Pf Magazine July 2019 by E4H Ltd

SPECIAL EDITION

PATIENT CENTRICITY “We are entering an exciting new world of true patient centric care and personalised medicine” Page 04

JULY 2019

Patient centricity & NHS sustainability Engaging patients earlier Bringing patient centricity to life PHARMAFIELD.CO.UK

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HEAD OF CONTENT

Hello.

elcome to the Pf Special Edition for July. This month, we’re looking at the raison d’être that lies at the heart of everything we do in pharma and healthcare – Patient Centricity. As one of our expert contributors puts it: “Patients are the experts of their conditions”. More than ever, the pharma and life sciences industries and the NHS are realising the value of putting patients at the centre of their care. But how does this mantra of patient centricity play out in real life? How does it translate from words, into action? In the pages of this Special Edition, we explore different ways in which patient centred healthcare is becoming embedded across the industry; why patient centricity is so important to the future sustainability of the NHS and how it fits into the NHS Long Term Plan; whether patients’ views can actually be used at scale, and why telling our people to be patient focused could actually be our biggest mistake. We also hear from two Pf Award winners, including the story of how one MSD Area Lead partnered with paramedics and a diabetes centre in Scotland to provide a comprehensive data-led service to improve the lives of patients with diabetes. It’s the reason why everyone who works in the pharma industry gets up and goes to work – the patient. We hope you enjoy this Pf Special Edition, and if you’d like to comment on anything you’ve read, or have your own stories of patient centric healthcare to share, get in touch at hello@pharmafield.co.uk, tweet us @Pharmafield, or join us on LinkedIn.

Emma Morriss emma.morriss@pharmafield.co.uk SPECIAL EDITIONS EDITOR

Amy Schofield amy@pharmafield.co.uk CREATIVE DIRECTOR

Emma Warfield emma@pharmafield.co.uk GRAPHIC DESIGNER

Olivia Cummins olivia@pharmafield.co.uk COMMERCIAL DIRECTOR

Hazel Lodge hazel@pharmafield.co.uk DIGITAL MARKETING EXECUTIVE

Emma Hedges emma.hedges@pharmafield.co.uk NEWS DESK

Hannah Alderton newsdesk@pharmafield.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

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M AG A ZI N E | J U LY 2019 | 1

July 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

DR MATT COOPER

Dr Matt Cooper is the Business Development and Marketing Director for the National Institute for Health Research’s Clinical Research Network. He leads a team promoting the UK as a destination for both commercial and non-commercial trials. Ask the experts, page 16.

LIZ ASHALL-PAYNE

NAGORE FERNANDEZ

Liz is the Co-Founder and CEO of ORCHA, a live resource for rated and reviewed medical and health care apps. ORCHA believes in a world where health care apps are reviewed, rated and are able to be recommended for use by the public and professionals. Digital therapy, page 22.

Nagore is Head of Clinical Services for Europe at Ashfield. With over 15 years’ experience in the pharmaceutical and health industry, Nagore is responsible for building and executing the strategy for Patient Solutions division in Ashfield for Europe and

Pf Magazine

Canada. She is a highly experienced leader in the area of patient services and engagement. Self care, page 24. JILL DONAHUE

Jill is the creator of ‘The Power of Purpose’, a powerful masterclass that is taking patient centricity off the wall and embedding it into our hearts and hands. She has a dream to lift our entire industry by igniting the power of purpose in each and every person. She is a popular keynote speaker, author and thought leader who has authored two books on engaging in patient-focused ways. She co-founded The Aurora Project, a global patient-centricity group. All in the execution, page 6.

STEVE HOW

Steve is Programme Director for Wilmington Healthcare’s Consultancy Division and has more than 20 years of experience working in the healthcare and pharmaceutical industries. He is passionate about partnership and public engagement with the NHS and sits on the board of one of the new Integrated Care Partnerships as Chair of the Citizens Council. Tailored approach, page 20. LYNN JEGGO

Lynn joined Apodi following 15 years in the pharmaceutical sector. Lynn has had a variety of roles including Head of Marketing. Her role at Apodi now includes being the Care Quality Commission’s Registered Manager and she is

the Operations Director for both healthcare and the commercial business. Driving force, page 18.

In this issue

NEIL MACDONALD

Neil is Area Health Lead for MSD in North and East Scotland, covering market access, patient/population access and project work with the NHS and other healthcare partners in the healthcare sector. HYPO-real, page 12. EMMA MORRISS

Emma is Head of Content at Pharmafield and E4H. She’s an experienced editor and content strategist with a background in health and social care. Double Down, page 14 & The Cost of Constipation, page 26. JAMES ROACH

James is an experienced NHS director who has held roles in hospitals, clinical commissioning groups and in joint roles with social care. He runs Conclusio Limited, developing innovative solutions in health and care systems in the UK and China. Be the change, page 8. HANS SOLGAARD

Hans is Healthcare Director, IQVIA, and is responsible for patient experience and outcomes solutions. Hans has 20 years’ experience in healthcare, having worked for seven years for the NHS (CIO) followed by nine years in UK and global consulting, business development and leadership roles at global blue chip companies before joining IQVIA in 2015. First-hand feedback, page 4. PAUL TODD

Paul is Director of Access Solutions, Apodi. He joined Apodi from GSK where he was the senior director in Customer Solutions. Paul has significant market access experience and knowledge of developing strategies in response to issues driving change for both the pharmaceutical industry and the NHS. Driving force, page 18.

INTELLIGENCE

NHS

First-hand feedback: Working in partnership with patients

Be the change: Creating shared responsibility for healthcare

HANS SOLGA ARD

JAMES ROACH

All in the execution: Bringing patient centricity to life

Tailored approach: Delivering patient centric care in the NHS

JILL DONAHUE

STEVE HOW

INSIGHT

TECHNOLOGY

Ask the experts: Engaging patients earlier in clinical development

Digital therapy: Simplifying health apps for the public

DR MATT COOPER

LIZ ASHALL-PAYNE

Self care: Developing product and patient centric services NAGORE FERNANDEZ

The Cost of Constipation: What is the condition costing patients & the NHS? EMMA MORRISS

IN PRACTICE

Driving force: Building a patient centricity model LYNN JEGGO & PAUL TODD

PF AWARDS

HYPO-real: A Pf Award-winning partnership NEIL MACDONALD

Patients are the experts of their conditions; they are the only people who can truly tell us if we are achieving the right balance

Dr Matt Cooper, page 16

Double down: Ashfield’s Lorna Towndrow, double Pf Award winner EMMA MORRISS

28 Directory

INTELLIGENCE

Although we’ve seen some great leaps in the quality of patient real-world examples of how this data improves healthcare outcomes, data is still very siloed to individual hospitals and other care providers. This makes it a challenge to manage health across populations including primary, secondary and social care and gives patients the impression of a very disjointed experience as they navigate between providers.

