health-sciencenetworks/national-programmes-priorities/lipid-management-and-fh/ child-parent-screening

M AG A ZI N E | AU T U M N 202 1 | 21

g n i y a L s d a o new r A look at the UK’s post-Brexit route to market WORDS BY

22 | P H A R M A FI EL D.CO.U K

Claudia Rubin

t is hard to imagine what Brexit might have brought if it weren’t for the pandemic. However, five years on from the UK’s vote to leave the European Union (EU), we can take stock of what Brexit has meant for the life sciences industry; whether our hopes or fears have been realised and where the industry should turn its gaze to from here. The new Life Sciences Vision, published by the government in July, is the third iteration of the UK’s strategy and is emphatic about how critical the industry is to the future of UK plc. It also presents the strongest case yet, not only for how essential it is for the economy, but also how intertwined it is with transforming the health, and healthcare, of the nation. Unquestionably, the biggest tangible life sciences success attributed to Brexit is the Covid-19 vaccination scheme. The

INSIGHT

rapid roll out of vaccines has made household names of the likes of Pfizer and AstraZeneca. The celebration of the vaccine programme’s Britishness – in the science, the commercialisation and in the rollout – has certainly served to paint a picture of what post-Brexit Britain can achieve. In reality, Britain’s vaccine programme was not a by-product of Brexit. The UK could have gone its own way as a member of the EU, as well. It is not because of Brexit that the UK was able to procure its own vaccine supplies.1 However, arguably the vaccine scheme has illustrated the real and tangible benefits of reclaiming sovereignty over our medicine regulations, clinical trials, approvals and procurement. It is certainly the best, if not the only, visible example of this impact so far, though that is the crux of the problem; to date, we have little evidence of meaningful step-change from anywhere else. Taking a critical look at the three major stages in medicines and medical technology access – clinical trials, licensing and reimbursement – leads us still to conclude that the jury is out, at best, as to whether the UK is turning Brexit into a transformative opportunity for access to healthcare innovation for UK patients.

ON CLINICAL TRIALS

The last 18 months of Covid trials have shown what is possible if we move with great agility. Building on these experiences to be more dynamic and using more digital technology in research delivery features strongly in the Life Sciences Vision, which sets a goal for the UK to be ‘the leading global centre for innovative research design and delivery’. However, a very real and ongoing issue for many scientific institutions is the PhD student brain drain; straining human resources and hampering research for over five years now. With further uncertainty surrounding the postBrexit immigration system, the renewed positivity underpinning our clinical trial infrastructure remains somewhat hindered. ON REGULATION

Another perceived strength of postBrexit Britain is in our ambition to become a global regulator of choice for the rapidly growing digital health sector, as well as transformative pharma and medical technology. The Medicines and Healthcare products Regulatory Agency (MHRA) has implemented some welcome post-Brexit reforms, signalling both its intention, as well as some practical steps, through the new Innovative Licensing and Access Pathway (ILAP) pathway, to bring innovative products through the licensing process faster. The MHRA also has the intention of attracting a wider variety of biosimilar products through accelerated UK market entry, prior to the European Medicines Agency (EMA) process. The difference here is not so much about timelines – for these are broadly similar – but rather less burdensome efficacy trial data and an acceptance of real-world evidence. Therefore, whilst the regulatory approval timelines are very similar, the less demanding MHRA process can offer a route to market that may involve significantly lower investment on behalf of the submitting company. But a comprehensive new regulatory regime, for which the scene has been set by the new Medicines and Medical Devices Act, is yet to unfold. Undoubtedly, the additional administrative burden from new regulatory frameworks, the need to track changes to legislation between the EU and the UK, monitoring the Northern Ireland protocol, as well as the new Trade and Cooperation Agreement, will all need to be offset by some tantalising incentives for pharma. M AG A ZI N E | AU T U M N 202 1 | 2 3

INSIGHT

“

There is no shortage of innovative ideas, entrepreneurial clinicians or promising pilots across the NHS, but successful adoption and scale at a national level remains a key weakness

” ON REIMBURSEMENT

The third piece, the one that would truly lift the UK above its competitors in this sector, is whether we can leverage the gift to innovation uptake presented by our National Health Service; finally realising the promise of the NHS developing into the world’s largest testbed for life science innovation. Traditionally uncomfortable bedfellows, the pandemic has demonstrated emphatically the necessity of a truly symbiotic relationship between science and healthcare. There is no shortage of innovative ideas, entrepreneurial clinicians or promising pilots across the NHS, but successful adoption and scale at a national level remains a key weakness. After all, it is only when innovation becomes standard of care, that transformative healthcare makes a real difference to patients’ lives. Without a realistic prospect of widespread reimbursement, a world-leading trials infrastructure that feeds into an efficient licensing pathway becomes rather a road to