WORDS BY

Hans Solgaard

BURNING PLATFORM

FIRST-HAND FEEDBACK DOES BIG DATA DELIVER ON ITS PROMISES – AND WHAT DOES THE PATIENT REALLY THINK?

ver the past 20 years, big data has exploded with larger, more complex and new data sets to analyse and turn into actionable insights. Healthcare is no exception to the rule – the NHS for instance has been collecting Patient Reported Experience Measures (PREMs) and Patient Reported Outcome Measures (PROMs) for the past 10 years but are we getting the full benefit from them?

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

The Secretary of State for Health and Social Care Matt Hancock has announced the launch of NHSX through his Tech Vision, building on the NHS Long Term Plan launched in early 2019. The overall aim of NHSX is to improve health outcomes for patients, free up time for NHS staff to focus on patients, and explore how technology can also help both service users and staff of social care – all through leveraging technology better. Sounds familiar? Is this a re-run of the failed NPfIT programme? Not necessarily; this programme sets out to promote integration and data exchange between existing systems such as EPR, rather than setting about to replace them all with one new system. If a success, this will absolutely help drive improvements, both directly at the frontend for patients and health providers, for instance patients could have a complete view of their end-to-end journey of care through all care givers, and also for more strategic transformation of care and treatments through better analytics based on much richer datasets. LIFE CHANGING DATA

THE PROMISE OF BIG DATA

As recent as the early 2000s, fax machines were heavily relied upon by the NHS and still are to some extent, although they’ve now finally been banned by Matt Hancock. Widely used electronic Patient Administration Systems (PAS), were exactly that; systems used to administrate patient appointments only. PAS have evolved and are now often part of integrated Electronic Patient Record (EPR) systems – with a greater focus on collecting clinically relevant patient data. The much-maligned National Programme for IT (NPfIT) Government initiative, launched in 2002, may not have delivered the panacea it set out to, but the £10bn spent certainly moved digitisation along, with a large number of hospitals adopting EPR and radiology picture archiving and communication system.

The value of this data has also transformed in line with the improved quality and the volume of data collected. Analytics are evolving from basic descriptive reporting on what has happened, to the world of predictive analytics, where machine learning, data modelling and artificial intelligence (AI) techniques are helping to predict the likelihood of an outcome, based on patterns in collected data. This clearly holds a lot of promise in a clinical environment, where early diagnosis and accurate intervention can mean the difference between life and death or at least a speedier positive outcome for the patient. We are entering an exciting new world of true patient centric care and personalised medicine. Health and social care providers have the ability to collect more data than ever before, through a variety of clinical systems and devices. However, these are all data

points we can measure. What if we could work in partnership with patients to easily capture their own feedback about their experiences and outcomes, and what if we could structure this feedback in a way that would provide a new perspective? There are plenty of examples where healthcare, life sciences and health technology industries have become very good at collecting and using non-identified, patient-level data to improve health outcomes. Despite NHS policies to have patients at the centre, patient experience is not systematically captured. Engaging directly with patients and carers to garner their thoughts and experience will not only further engage them in their own care, it will also provide valuable insights to health commissioners and providers, life sciences and health researchers alike. This works both from an interventional perspective, where healthcare professionals can proactively act upon feedback from patients, and also from an observational perspective, where services, treatments and therapies can be improved based on the evidence provided by patients.

>> > >>>>

What if we could work in partnership with patients to easily capture their own feedback about their experiences and outcomes?

IQVIA’s Patient Data Capture platform, recognise the importance of keeping the patient engaged and ensuring they continue to provide feedback throughout the scheduled period and beyond the first few data collection points. This is done by making data capture flexible and simple, while providing the patient with real-time feedback based on their responses. This approach helps patients to better manage their condition and treatment and provide further relevant insights – making them feel confident in the knowledge that someone can intervene if necessary.

From real world data. To real-time analytics. To ah-ha moments for your brand. >> > >>>

HARNESSING COLLABORATION

The value of PREMs and PROMs is immense. It’s a unique opportunity to get first-hand feedback on experience and outcomes from patients during treatment, involved in research or as part of a clinical trial. A combination of relevant Patient Reported Outcome (PRO) instruments, such as EQ-5D Quality of Life, or more disease specific ones, and other outcome and experience measures, will help bring patients and pharma closer together, build trust, inform how to drive further improvements in treatment, reduce the cost and burden of care and even avoid illness. Triangulating this data with observations and feedback from physicians and relatives, not to mention the vast amounts of patient data already collected, provides further insights yet. Despite these obvious benefits, PROMs and PREMs are often not used to their fullest extent, if at all. Barriers include the quality of the feedback collected and the cost and timeliness of collecting the data in the first place. New digital methods of collecting PREMs and PROMs – commonly referred to as ePRO – are now able to help to tackle these concerns. Next-gen electronic patient data capture platforms, such as

REAL TIME INSIGHTS

From a study management perspective, it’s immediately apparent if PRO data isn’t being provided to the required schedule and automated interventions can be triggered as necessary. PRO instruments can be presented in easier to complete formats, while ensuring these formats are validated and approved by the licence holder. This also means that data is available in real-time to pharma at a higher quality, delivered at lower cost. As a population, we’re surviving longer and are living with more complex diseases than ever before. Continuing to improve data integration and quality, enhance AI algorithms to spot more issues and provide earlier diagnosis using big datasets, are all critical steps to meet the longevity and disease complexity issues we face as a society. These challenges require improved access to care and personalised medicine and will no doubt improve quality of life for generations to come. However, if we truly want to make medicine patient centric, we must embrace real-time PREMs and PROMs, coupled with closer alignment and trust between healthcare providers, patients and the pharma industry. Hans Solgaard is Director, Healthcare, IQVIA. Go to www.iqvia.com

Y O U R W AY F U R T H E R IQV IA.COM/FURTHER

M AG A ZI N E S P EC I A L ED I T I O N | J U LY 2019 | 5

INTELLIGENCE

All in the execution How can pharmaceutical companies bring patient centricity to life for their people?

WORDS BY Jill Donahue

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

hat’s one of the biggest mistakes we’re making in pharma? We’re telling our people to be patient focused (which is akin to telling them to be purpose-driven) but not helping them to figure out what that means to them. The common wisdom in the world is that you ‘find’ your purpose. This is the big myth of professional life. Purpose is built, not found. Likewise, for patient centricity. The Aurora Project’s global ‘Patient-Centric Benchmarks Survey’ shows that there is an execution gap between saying we are patient centric (it’s all over our websites) and bringing it to life. Participants ranked their perception of the ‘Importance’ of their patient-focused mission as high (91% ranked it > 8/10) but their confidence in achieving it was low (30% felt confident they could achieve it). When it comes to teaching our people how to be patient focused, 78% said that their company doesn’t know how or is looking to figure this out.

THE MISSING LINK

What is missing is helping people to take patient centricity off the wall and put it into their hearts and hands. Making it part of the culture is the elusive holy grail. There has been an explosion in the literature illuminating the incredible impact of purpose-driven people, teams and organisations. I’ve been talking and writing about patient centricity (our purpose in pharma) since before it was a term. After my father died from a prescribing error, I made it my life’s work to figure out how we, in pharma, can better collaborate inside and outside our organisations to create greater outcomes for all. I’ve interviewed hundreds of best-selling authors and pharma executives around the world. I’ve also written two books and created award-winning programmes on the topic. My research and experience show that igniting a purpose-driven culture is the missing ingredient to our success.

What is missing is helping people to take patient centricity off the wall and put it into their hearts and hands

Specialists in Recruitment, Contract Sales Teams and Outsourcing

THE WHY OF WORK

So, what is culture? It’s the way an organisation thinks, acts and interacts. Leaders know that culture eats strategy for breakfast (the phrase made famous by Peter Drucker). And never before have they wanted a patient-focused culture more than they do now. But how to get it? That’s the million-dollar question. In ‘Alive at Work’, Daniel Cable shares two key elements to help people to connect with their purpose. 1 Help people witness how their work impacts others. This is easy for us in pharma where our work changes lives! Companies are starting to see the value in their efforts to: • Bring patients to the front of the room • Hang patient pictures and stories on the walls • Start meetings by talking about patient stories • Volunteer with patient groups • Create simulation exercises to try to experience how a patient feels. 2 Help people develop their own story about the why of their work. They need to move beyond thinking of their work as a job or even a career, to thinking of their work as purposeful. This is powerful! After building their purpose, pharma professionals (in all departments) have told me that they feel more confident, enthusiastic and proud.

How do you achieve that type of impact? Attitude is one of the hardest things to change so while it’s not easy, it can be done. We’ve had great success with this recipe: a S tart by sharing the evidence that the most successful pharma companies and pharma people are the ones who have figured out how to light the fire of a purpose-driven/patient-focused culture – and keep it lit. b Roll up your sleeves to connect with, articulate and communicate each person’s own purpose story in a way that fuels internal motivation and inspires external collaboration. c F inally, work together to identify the ‘so what?’ What do you need to start, stop and continue to do to live your patient-focused intentions? Imagine if you could light the fire of purpose in each member of your team. Imagine a world where healthcare professionals and patients trust, admire and believe that pharma professionals care for them… A world where pharma people are even more engaged and engaging, connected to the power of their purpose…A world where pharma people know how to help healthcare providers serve patients more effectively and exceed their business goals at the same time. Jill Donahue is the creator of The Power of Purpose Masterclass, founded Excellerate and co-founded The Aurora Project. Go to www.excellerate.ca. ► Read more about the 2018 Aurora Project Patient-Centric Benchmarks Survey’s results at www.pharmafield.co.uk.

Market Access Managers

Key Account Managers

Primary Care Reps

MSL Resource

Multi-Channel Account Managers 0113 457 0777 outsource@evolvecouk.com www.evolvecouk.com

M AG A ZI N E S P EC I A L ED I T I O N | J U LY 2019 | 7

BE THE CHANGE How NHS England is engaging patients in the shared responsibility for their own healthcare by striving to change consumer behaviour.

WORDS BY

James Roach

t could be argued that, following the publication in November 2017 of ‘NHS England’s Items which should not be routinely prescribed in primary care: Consultation report of Findings’, a lot has changed. The concept of getting people to recognise and acknowledge the finite nature of NHS resources, and change their behaviour as ‘consumers’ accordingly, is gaining traction. The national consultation behind the report has given clinical commissioning groups (CCGs) licence to increase their retreat from prescribing non-prescription drugs. Items available over the counter that alleviate symptoms and are considered common ground for reducing cost, time pressures on GPs and engaging with the public on the ‘shared responsibility’ of providing for their healthcare needs. This is a concept at the heart of the NHS Long Term Plan (LTP). Back in 2017, NHS England’s report showed the extent to which participants agreed with the proposals to restrict the prescribing of over the counter medicines (OTC). Overall, 50% of members of the public agreed. Of course, obtaining agreement with a proposal among half of respondents – or even a percentage or two more – is not a guarantee of unfaltering traction; the EU referendum the year before is testament to that.

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

NHS

THE FACTS

2018 IN

Creating behavioural change cannot be achieved by impediment, however, making a lasting difference can be secured by enabling people to design their way toward a new behaviour

1.1 BILLION PRESCRIPTION ITEMS WERE DISPENSED IN THE COMMUNITY

0.3% THIS WAS AN INCREASE OF

(2.9 MILLION)

FROM 2017

£9 THE COST TO THE NHS WAS JUST UNDER

BILLION EACH YEAR,

£569m

IS SPENT ON PRESCRIPTIONS FOR MEDICINES WHICH COULD BE PURCHASED OVER THE COUNTER

PRE-NHS

Looking back to a time before the NHS, the Victorian era offers an interesting insight on the public perspective of purchasing OTC. Poverty was high, illness stalked all from the very young to the very old, public health schemes were nascent, and getting the services of a doctor came at a price; all too often one that was not affordable to the many. However, seeing a ‘chemist’ was free and most Victorians got their medicines over the counter. Nobody would advocate a return to the conditions or system of healthcare that existed pre-1948, but the common thread is affordability. The NHS provides a ‘free at the point of use’ healthcare system, but we are all financial stakeholders with the costs pooled across a subscriber base of taxpayers. Affordability is still a central issue and the demands of sustaining the NHS represents an increasing financial tariff on everyone’s pocket. Each year, around £569m is spent on prescriptions for medicines which could be purchased over the counter from a pharmacy and other outlets such as supermarkets1. Clinical commissioners are forging initiatives to reduce this spend and time-burden and engaging with their communities to do so in the most effective and appropriate ways. The LTP offers

commissioners and communities the headroom to improve further this area of unnecessary cost. Its pledge is to ‘reduce the prescribing of low clinical value medicines and items which are readily available over the counter to save over £200m a year.’ Somewhat short of the current spend but savings in plans are seldom savings at the bank. However, it is the rumble of traction and a move forward. Just as the Voluntary Scheme for Branded Medicines Pricing and Access will allow best-value drugs to be fast-tracked through the approval process and provide up to £1bn of savings; the increasing place of OTC in the marketplace continues to grow. The OTC market currently stands at around £2.6bn 2 . Pain relief remains the highest value category-group, however, gastroenterology and eye care products have seen one of the largest increases. Replicating growth in the OTC pain relief market across other category groups is a sought-after goal and it’s one made clearer and more opportunistic as a result of the LTP.