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nowhere if rapid reimbursement remains elusive and the UK health system and its patients fail to benefit. Since Brexit, some proposed developments such as the Innovative Medicines Fund, the reforms from the National Institute for Health and Care Excellence (NICE) Methods Review, a firmer framework for commercial agreements and conditional approvals do offer some promise. They point towards a recognition that we will be unable to realise the benefits of a sovereign regime, if companies are put off from launching products here. But these iterative developments do not go far enough and have been subject to much delay. Being outside the EMA is still a real risk, and anecdotally at least, it instinctively feels that the UK’s position as a priority market is still questionable. A deeper look at the evidence around this would be welcome. The new Life Sciences Vision tackles this

T OP 5 TA K E AWAY S

1. The jury is out as to whether the UK is turning Brexit into a transformative opportunity for access to healthcare innovation for UK patients. 2. The Life Sciences Vision sets a goal for the UK to be ‘the leading global centre for innovative research, design and delivery’. 3. The new Innovative Licensing and Access Pathway (ILAP) pathway aims to bring innovative products through the licensing process faster. 4. Covid-19 pandemic has demonstrated the necessity of a truly symbiotic relationship between science and healthcare. 5. A highly aligned clinical trials, licensing and reimbursement programme is essential to seizing the post-pandemic opportunity. weakness in our value chain, with the promise of creating a task force to address the structural ‘scale-up and adoption’ problem head-on, but bold thinking, akin to the establishment of NICE and the National Institute for Health Research (NIHR), 20 and 15 years ago respectively, is still lacking. If we are to seize the post-Brexit, postpandemic opportunity, we need a highly aligned clinical trials, licensing and reimbursement programme that will do justice to the raft of exciting and novel advanced therapies and digital health technologies making their way into the world’s advanced healthcare systems. Claudia Rubin is Senior Director at Newmarket Strategy. Go to www.newmarket-strategy.com References 1. https://ukandeu.ac.uk/explainers/the-eu-vaccine-programme/

A DV ERTO R I A L

BRAND PLANNING As the Health and Care Bill begins its journey through parliament, how will structural changes to the NHS landscape influence brand planning within pharma companies? WO R D S BY Oli Hudson

arlier this summer, the government introduced the Health and Care Bill in parliament. It confirms much of the detail in the original White Paper and begins the process of putting the changes being made to the structure and governance of the NHS on a statutory footing. NOTHING WILL BE QUITE THE SAME

The proposed legislation marks out a series of departures from a consensus around how the NHS operates that stretches back to the 1990s. The substance of these reforms is well-known, though the full implications for industry are still being grasped. In place of the provider-commissioner split, there will be integrated care systems (ICSs), and in place of competition and tariff-based funding, there will be a new generation of networks, governance structures and relationships – all designed to foster collaboration across health organisations. For pharma, this means that nothing will be quite the same again – not least when it comes to brand planning, which must now rapidly adapt to some significant changes to access arrangements and decisionmaking across the NHS landscape. THREE DIRECT IMPLICATIONS FOR PHARMA RECONFIGURING ENGAGEMENT STRATEGIES

The first involves recognising the reality that healthcare professionals (HCPs) in provider organisations will increasingly be making collective purchasing decisions at a system level. It will therefore no longer be enough to zero in on a select group of favourable key opinion leaders (KOLs) to maintain your market position. The modus operandi for engagement and customer relationship management will need to broaden – not just consolidating support of your advocates, but influencing a wider selection of decision-makers across a system.

ADAPTING AND OPTIMISING COMMERCIAL OPERATIONS

Second, the reforms involve a significant move towards greater integration at three levels – system, place and neighbourhood – which will present a major organisational challenge to pharma companies. Organising field teams around outdated territories, or basing engagement around ‘hospital specialisms’ is unlikely to mesh effectively with the changing pattern of decision making across the NHS landscape. There is a training challenge, too, in terms of enabling cohorts of pharma staff to manage engagement at system, place and neighbourhood levels, and to get under the skin of the context in which these new decision-making units operate.