M AG A ZI N E S P EC I A L ED I T I O N | J U LY 2019 | 9

NHS

up the gears Shifting JOINING FORCES

AGENT OF CHANGE

The LTP aims to bring down the walls between primary care and community health. This is supported by a population-based approach in primary care and the creation of Primary Care Networks (PCNs). The new landscape, underwritten by £4.5bn of new investment for expanded community multidisciplinary teams, aligned with new PCNs of neighbouring GP practices, will cover populations of between 30,000-50,000 people. In practice, this will mean: • GP practices in a network contract, an extension of their current contract • Designated single fund through which all network resources will flow • Expanded neighbourhood teams will include GPs, pharmacists, district nurses, community geriatricians, dementia workers and allied health professions, for example physiotherapists, podiatrists/ chiropodists, joined by social care and the voluntary sector.

The LTP is not a magic bullet for primary care. Emerging PCNs will still have to solve the same problem that is the GPs’ daily mathematics seen in the diagram below. The LTP aims to offer a framework within which efficiencies and innovation can be managed that, in turn, operate on supply and demand. Shifting up the gears in the reduction of demand requires a concerted effort across all stakeholders – commissioners, clinicians, communities and industry – to engage with the public on the concept of ‘shared responsibility’. Historically, the NHS outlook on patients taking a greater share in healthcare has focused on getting them to stop doing something. That is not sharing, that is just didactism. Creating behavioural change cannot be achieved by impediment, however, making a lasting difference can be secured by enabling people to design their way toward a new behaviour. The new PCNs are incentivised by a shared savings scheme; this needs to bring a dividend for patients too. Not just reinvested savings for new services, but benefits that register with local people within their experience of the PCN offer. Pharma can be a real agent of change here. In moving the OTC medicine plan off the page, pharma is well placed to support primary care and the public in designing a new model of engagement with medicines management.

PCNs will have access to a ‘shared savings scheme’ linked to reductions in hospital activity, such as A&E attendances, avoidable outpatient activity and delayed hospital discharges. This could also embrace savings from medicines management. WORKING IN PARTNERSHIP & ADDING VALUE

A significant change within the PCN model is the increase in clinical pharmacists in primary care; by seeing patients face-to-face and reducing polypharmacy, they will be key to improving outcomes and reducing admissions from adverse events. They will shape the outlook on reducing the prescribing of OTC medicines.

Limited supply (time)

Increasing demand (patients/ consultations/ complexity)

SHARED RELATIONSHIP

Much work already takes place among commissioners and providers; information campaigns are common but a poster in a GP waiting room or a flurry of digital messages will not secure enduring involvement with, and participation in, co-owned change. Relationships are the key; the networked gearing in the new primary care model provides opportunities for the very players with whom pharma already has the relationships. It is clear that the LTP intends to free up both time and resource; time spent looking after the patients with the greatest need, and resource reinvested in innovation and the transformation of services. Supporting the system means getting closer to the people and sharing in the relationship between clinician and patient. Whatever challenges exist for pharma, be it those related to Brexit, or domestic issues like a possible return to the hub and spoke dispensing model, the LTP provides the opportunity to align with the NHS’ growing ambition for sustainability and affordability and to collaborate with NHS commissioners and providers at scale – but in a condensed way. Initiatives that support this will be well-received. James Roach is Director of Conclusio Limited. Email jamesprroach@yahoo.co.uk SOURCES:

Efficiencies

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

Innovation

In the year prior to June 2017, the NHS spent approximately £569 million on prescriptions for medicines which can be purchased OTC from a pharmacy and other outlets. https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-shouldnot-routinely-be-prescribed/ 2 Total sales value of over-the-counter (OTC) drugs amounted to 2.6 billion British pounds during the period of July 2017 to July 2018. https://www.statista.com/statistics/415963/ over-the-counter-otc-medicine-breakdown-of-sales-in-great-britain/ 1

WHO'S ON YOUR

PF POWER LIST?

NOMINATE TODAY FOR THE PF POWER LIST 2019 CATEGORIES Politics

Inspirational leadership

Women leading the way

•

Innovation

Mentors making a difference

Diversity and inclusion

•

Best practice

Changemakers

Corporate social responsibility

You call it – for nominees who don’t fit a category

EMAIL DETAILS OF YOUR NOMINEE: person, team or organisation, with a paragraph on why you think they should be on the Pf Power List 2019 to emma.morriss@pharmafield.co.uk

s an Area Healthcare Lead for MSD in North and East Scotland my day-to-day role involves market access, patient/ population access and project work with the NHS and other partners in the healthcare sector. I have a biochemistry background but I found that working in a lab wasn’t for me, so I looked for a role that would provide a challenge but also make a difference. Since joining the industry I’ve worked in a number of roles and travelled all over the world meeting some amazing people whilst helping to improve patients’ health and wellbeing. SUPPORTIVE CULTURE

I really enjoyed working for both of my previous employers; however in my last role before joining MSD it felt like I was coming to the end of my journey with that company. When the MSD role became available it seemed right to apply for it as I’d been a quiet admirer of MSD for a long time because of their reputation within the industry which starts with their people.

Neil MacDonald, Area Healthcare Lead for MSD in North and East Scotland, on the Pf Award-winning real time data-led joint working project involving the Scottish Ambulance Service which is improving patient care for people with diabetes in Scotland.

I am now in my third year with MSD and I’ve learned and grown a lot. They have a positive, non-hierarchical culture which expects a lot but also is very supportive and key for me is that there are people and forums to take forward ideas that can be discussed and shaped. The SAS-HYPO-FIFE project was defined during this process. THE PROJECT

The idea for the project came from an MSD project in the South of England which focused on upskilling paramedics, whereas SAS-HYPO-FIFE has the addition of having a real time data feed from attending paramedics to the Fife Diabetes Centre which is the first time that this has happened in Scotland. The patients experiencing a hypoglycaemic event and requiring an ambulance were then followed up by the nurse team at the Fife Diabetes Centre. WORKING TOGETHER

The paramedic training was based on a questionnaire to establish each paramedic’s needs and gaps in knowledge in relation to managing hypoglycaemic events. The training was then delivered to identified station leaders at each of the ambulance stations within Fife by NHS Fife’s Lead Diabetes Specialist Nurse. The project has had the following main outcomes - patients have reported via the Fife Diabetes Centre that they have never had such a comprehensive service to help with their diabetes; there has been around a 40% reduction in ambulance callouts for hypoglycaemic events (2018 v 2017) and a 40% reduction in ambulance conveyances to A&E (2018 v 2017) which means that there are more ambulances available for all patients in Fife and that there is less pressure on A&E. When this is costed out it represents a £230k saving (2018 v 2017) and the project will be rolled out across all the health boards in Scotland. As a project group we all worked closely to deliver the project.