Your territories are shifting Develop intelligence-driven customer segmentation and resource optimisation strategies

A MORE LAYERED APPROACH TO MARKET ACCESS

A third critical issue involves the new structure and composition of formularies. We are starting to see a considerably more layered, complex environment for market access, with ICS formularies at system level and ICP formularies making decisions at place/neighbourhood level. Regional Medicines Optimisation Committees, operating at a level above system, will also issue voluntary guidance that may influence local decision-making. Understanding the composition of these formularies and the context within which they make decisions will therefore become an increasingly important part of developing a go-to-market strategy. Oli Hudson is Content Director at Wilmington Healthcare. Find out how it supports brand planning and commercial optimisation by visiting www.wilmingtonhealthcare.com/ commercial-optimisation

Find out more at: wilmingtonhealthcare.com /commercial-optimisation

M AG A ZI N E | AU T U M N 202 1 | 2 5

PATIENT MANAGEMENT IN A DIGITAL WORLD How has the COVID-19 pandemic influenced the way the NHS engages with and manages patients? WO R D S BY Sam Grove

t is well established that the COVID-19 pandemic accelerated the digital evolution of the NHS by years in a matter of weeks, resulting in unprecedented changes to the way it delivers patient care, and demonstrating what is possible when there is a true sense of urgency. What has emerged out of this reimagination of service delivery is a radical change in patient engagement, which, though dramatic, has led to new ways of thinking and opened opportunities for the NHS to explore how patients may be managed in the long-term. There is a quest for proactive patient management as the NHS ultimately drives towards a fully integrated digital platform. Dr Graham Mennie, GP at Cheltenham’s Sixways Clinic, says: “We’ve been using COVID-19 as an enabler, because I’m seeing the process of change which I’ve been pushing for, for years. Things that I’ve wanted to do that have taken three years are now taking three weeks.” There is no doubt that progress has been made, but healthcare professionals (HCPs) are now faced with a dilemma as this new digital relationship is set to last: how to continue to deliver patient care and meet expectations as they become increasingly more involved in

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their own treatment, while navigating the historic hurdles of clinical system interoperability issues. CLINICAL SYSTEMS

Pharma has made great strides to adapt to the changing environment in which their NHS customers work, but what else can the industry do to support the changing needs of their customers? Pharma has a real opportunity to help the NHS to develop clinical system solutions to support improvements in the way patients are managed. Better management of the patient journey, using the clinical systems and NHS processes, provides a platform for HCPs to make better-informed decisions, leading to improved outcomes in patient care, while supporting the NHS on their journey towards becoming a truly digital organisation. When COVID-19 struck, face-to-face GP appointments shrunk by 33% between March and April 20201, and 99% of practices switched to ‘partial’ or ‘total triage’2, using remote consultation to assess patients before offering appointments to reduce risk, but also as one of the goals of The NHS Long Term Plan. Dr Mennie says: “COVID-19 made an overnight change to the way that we consult, both in Primary and Secondary

Care. Patients initially access our surgery now via phone calls, video calls and e-consult. Everything initially is remote. We still, of course, see patients face-to-face when clinically appropriate and have been doing so since the start of the pandemic, despite media stories to the contrary.” A 2020 BMA survey 3 suggests 88% of GPs want remote consultations to stay, and from a patient perspective, 79% 4 surveyed in a September 2020 study also want remote consultations in the future, with 90% saying they were happy with the care received. In addition, 40% of respondents to an April 2020 poll by NHS England said they avoided contacting their GP practice for a face-to-face appointment due to concerns about adding to an already stretched NHS5 . Diagnoses were consequently down in 2020. Analysis of GP records in a Salford study6 revealed diagnoses of conditions including cardiovascular issues and mental health problems last spring were 50% lower than was expected. ONGOING MANAGEMENT

Writing in The Lancet, first author of the research from the NIHR Greater Manchester Patient Safety Translational Research Centre, Richard Williams, said: ‘It is not unreasonable to assume this is also

A DV ERTO R I A L

“Pharma has made great strides to adapt to the changing environment in which their NHS customers work, but what else can the industry do to support the changing needs of their customers?”

happening across the country […] There are going to be people […] who were just afraid, and not going to a healthcare setting for fear of catching coronavirus’. While patient footfall has decreased throughout periods of lockdown, there still remains a large number of patients within an HCP’s caseload who require ongoing management, especially those with chronic conditions who may be at risk. This is where the true value of patient identification and mobilisation of care pathways come into their own – providing the NHS with the opportunity to reach out to those patients who need it most, as well as delivering pharma a chance to support the NHS in developing innovative healthcare solutions. At Star OUTiCO Healthcare Solutions, we utilise the knowledge we gain from working in the NHS to develop solutions that enable HCPs in primary care to proactively manage at relevant touch points along the patient journey. Optimising the use of clinical systems and NHS processes, our solutions not only support HCPs to identify and manage patients within the capacity they have available, but also enable them to make better-informed decisions, through the mobilisation of care pathways. Through the intelligent configuration of those clinical systems, Star OUTiCO’s Patient Identification & Management

solutions allow HCPs to identify patients who may benefit from a review of their condition, their medication, or a referral to a specialist service. Where there is that requirement, we work with the NHS to ensure that the patient journey is seamless, using NHS processes and systems to underpin it. This digital interaction to drive the patient journey is where clinical systems that are centred around patient identification and care pathways can support. Our solutions not only provide a platform for improved access to medicines and specialist services, but they also provide HCPs with the means to communicate with patients to drive adherence with their treatment and support patient education. Dr Mennie says: “With our suppliers, we’re really looking for them to partner with us in the new ways that we work. We’re looking for remote self-management of patients, so we need our suppliers to think and work in a completely different way that reflects the journey that we’ve taken.” The NHS are forging ahead in evolving how they use the systems available them to manage patients: how are you planning to evolve your relationship to join them on their journey, as we head towards a fully digital NHS?