HYPO-real 1 2 | P H A R M A FI EL D.CO.U K

P F AWA R D S

THE SAS-HYPO-FIFE PROJECT

Patient engagement

Manage at scene

AMBULANCE CALLED OUT

Appropriate management

THE DIABETES CENTRE

NO HYPO

HYPO

YES

SCI DIABETES

Intensive nurse led management

>2 HYPOs in 6 months

Patient at home

YES

Managed over phone

OPTION

Managed in A&E

Diabetes

Managed on ward

YES

Follow up with primary care provider

Appointment made with diabetes centre

PF AWARD-WINNING WORK

THE FUTURE

When my name was called out at the Pf Awards I was shocked and incredibly proud all at once. The conversation was flowing well, I had taken my tie off and was looking forward to the rest of the evening when my name was announced. Then on the long walk up to the stage it dawned on me – I thought, “We’ve actually won – the team has won” (throughout the PF Award process I felt I was there to represent the team involved with the project). It felt fantastic, as the project will ultimately save lives and now it’s been recognised as the best in the pharmaceutical industry in 2019. It was great to represent the group at the Pf Awards, and even better that the Pf Awards committee has also given a trophy to each of the partners.

My colleagues were very supportive of the project and delighted when we won. If anything, it has had such a positive impact not only with MSD but also with our partners – we all want to do more of this collaborative working where we put the patient at the heart of what we do. Our work does not stop now; we want to keep this momentum going and continue to identify further opportunities to work with our partners in the healthcare sector – none of us can do this alone. I would also like to bring another project to the Pf Awards in 2020! Neil MacDonald is Area Healthcare Lead for MSD in North and East Scotland. Go to www.msd-uk.com

The project will ultimately save lives and now it’s been recognised as the best in the pharmaceutical industry in 2019 by the Pf Awards

WORDS BY Neil MacDonald

M AG A ZI N E S P EC I A L ED I T I O N | J U LY 2019 | 13

P F AWA R D S

► Lorna receiving one of her two Pf Awards. From L to R: Mark Ward, Jack Worts, Lorna Towndrow and Pf Awards host, Hugh Dennis

INTERVIEW BY

Emma Morriss

Double down Lorna Towndrow, Training & Operations Manager at Ashfield and winner of both the Future Leaders and Outstanding Performer Pf Awards 2019, on preparing for success.

ongratulations on your double Pf Awards 2019 win! Thank you – it was amazing and a shock to hear my name called out from the stage. Being a finalist at the Pf Awards is such an incredible privilege in its own right, so to make it that far was an achievement – to win was even better! It wasn’t until I sat back in my seat that it really started to sink in, and I felt completely overwhelmed.

What made you enter the Pf Awards 2019? I actually applied for the Emerging Talent Award in 2018 and thoroughly enjoyed the assessment process – it was fantastic to be able to highlight the work I had been doing at Ashfield to industry experts and to meet other industry professionals. The atmosphere on the Pf Awards Assessment Day is both relaxed and professional, which makes it enjoyable and calms the nerves slightly! Unfortunately, I didn’t win in 2018, so when the opportunity was given to me by Ashfield to put myself forward for another award for 2019, I jumped at the chance.

Ashfield

Make your smartest move yet... 14 | P H A R M A FI EL D.CO.U K

With a global product lifecycle partner by your side, every move you make is a great one. www.ashfieldhealthcare.com

A DV ERTO R I A L

Without the consistent How did Ashfield support you with your application? As always, support from the I received fantastic support from beginning of my career various leaders throughout Ashfield with Ashfield I probably during the application process. wouldn’t be here today Initially, my manager was fantastic, encouraging and supporting me in selecting examples of my work that would demonstrate what I had achieved over the last 12 months. For the Pf Awards Assessment Day, I was required to create a 30-minute presentation (with a maximum of five slides) on a leadership topic. For this, I sought support from our training manager, and we brainstormed ideas for the presentation to keep the content succinct and to really display my achievements at a top level. Once the presentation was finalised, I practised (quite a lot!) and received feedback from one of Ashfield’s senior recruitment executives to make sure I was confident on the day. In reality though, the support from Ashfield came long before my Pf Award applications. Since joining Ashfield in 2016, I have been provided with a number of fantastic opportunities across various areas of the business – it has been great to get involved and learn from senior leaders within the company. Having this support and experience is essentially what contributed to and shaped my application. So, without the consistent support from the beginning of my career with Ashfield I probably wouldn’t be here today! You won the Future Leaders Pf Award, what do you think made you stand out? The Pf Awards Assessment Day is all about showcasing what you have achieved, but I’d like to think that what made me stand out was that I focused not just on my achievements, but what they meant to Ashfield and my colleagues within the business. For example, in my presentation I discussed a recent training programme that I had put together – expanding to discuss how this helped develop our people, deliver successful projects to our clients and ultimately achieve our business goals. Also, despite the cliché, just being myself was really important on the day! The assessors do make you feel relaxed and encourage you to make the most of the experience, so being confident and relaxed helped me to demonstrate and articulate myself in the best way. You also won the Outstanding Performer Pf Award, how did it feel when you became a double winner? It really hadn’t even crossed my mind that I could/would win the Outstanding Performer Award, I was still so overwhelmed with winning the Future Leaders Award that I wasn’t fully concentrating. It wasn’t until I heard my name again that I realised what had happened. I really couldn’t believe it and I was extremely proud to be recognised for this award. What do you hope these Pf Awards wins will do for your career? I do think it is important to stay grounded after an experience like this. I hope to continue learning about our business and developing relationships across the pharmaceutical industry. It would be great if I could just continue adding value in whatever I do; whether that be for our clients, healthcare professionals, or patients. The award wins will give me the confidence to continue progressing the same way I have up to now. What are your plans for your future? To continue to develop myself and others, whilst fulfilling a career that I love! When I joined Ashfield, I wanted to be a medical sales representative in the field, and actually I was exposed to other interesting roles and opportunities. I am excited to see how the pharmaceutical industry develops over the next five, 10, 20 years, and even more excited to be a part of it! Go to www.ashfieldhealthcare.com

ASHFIELD’S NEW MSL ACADEMY

s the pharma industry evolves, so does the role of the medical science liaison (MSL). As this environment changes, we need to refine how we approach their training to ensure they demonstrate value for both customers and clients alike. Ashfield’s MSL academy is a new training and development programme that has been created with these challenges in mind. It is suitable for new to industry MSLs, MSL managers, existing MSL teams and as a development programme for those considering transitioning into an MSL role. Our comprehensive set of training materials has been reviewed by clinicians, key opinion leaders and HCPs across the UK to identify what skills are currently missing within MSL teams across the industry and to match the needs of the individuals that they will be communicating with. Its modular format means that it can be tailored quickly for existing MSLs to focus on areas of development or update their core skills. As a full programme, it is suitable for new to industry MSLs and can also be used as a development/progression programme for experienced KAMs who may want to transition into an MSL role. As an addition to the necessary scientific knowledge, a key area of MSL development lies within communications skills. Most MSLs are already scientifically competent by the nature of their academic background, but can sometimes have difficulty with communication, leadership and influencing skills.

For more information on Ashfield’s MSL services, go to www.ashfieldhealthcare.com

M AG A ZI N E S P EC I A L ED I T I O N | J U LY 2019 | 15

ACHIEVING BALANCE To achieve that balance it is crucial that patient engagement happens early in the clinical development process. However, for the life sciences industry, this brings with it many challenges:

How do companies find patients/public to work with?