Head over to www.pharmafield.co.uk to watch the free webinar series from Star OUTiCO and Pf Media on demand; exploring the role that pharma can play in the NHS recovery, following Covid-19.

Star OUTiCO Healthcare Solutions offer a comprehensive range of solutions that leverage our clinical systems understanding, which include Intelligent Systems Insights Workshop & Consultancy, Patient Identification & Management, Care Pathways & Formularies Solutions and Transfer of Care. We are the long-term partner of choice for many in the market. For more information, visit www.‌s taroutico.com Sam Grove is Client Service Implementation Manager, Healthcare Solutions, Star OUTiCO. References 1. GP Appointment Publication, Sept 2020 2. The impact of Covid-19 on the use of digital technology in the NHS, Nuffield Trust, Aug 2020 3. ‘BMA Covid-19 tracker’, British Medical Association (2020) 4. Patient Experience of Remote Consultations during the COVID-19 Pandemic, Oxleas NHS Foundation Trust 5. w ww.gponline.com 6. Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study, The Lancet

M AG A ZI N E | AU T U M N 202 1 | 27

WHAT IS A PATIENT TREATMENT PATHWAY?

WORDS BY

Emma Morriss

t a time of immense change for the NHS, pharma has a role and responsibility in supporting this. As the NHS looks to keep patients out of hospital, reduce waiting lists and the number of times patients attend hospital whether for treatment, testing or drug administration, it’s important to have a clear, appropriate and best practice-based patient treatment pathway or journey. Covid has empowered patients to take more control of their health and shifted care into the community and at home, wherever possible. This change needs to be reflected in treatment pathways, to understand patients’ healthcare touchpoints, the journey they take and the time it takes at each stage.

A patient treatment pathway is a best practice journey for the patient to receive appropriate treatment for their health needs. It should be evidence based and draw on expert opinion from all stakeholders, including patients or support group representatives. For the pharmaceutical industry, mapping the patient treatment pathway gives you the tools to plan your marketing strategy by focusing on those services and patients that are most appropriate and understanding how patients move through their treatment pathway and who they interact with along the way. For commissioners and healthcare professionals (HCPs), the activity means they can see where a pathway is working, where people may experience delays or drop off and this enables them to address those elements to deliver a quality patient experience. Not only does an efficient patient treatment pathway benefit the individual, industry and healthcare it also aligns with policy to improve quality and deliver safe, effective, person-centred care in a timely manner. MAPPING THE PATHWAY

In order to consider pathway improvements, you need to understand the existing patient journey. To do this, it’s necessary to gather relevant information from the most appropriate stakeholders. During this process you can identify improvements that will lead to creating the ideal pathway. First, identify your stakeholders. These can range from primary and secondary HCPs, commissioners and budget holders, patients or patient support groups, pharmacists and ancillary staff who interact with patients across the pathway. Getting a good representation of people to input into the

pathway map will ensure the journey is considered from all angles. Engaging all these people can be logistically difficult, but it pays dividends not only in identifying areas of improvement, but also in creating co-working relationships to move to pathway improvement as a collective. An independent facilitator can undertake the administrative elements to bring all relevant parties together as well as run the event to ensure all voices are heard and the process is completed comprehensively and efficiently. AGREEING THE PATIENT TREATMENT PATHWAY

As mentioned, the first step to improve the patient pathway is to identify each stage in the existing journey. You can’t improve what you don’t know. There shouldn’t be too may stages here and it needs consensus, but consider: • Where does the patient start their journey? • Does it start with their call to the GP surgery or a referral? • What prompts patients to seek help and who do they seek it from? • Who interacts with them; receptionist/ phone triage? • Do they visit the pharmacist for advice? • What information or resources can they access? • Where do they go following GP contact? • Do some patients go straight to A&E and bypass primary care? • O nce in secondary care, where do they go? • What treatment do they receive? • Where does the journey end? You can map the answers graphically or as a flowchart, using directional arrows to show how the patient moves through the stages.