ASK the EXPERTS Successful patient engagement is essential to the clinical development process. How can companies get it right?

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atient and public engagement in clinical research means that research is done in collaboration with patients and the public, rather than ‘to them’ or ‘for them’. It is a definition that we have all become familiar with and the research community, including the life sciences industry, now unquestioningly accept that patient engagement should be a feature of any high quality research proposal. There is also agreement that well executed patient engagement activities lead to better designed research and improved participant recruitment. Patients are the experts of their conditions; they are the only people who can truly tell us if we are achieving the right balance between the ‘ask’ of the research and the burden of the disease.

How do companies manage legal requirements, professional standards and commercial sensitivities? Will patients/public have sufficient understanding of scientific and research language? What formats should companies use to communicate to and work with patients/ public to achieve respectful relationships? How should patients/public be thanked and recompensed for their time, commitment and expertise?

INSIGHT

COLLABORATION

FACILITATION

Last October, the National Institute for Health Research’s Clinical Research Network (CRN) announced a pilot project which aimed to address some of these challenges while focusing on facilitating patient and public engagement activities earlier in the clinical development process – specifically at the protocol finalisation stage. Throughout 2018, we collaborated with patients and a global pharmaceutical company, Pfizer Ltd, to design and pilot this new service. The pilot involved two Pfizer studies looking at a new treatment for eczema which were both paediatric and adult studies. The CRN facilitated two meetings at Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, firstly with a group of young people and then with a group of parents/carers. Sophie Evett, Feasibility Lead for Pfizer UK, who led Pfizer’s participation in the pilot, said: “At the study level, the clinician who wrote the protocol met with both patient groups in person, as did my colleague who supports recruitment for Pfizer globally. They were surprised at some of the questions they were asked by the young people in particular. Some of the questions were very scientifically technical, for example around how the drug might alter your immune system and what effects that might have on the body. The young people were not afraid to say what they felt and were very clear about what they wanted to see included in the informed consent and assent document. For the adult study, one element of the draft protocol relating to prohibiting other medications was amended as a direct result of engagement with the parents/carers, and the study has since been approved to move to site selection stage. “Looking at the pilot more broadly, it took a little longer than expected to satisfy our legal and compliance teams initially, mainly because it was a completely new way of working. However, it was a worthwhile exercise because it has enabled us to work through the many legal and compliance challenges and develop documentation that we can use time and time again for patient engagement activities, regardless of the study, patient group or therapeutic area.”

The model is currently being tested by a number of early-adopter companies and it has emerged that having the CRN act as an independent ‘go-between’ is an important factor in the pilot’s success. Keith Wilson, Patient Research Ambassador for Liverpool Heart and Chest Hospital NHS Foundation Trust, worked with CRN on developing the pilot. Keith explained: “The main challenge in the past has been around trust. Patients and the public have historically been wary of the life sciences industry, and some may still harbour some misconceptions. “I thought the pilot was a great idea and long overdue but, at the same time, I was initially sceptical that the project would achieve the desired outcomes. However, having the CRN – which has worked in partnership with our NHS for over a decade – facilitate the service has made an enormous difference. Patients love their NHS, and if the approach comes from the CRN, patients and members of the public are more open to having those direct discussions with life sciences companies. The CRN is absolutely instrumental and fundamental to brokering that deal.” The pilot continues and in the autumn we plan to publish case study material from our early adopter companies which will describe how this patient engagement process can have a positive impact on clinical trial design. The ambition is then to establish a national framework for earlier patient engagement by 2020, with the CRN providing a clear route for life sciences companies to connect with relevant patients to help ensure patient-friendly clinical trial designs. Dr Matt Cooper is the Business Development and Marketing Director for the National Institute for Health Research’s Clinical Research Network. Go to www.nihr.ac.uk

Patients are the experts of their conditions; they are the only people who can truly tell us if we are achieving the right balance

WORDS BY Dr Matt Cooper

M AG A ZI N E S P EC I A L ED I T I O N | J U LY 2019 | 17

Driving force How one company created a core proposition which puts the patient first in all the work it does. WORDS BY

atient centricity is of critical importance to the future success of healthcare economies. It impacts on every single part of a medicine’s life cycle from development, clinical trials and commercialisation to the treatment and care received by patients. For a medium-sized company like Apodi to address patient centricity effectively, we had to narrow our perspective and address how we could play our part in driving patient centricity within the confines of the services we provide, which impact on patient outcomes and experiences. The key to this was to build our own ‘patient centricity model’ that forms a key part of all our working practices. To develop the model, we first started by trying to find a generally accepted definition of patient centricity that was relevant within our marketplace and could form the basis for further development and customisation.

Paul Todd & Lynn Jeggo

CUSTOMISATION

To assess how the definition could be adapted and customised to drive patient centricity in the work we do we then had to: • Revisit our core proposition • Build a model to help us identify solutions to our clients’ challenges that would drive patient centricity • Build a model to help us implement programmes developed from the chosen solution that would drive patient centricity. CORE PROPOSITION

We identified ourselves as a ‘high-performance outsourcing organisation that identifies and implements innovative access strategies in partnership with our clients which drive patient access to our clients medicine(s)’. Given the above, a key foundation stone of our patient centricity model needed to be ‘access’ – our services need to ensure that patients can access medicines (and associated specialist support) when it is in their interests to do so.

Another key part of the proposition noted is the identification of innovative (and compliant) access strategies. We need to be able to assist our clients in identifying the most appropriate solution to address their specific requirements to drive access and build a model of patient centricity. To do this we developed our Sourcing: Speed: Duration: Model; most of our work is involved in one or more of the following: • Sourcing: Finding new patients who are currently being sub-optimally treated. • Speed: Creating new capacity to drive patients through a care pathway to facilitate access to appropriate treatments. • Duration: Ensuring patients remain on treatment for as long as it is appropriate to do so. Typical programmes will combine the above. Put simply, a programme which creates new capacity through the provision of specialist nurse resource may be supported by a patient support programme that drives compliance.

DEFINITION

The definition that seemed to be both generally accepted and relevant to the work we do was: ‘Putting the patient first in an open and sustained engagement of the patient to respectfully and compassionately achieve the best experience and outcome for that person and their family.’ We believed this definition caught the essence of the work we wished to deliver for our clients, although it wasn’t specific enough in itself to define exactly what our services would consist of.

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DRIVING PATIENT ACCESS THROUGH PATIENT PROGRAMMES 1 SOURCING Sourcing development programmes are about finding suitable

cohorts of patients to enter into a pathway. 2 SPEED Speed is delivering a service development programme which will

push patients through pathways as quickly and efficiently as possible and drive appropriate access to medicines. 3 DURATION Duration programmes are about supporting patients on treatment so they are concordant and adherent, thus improving time on therapy.