IMPROVING THE

patient treatment pathway A clear, appropriate and best practice-based patient treatment pathway is crucial. Explore how to review an existing pathway to identify improvements. 2 8 | P H A R M A FI EL D.CO.U K

INSIGHT

#WeAreE4H

Once you have a draft patient pathway, consider how many steps there are and how much time each step takes

DELVE INTO DETAIL

Once you have a draft patient pathway, consider how many steps there are and how much time each step takes. How long are patients waiting for an appointment or a referral? Is a patient referred multiple times? Is this required? Add these to your map to build up a picture of the typical timescale. Alongside exploring timescales, you also need to examine and note down the tasks involved. These can include: • Who undertakes which tasks? • Where common errors lie • Which tasks are necessary, or repeated? • O utputs for each stage • The correct order for tasks to avoid • Patient experience errors or repetition • Performance against targets.

REVIEW

You now have a typical treatment pathway with input from all stakeholders. You have examined all elements, identified time taken and potential sticking points. You now need to review the diagram to help identify improvements to create the optimal treatment pathway. Consider whether a patient on the typical pathway is receiving timely and appropriate care. Could they have been diagnosed quicker? Treated quicker? Look at where there may be sticking points, such as: • A re some steps taking too long? • A re there gaps in HCP training? • A re people being referred quickly • A re tasks being repeated? enough or correctly? • A re the outputs timely • Is there a lack of information for and appropriate? patients to seek help? • Is communication sufficient? • A re they presenting at A&E? Now categorise these into quick fixes that can be addressed easily and immediately. This might be improving communication, training, streamlining data collection, or combining tasks. Decide who is best placed to make these quick fixes and task them accordingly. For larger, more system-wide changes, schedule a follow up meeting with the appropriate stakeholders to discuss the next steps to implementation. By crystallising the current patient treatment pathway, identifying improvements, and implementing them, you will create an efficient treatment pathway, with the backing of all stakeholders, which ultimately improves patient care. Emma Morriss is Head of Marketing Operations at E4H. For expertly facilitated patient treatment pathway workshops, call E4H on 01462 226126. www.e4h.co.uk #WeAreE4H

References 1. How NHS funding and finances are changing patient pathways https://pharmafield.co.uk/opinion/funding-arrangements-finances/ 2. Negotiating the changing NHS landscape: five critical shifts the pharma industry must embrace https://pharmafield.co.uk/spotlight/ negotiating-the-changing-nhs-landscape-five-critical-shifts-the-pharma-industry-must-embrace/

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TRANSFORM YOUR MARKETING TODAY www.e4h.co.uk 01462 226126

M AG A ZI N E | AU T U M N 202 1 | 2 9

Parting c mpany Exploring spin-offs as a strategic option WORDS BY Paul

Riley and Mark Davies

n the pharmaceutical and medical technology sectors, the number of new companies being spun out of existing companies is on the rise. Recently, global medical technology company BD announced its intention to spin off its Diabetes Care business as a separate company. Shortly before that, bluebird bio announced it would be spinning off its cancer assets into a new company, 2seventy bio. And MSD has just completed a spin-off, placing its women’s health, biosimilars, and established brands into new entity Organon. The aim typically of spin-offs is to enhance the value of both the spin-off and parent company in relation to assets, employees, intellectual property, technology, and/or existing products. But how do companies decide when it’s time to spin off part of their business, and what does this involve?

T OP 5 TA K E AWAY S

THE SEARCH FOR VALUE

In 2011, Abbott announced it was to separate into two leading healthcare companies by the end of 2012. One was to be a diversified medical products company – Abbott – and the other a new research-based global biopharmaceutical company – AbbVie. This separation would seem logical; the two companies were quite different with regards to resources and capabilities, and there would appear to be more advantage in them being apart than together. The decision turned out to be the right one, with both companies growing strongly (and AbbVie ensuring ongoing revenues from Humira, historically the highest earning medicine globally). But do spin-offs really enhance value? A recent analysis of spin-off performance focusing on AbbVie, CareFusion,

1. Typical aim of spin-offs is to enhance the value of both the spin-off and parent company in relation to assets, employees, intellectual property, technology, and/or existing products. 2. Spin-offs allow each company to focus expertise and resource allocation on a narrower, more clearly defined strategy and operational business model. 3. Consider a spin-off when brands in the portfolio become less of a priority, leading to a ‘two-speed’ company. 4. Have a clear rationale about where the enhanced growth and margins will come from, both for the spin-off and the parent company. 5. Mitigating risk means focusing on critical success factors important to deriving value from the business, post-spin-off.

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INSIGHT

Mallinckrodt, and SeaSpine found that these companies grew by at least 5% more during the two years after their spin off, compared with the two years prior 1. Not only did the performance of these spin-offs improve, but so did that of the parent company – the parents sustained or grew their profit margins in the year following the separation. This performance improvement may be down to a number of factors, including greater focus on the business2 , which was one of the key intentions behind another high-profile separation – the spin-off of Baxalta from Baxter. Whilst the newly formed business unit leveraged capability and experience in haematology and immunology to successfully build a presence in oncology, the parent company, Baxter, focused on dialysis equipment, IV pumps and solutions, injectable drugs and intravenous nutrition. This allowed each company to focus expertise and resource allocation on a narrower, more clearly defined strategy and operational business model.

REASONS TO SEPARATE

Beyond refocusing businesses, another important reason for considering spin-offs is when brands in the portfolio become less of a priority, leading to a ‘two-speed’ company with high levels of investment and input into some business units, and relatively low levels in other units. This, in time, can lead to stagnation in those units with revenue drop-off and demoralised teams. In a press release addressing the spin-off of Organon from Merck (known as MSD outside the United States and Canada), Rob Davis, President of Merck, said that it allows the parent company to become, “a leaner, more focused and agile company”. Also quoted was the CEO of Organon, Kevin Ali, who described Organon’s portfolio as consisting of, “many well-known products that were once core to Merck’s business but have since strategically received limited resources and investment”. He added that Organon believed its portfolio would be, “responsive to commercial investment.”

M AG A ZI N E | AU T U M N 202 1 | 31

INSIGHT

So, should a business spin-off be a strategic option for your company? If the performance of your organisation is hampered by a lack of focus, competing priorities, operational inefficiencies, or one of many other reasons, then maybe a spin-off is an appropriate option. You will need a clear rationale about where the enhanced growth and margins will come from, both for the spin-off and the parent company. And whilst achieving that may sound daunting, there is a cohort of pharma companies that have been through the process successfully. Even if now doesn’t seem like the right time to spin off, exploring it as a strategic option means you are better prepared when the time comes. IMPROVING THE CHANCES OF SUCCESS

Perhaps buoyed by the many positive examples of pharma spinoffs over the years, companies are seeing the spin-off model as an important and potentially lucrative strategic option. However, based on evidence from other sectors, spin-offs are not without risk, including business failure, unpredicted costs and negative staff reaction where high performing employees are lost to other companies. Mitigating against these risk factors means focusing on critical success factors important to deriving value from the business, post-spin off. Early activation of the new business strategy prior to spin-off is one example of how businesses can manage risk – the new way of working whilst still within the parent company helps ensure the spin-off is fit-for-purpose when becoming a standalone entity. Also helpful is the adoption of benchmarks and key performance indicators more aligned to those used by ‘target’ peers rather than the parent company. Early consultation and collaboration with staff and suppliers are also key factors in future-proofing spin-offs. A more technical area to consider is that of intellectual property, such as the importance of clearly dividing patent rights and applications between the two entities. Again, preparation is key. As Robert Watson, Patent Attorney at Mewburn Ellis notes, “spinning out an entity will bring a detailed due diligence process, including of the intellectual property. This process can be made much simpler by preparing for this in the same way as any intellectual due diligence, ie. checking everything is in order well in advance!”.

“

Early consultation and collaboration with staff and suppliers are also key factors in future-proofing spin-offs

”

SPIN-OFFS AS A STRATEGIC OPTION – THREE SIMPLE RULES

Actively considering a spin-off may be a valuable aspect of your strategic review process. Reflecting on lessons from others in the pharma sector will certainly enhance your strategic thinking. To support your thought process, here are three ‘simple rules’ to equip you and your colleagues to undertake an initial review of whether a spin-off would be a prudent option:

Challenge your organisational structure: consider the examples of spin-offs in your therapy areas of interest and look at whether the advantages they have obtained could be achieved by spinning off part of your business, such as refocusing the business or reinvigorating disinvested product lines. Identify the risks of spinning off part of the business: although there are plenty of positive examples, a successful spin-off is the result of thorough analysis, careful planning, and meticulous execution. It should not be attempted unless the business case is clear and the strategy is realistic and achievable. Consult widely: you may have the best understanding of your part of the business, but you will not necessarily have the best understanding of the opportunities that could be realised by pursuing a spin-off. Ensure you gather insights and opinions from colleagues in different functions across the business, and even beyond, with trusted stakeholders outside the company. Paul Riley is Medical Affairs Director at Glasshouse Health. Go to www.glasshousehealth.com. Mark Davies is an NHS Consultant and Director of Res Consortium. Go to www.resconsortium.com

References 1. McKinsey (2019) Divestiture in medtech: Are you the natural owner of your businesses? 2. Vantrappen & Polastro (2015) How to Know If a Spin-Off Will Succeed. Harvard Business Review