IN PR ACTICE

THE MODEL Once a solution is identified, the ‘Patient Centricity Model’ is applied to the implementation phase. This involves five key principles which drive patient centricity in our work:

All companies within the healthcare sector can play their own part in the drive towards patient centricity

Access

Providing appropriate access to medicines is fundamental. This is delivered in a variety of different ways which provides additional incremental capacity into NHS systems, such as the provision of initiation and review clinics and sourcing suboptimally treated patients.

Outcomes and Experiences Every programme must drive improved outcomes and experiences for patients. The measurement of experiences is a simpler concept, and this is measured on almost every interaction we have with patients. The measurement of outcomes is sometimes more difficult given the nature of our work.

Concordance and Adherence Our programmes must ensure that patients who have access to medicines also have access to transparent and unbiased information on disease and treatment options and available specialist resources that drive compliance and patient choice to their treatment regime.

Expertise Our programmes need to be delivered by specialist healthcare professionals (HCPs) with the expertise to deliver on patient requirements through the most appropriate patient engagement channels. The programmes also need to be designed in such a way that the HCPs have sufficient time to care for patients – Apodi nurses would normally have more time than is typically afforded to NHS nurses.

Integration Providing continuity of care is critical and this can only be delivered through close integration with NHS HCPs. Apodi fully understands its role in the care pathway – we provide support to the NHS in their management of their patients.

IN SUMMARY

All companies within the healthcare sector can play their own part in the drive towards patient centricity. The key to making this happen is for companies to define what this role may be and what specific values and principles will drive patient centricity in the business. Paul Todd is Director of Access Solutions at Apodi and Lynn Jeggo is Operations Director at Apodi. Go to www.apodi.co.uk

M AG A ZI N E S P EC I A L ED I T I O N | J U LY 2019 | 19

TAILORED ‘Patient centricity’, the process of designing a service or solution around a patient’s wants, needs and preferences, is a key aspiration for the NHS. But what does it involve and how can it be enabled?

he NHS recognises that many factors can affect health and wellbeing, hence it plans to integrate health, social care and other services, such as housing and the voluntary sector, around an individual by ensuring that all areas of England are covered by an Integrated Care System (ICS) by April 2021. These place-based services aim to bring care closer to patients’ homes, allowing more people to be treated in the community by specialist nurses, rather than in hospital outpatient departments. Specialists will be able to view patient records remotely to determine if and when they need to see them and many of these appointments will be conducted online. The NHS also aspires to make personalised therapeutic options more widely available. For example, last autumn, the NHS became the first national health system in Europe to give the go-ahead to a breakthrough cancer treatment based on modifying a patient’s own CAR-T cells.

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NHS

APPROACH SHARED RESPONSIBILITY

However, patient centric care is not just about changing the way services are designed and delivered. With an ageing population and growing burden of diseases, many of which are preventable, the NHS can no longer afford to take a paternalistic approach to patient engagement. A King’s Fund paper argues that most people already take responsibility for their health and care but that more could be done to reduce overdependency on services and draw on people’s own expertise. In the paper, published in November 2018, and titled ‘Shared responsibility for health: the cultural change we need’, the King’s Fund says: ‘The cultural change we would like to see affects staff as well as patients because it requires staff to work differently in order to fully involve patients and the public in decisions about their health and wellbeing. By staff, we mean both clinicians who provide care and support and others working in public services.’ As part of a wider move towards shared responsibility over the next five years, the NHS Long Term Plan promises that the NHS will ‘ramp up support for people to manage their own health’. This will start with diabetes prevention and management, asthma and respiratory conditions, maternity and parenting support, as well as online therapies for common mental health problems. PERSONALISED CARE

The NHS has developed a Comprehensive Model of Personalised Care in partnership with more than 50 stakeholder groups and it is now being implemented across a third of England. Personal Health Budgets (PHBs), which are already in use in some parts of the NHS and give people more control over the services and care they receive, are a key aspect. According to the NHS Long Term Plan, up to 200,000 people will have a PHB by 2023/24 and this will include provision of bespoke wheelchairs and community-based packages of personal and domestic support. Social prescribing will also be included in the personalised care model.

WHAT IS PHARMA’S ROLE?

The importance of diet for disease prevention and management is already being recognised and acted upon by the NHS in diabetes management. For example, the Long Term Plan explains how medical research has shown that some people with type 2 diabetes can achieve remission by adopting a very lowcalorie diet. Consequently, the NHS plans to test a programme supporting very low-calorie diets for obese people with type 2 diabetes. In line with this, pharma needs to think beyond the pill and consider the implications of the wider determinants of health, such as diet and fitness. It also needs to define how relevant preventative interventions fit into patient pathways and how it can support the NHS in tailoring preventative interventions for particular cohorts of patients. For example, pharma could review patient care around diabetes and other conditions. This could provide valuable insights for population healthcare management programmes and lead to a quicker uptake of appropriate drugs for appropriate patients, resulting in improved outcomes. Pharma also needs to ensure that it gathers feedback on the patient’s overall experience of a drug and their ability to resume a normal life. This could involve creating an app through which patients can record data and this, in turn, could support services and forums that are already enabling patients to record information as well as the NHS’s National Patient Reported Outcome Measures (PROMs). Industry also needs to review its activity around medicines optimisation and monitoring adherence, since this too is becoming increasingly personalised.

The NHS can no longer afford to take a paternalistic approach to patient engagement

WORDS BY Steve How

HOLISTIC APPROACH

Patient centricity is manifesting itself in many ways in the NHS – from service design and delivery to the development of personalised treatments and the ambition to form a new relationship with patients. While this is unlikely to lead to a reduced reliance on drugs in the short-term, there will be an increased emphasis on more holistic ways of improving the nation’s health. Pharma needs to define where its products fit into the new integrated care pathways that are emerging and think beyond the pill in helping the NHS to achieve its vision. Steve How is part of Wilmington Healthcare’s Consulting Team. Go to www.wilmingtonhealthcare.com

M AG A ZI N E S P EC I A L ED I T I O N | J U LY 2019 | 21

Digital therapy Health professionals see apps as a crucial step on the road to care that is more efficient and more patient centred than today. How can patients be sure that they’re getting the accurate information they need?

ore than 90% of health professionals think that digital health is one of the major weapons to enhance NHS services. But there are three big problems standing in the way. 1. Finding the right app: With 385,000 in app stores, how can you find the great ones in such a crowded space? 2. Trusting an app: With app stores unregulated, how do you know if an app is safe to use and won’t mistreat your data? 3. Integrating the app into care: How can apps work along with other services you use? That’s where ORCHA comes in. We’ve reviewed almost 5000 apps to date and test more apps than anyone, which helps us to cover more conditions. Our evaluations include criteria set out by regulatory bodies across the world. We’re home to the world’s only library that lets professionals and patients find and compare health apps against a range of criteria including effectiveness, usability and security. This helps people to find or recommend apps with confidence. To drive uptake of health apps and target specific communities, we provide locally