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MOVERS & SHAKERS

Movers &Shakers HEALTHCARE

WHO’S ON THE MOVE IN THE INDUSTRY? WORDS BY

Emma Cooper

AGENCY

Dr Dennis Langer & Professor Ken Herrman

Theragnostics, which is developing molecular radiotherapy for imaging and treating a broad range of cancers, has announced the appointments of Dr Dennis Langer and Professor Ken Herrmann as Non-Executive Directors to its Board. Dr Dennis Langer has served as a director of both public and private biotechnology, pharmaceutical and diagnostic companies, and has an extensive pharmaceutical company background. Professor Ken Herrmann is Chair of the Department of Nuclear Medicine at the Universitätsklinikum Essen in Germany. Among his many achievements, he is a world leading expert in the clinical development of therapeutic and diagnostic radiopharmaceuticals.

PHARMA

Dr Caroline Austin

Cambridge-based clinical analytics company Qureight has announced the appointment of Dr Caroline Austin, vice-president and head of business development transactions at the pharmaceutical company AstraZeneca, as its first non-executive director (NED). Qureight CEO Dr Muhunthan Thillai said: “Caroline's in-depth understanding of the pharma industry will be invaluable to ensure we maximise the value our technology can bring to the next generation of clinical trials.”

Onyx Health

Healthcare marketing communication specialists Onyx Health have made six new appointments to their rapidly expanding team since the last lockdown. The new additions to the team include Senior Designer Anabel Dakin, Business and Finance Manager Beth Kerrigan, Senior Marketing Communications Project Manager Suman Kaur and Marketing Communications Project Managers Sophie Ferguson, Adrian Flanagan and Jake Dickens. Annabel previously worked for NHS England, Beth is a qualified accountant and Suman is a marketing expert who previously worked for the agency, Cool Blue. Sophie is a former Brand Manager for a pharmaceutical company; Adrian provided communications for the NHS, and Jake previously worked for international battery company Energizer.

PHARMA

Laura Steele

Eli Lilly & Company has appointed Laura Steele as President and General Manager (GM) for UK, Ireland & Northern Europe. Laura succeeds Ashley Diaz-Granados and will lead Lilly’s commercial business operations in six countries, across the company’s current and emerging portfolio in Diabetes, Oncology, Immunology and Neuroscience. She brings 18 years’ experience with the company to her new role and joins from Lilly’s Corporate Business Development division in Indianapolis.

M AG A ZI N E | AU T U M N 202 1 | 3 3

The palm tree & the pine Tech-enabled pharma marketing strategies

alm trees bend and sway in hurricane-force winds that could topple an oak or crack the trunk of a sturdy pine. There’s a lesson here for biopharma marketers during the planet-wide hurricane that has been Covid-19. Flexibility in the face of uncertainty is essential – especially as we transition to a new world of omnichannel marketing and tech-enabled field representatives. The takeaway is selfevident: be the palm tree, not the pine.

As marketing engagement turned virtual in the early days of the pandemic, the rush into remote calling, webinars and other modes of digital outreach seemed to support a broader push toward omnichannel, as conventionally described. In one sense, this was appropriate. A plethora of new tools enable us to look at healthcare professionals (HCPs) holistically, analyse how they interact with digital media, measure each impression and assess preferences with the help of behavioral science.

Table 1: HCP PREFERENCES AROUND VIRTUAL CALLING

28%

Willingness to engage remotely with field staff 16%

Utilising more web based materials

51%

Still prefer traditional F2F calls when possible 22%

Virtual calls offer poor value contents Need for more flexible platforms/apps when connecting virtually

28% 16%

Virtual calls get straight to the point Virtual calls are more flexible around my time availability

42% 21%

Virtual calls have greater focus on contents 0

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INSIGHT

In the same way that brands in Europe must secure permission to engage with any customer, via any channel, we also must embrace the heterogeneity of our client base CUSTOMISING DIGITAL ALTERNATIVES

WORDS BY

Ewan Cuthbertson

Under the banner of non-personal promotion (NPP), representatives can also extend their brands through tailored one-to-one experiences, both face-to-face and virtual. Marketing automation platforms like Salesforce, meanwhile, can help the representative increase a sense of personalisation without an in-person presence. The trouble is, Covid-19 gave marketers license to pump out untailored, undifferentiated content. Bombarded by noise throughout last summer, European HCPs began to withdraw permission for marketing engagement. Not just digital outreach – any kind at all. This is the rough equivalent of an oak tree crashing on a power line. It’s exactly the outcome omnichannel aims to avoid.

TOP 5 TA K E AWAYS 1. Flexibility in the face of uncertainty is essential. 2. The march toward tech-enabled field forces and omnichannel must be nuanced and flexible. 3. Digital content and algorithmically enhanced channels should amplify messaging, not replace it. 4. Heterogeneity and hybrid experiences will be key going forward in Europe. 5. Be the palm tree, not the pine.

Table 1. Data extracted from survey conducted by Syneos Health in October 2020. Survey designed to explore HCP attitudes and experiences of promotion channels during the pandemic and beyond. 493 European hospital specialists responded.

In Europe, perhaps more so than in the U.S., the march toward tech-enabled field forces and omnichannel-everything must be nuanced and flexible. In the same way that brands in Europe must secure permission to engage with any customer, via any channel, we also must embrace the heterogeneity of our client base. Even at the height of the pandemic, many HCPs still preferred face-to-face over any digital modality. When this is not possible, the onus is on the marketer to customise digital alternatives for each engagement based on known preferences of the content recipient. Market research by Syneos Health® strongly supports this approach. Last October, we surveyed European HCPs on their preferences toward promotion channels during the pandemic and beyond. Of nearly 500 respondents, fully half said they prefer face-toface calls when possible. But, in almost equal numbers (42%), they approved of the flexibility around virtual calls with regards to time availability. On the minus side, just 16% said they were utilising more web-based materials. Do virtual calls get straight to the point? Again, only 16% said “yes.” Digital content and algorithmically enhanced channels are useful when they amplify welldesigned, calibrated messages. They cannot serve as a replacement. Missing this point, you may find yourself in the awkward position of inviting an HCP to join your Zoom meeting, not realising the state-run health system prevents her from downloading the app. Or...you have gone to the trouble of optimising your digital service for Google Chrome, unaware the local health system bans the use of this browser. Now that Covid-19 vaccines are available, everyone is looking to regain some footing in a radically altered environment for biopharmaceutical marketing. However that continues to play, Syneos Health believes that the future will not pave over the past. Heterogeneity and hybrid experiences will be the game in Europe. Even in a calmer climate, we will sing the praises of the graceful palm. Ewan Cuthbertson is Senior Vice President, European Deployment Solutions at Syneos Health. Go to www.syneoshealth.com

M AG A ZI N E | AU T U M N 202 1 | 35

CAREERS

Pf talks to Paul Steckler, Managing Director Europe of Canopy Growth Corporation. INTERVIEW BY Emma

Cooper

Tell us about the roles that led you to Managing Director? I’ve always had a passion for understanding and supporting health and wellbeing, starting with me studying the things that cause us to be unwell. I graduated from the University of Warwick with a degree in microbiology and virology. I then started a 15-year career with Pfizer as a sales representative and progressed to Commercial Director, growing specialty brands and anti-infectives from pre-launch to loss of exclusivity. In 2015, I joined Shield Therapeutics as Chief Commercial Officer where I supported a successful IPO for the company, while simultaneously leading global commercial operations for their lead product to treat iron deficiency. I was then drawn to the cannabis industry and started my journey as Chief Operating Officer of the medical arm of the business, before becoming Managing Director for Canopy Growth in Europe and the UK. I am also leading the growth of our medical and consumer-focused brands in Latin America and the Asia-Pacific region. What do you enjoy about being a Managing Director? Leading an ambitious and talented team who are working hard to improve patients’ lives by unleashing the full power of cannabis is what drives me each day. My colleagues have a vested interest in our mission, which makes my role in bringing people together to achieve a common goal that much easier.

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How would your team describe you? I believe my team would see me as hard-working, inclusive and an innovative thinker. What inspired you to work in the field of medical cannabis? I started to see the impact of medical cannabis on the lives of people around the world, including some close friends – I truly believe these medicines bring value to patients who have no other treatment options or have been let down by their current standard of care. So, when Canopy Growth approached me, it seemed like a natural next step, and I have never looked back! How have you seen the industry change over the years? I feel lucky to have witnessed a dramatic shift over the past several years, where individuals and healthcare professionals are increasingly seeing medical cannabis as a viable treatment option, especially for those struggling with unmet medical needs. As an industry, we have an incredible opportunity to support this continued

CAREER CLOSE-UPS

progress and in doing so, we can transform the way that people understand and experience this powerful plant. What is the best piece of career advice you have ever received? Do what you’re passionate about and stick to your values, nothing else matters. What is the biggest challenge you have faced in your career? I’ve been fortunate enough to bring my pharma experience to the industry, however a brand-new industry brings brand-new challenges. We continue to face barriers due to stigma and restrictive regulations of medical cannabis, but we’re making important progress. Do you have any rituals or habits that help you have a productive day? I have a short list of key things that I need to achieve and let nothing else get in the way (with exceptions of course). I also take time to refocus when faced with a barrier – even a short walk can help give me a new perspective.

Interested in more career close-ups? Head over to www.pharmafield.co.uk for our regular feature.

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