5 STEPS

to start embracing health apps:

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Identify a shortlist of your priority health conditions

T EC H N O LO GY

branded and tailored microsites. Our tools enable professionals to prescribe health apps, which is proven to increase the take-up of apps. The best way to support the use of apps to support healthy living and condition management is by embedding and standardising app recommendation as part of care pathways. We support NHS trusts and clinical commissioning groups to embed apps system-wide. We now work with 20% of NHS organisations, including NHS Digital. When healthcare professionals use the ORCHA platform, they achieve a 71% activation rate amongst patients. 200,000 consumers have signed-up to our service; and most importantly, every day we hear of the real impact health apps are making on the health of the nation. SUPPLEMENTAL SUPPORT

Eating disorders can severely affect the quality of life of the sufferer and those that care for them and can shorten a person’s life. But with the right care, people can recover. Lancashire Care NHS Foundation Trust hadn’t consistently used digital solutions as part of therapy, but saw that patients were increasingly on digital media. When the Trust provided its staff with access to the ORCHA platform, the eating disorder team immediately saw the potential and now prescribes health apps to supplement and enhance its therapy. Dr Hannah Wilson, Clinical Psychologist, explained: “I’ve found apps especially helpful when a patient is waiting to start their treatment. Although the team always strives to offer treatment to someone within

Set demographic and activation targets

a short space of time, sadly there is often a wait between assessment and treatment. This way I can recommend apps that can start to help them in that time.” She added: “For me, eating disorders are complex. An app by itself is unlikely to be enough to enable a patient to recover, but I have found that they support, supplement and back up sessions. The apps enable patients to receive some support between appointments. For example, they help people to more accurately monitor what we have asked them to, be it their mood or what they’ve eaten. People carry their phone everywhere and so are much more likely to simply and discreetly make a note, rather than pull a piece of paper that could be spotted by others or lost. Apps can also provide a source of motivation to help patients keep to their treatment plans. Some also provide practical assistance with meal planning.” Talking broadly of the programme, Dr Wilson said: “Our clients of all ages use apps every day. If we can become part of that world, we can become more effective and sustainable. Apps also provide a great tool for patients to use long after they have been discharged from our service, to help maintain their progress and stay well.” Health services across the country echo such results. From diabetes prevention programmes, to occupational health teams, professionals are working with ORCHA to pinpoint the best apps that will help improve services and make a difference to patients. Liz Ashall-Payne is Co-Founder and Chief Executive Officer of ORCHA. Go to www.orcha.co.uk

Research what digital technologies are available for these conditions and the patient characteristics

How do you know if an app is safe to use and won’t mistreat your data?

WORDS BY Liz Ashall-Payne

See if you can trust the apps you identify or look for inspiration in our app review library: appfinder.orcha.co.uk

Identify points in the patient pathway when the app is best embedded.

M AG A ZI N E S P EC I A L ED I T I O N | J U LY 2019 | 2 3

SELF CARE What are the trends shaping the successful delivery of patient centric services?

WORDS BY

Nagore Fernandez

he pharmaceutical industry is evolving rapidly and as times change, so do the industry’s challenges. One of the most important trends has been the rise in patients’ engagement with their care; as patients increasingly engage and make decisions around their own healthcare, care providers and other stakeholders must evolve their strategies to address their needs. In response, pharma companies are trying to develop more patient centric approaches and ensure healthcare providers (HCPs) can offer patients greater support in managing their condition. Pharma companies want to build stronger relationships with both patients and healthcare professionals and deliver valuable patient support information as well as research and educational materials. How can they achieve this? BEYOND THE MANTRA

It is quite common to see pharma companies adopting the mantra of ‘patient centricity’ and it will soon become integral to business strategies – affecting everything from sales and marketing to manufacturing, pharmacovigilance and operations. The ‘involvement’ of patients at all points of the lifecycle of a drug, from early development through to commercialisation, is the next big step for pharma that will lead to personalisation of the patient experience and better patient outcomes. This is the ultimate aspiration of the collective life sciences. As the commercial value of being patient centric is realised, the industry will see more demand on patient focused strategies and initiatives linked to the development and launch of new molecules. Because of these patient centric strategies, there

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INSIGHT

will be a notable increase in demand for patient solutions, such as patient support programmes and patient educational campaigns. Pharma companies must then develop scaleable capabilities and strategic partnerships with organisations that can meet this need. This shift of paradigm, where patients are truly the customers and HCPs are the conduit to them, means an honest appraisal and change of the status quo for most companies. This will ensure that patients can truly have a voice. Normally through patient associations, patients can get involved in clinical development and act as consultants in clinical trial design and impact the implementation of post-commercialisation patient support. TAILORED TECHNOLOGY

Patients have been moving away from traditional face-to-face interactions towards mobile or mHealth management for many years. Health apps are increasingly being used by patients to engage with and manage their own wellbeing. Patients can take their own blood pressure, body temperature, blood oxygen levels, glucose levels, and record this data. There are even smartphonecontrolled patches that provide electrical neuromuscular stimulation to manage pain. This shift has made it clear that patients have an appetite for more tailored and personalised health management. But it also means that there is yet another platform for engaging with patients and a new source of data that HCPs and pharma businesses can access to improve their operations. A survey of adult social media users with health conditions, conducted by PatientsLikeMe, showed that 94% would be willing to share health data to help doctors improve care and 84% would be willing to share information with drug companies to help them make safer products. The challenge for all stakeholders is to collaborate and create tools and an environment where information is freely exchanged between patients, caregivers and pharma companies to improve everything from primary care to research and development, and even the manufacturing and logistics in between.

SERIALISED DATA AND APPS

This shift of paradigm means an honest appraisal and change of the status quo for most companies

BUILDING ON COMPLIANCE

Global serialisation regulations have digitised information sharing models throughout the pharmaceutical industry. The US Drug Supply Chain Security Act (DSCSA) and EU Falsified Medicines Directive (FMD) have created an information sharing platform that could revolutionise the way the collective life science industry, HCPs and patients engage with each other. We are now able to identify and track every serialised drug product as it moves through the supply chain. The opportunity for improving care arises when the industry connects this information to the patient – for example, linking medicines to individual patients can prevent prescription errors in hospitals. The NHS is currently trialling such a system - ‘Scan4Safety’. Six sites are implementing GS1 standards and using barcodes to identify every person, product and location. The approach involves scanning the barcodes of each patient and products used on a patient at the point of care. The scan gives HCPs product information such as expiry data and batch/lot number and administrators the ability to digitally verify who gave what to who, where, and when. Digitising healthcare in this way not only improves patient safety but offers significant efficiencies; the Scan4Safety trial sites have already saved millions of pounds. In the future, the entire eco-system of stakeholders involved in providing care will have the ability to analyse outcomes based on patient treatment patterns and deduce the best course of therapy for a patient of a given profile.

Apps will also be developed that use serialised data to deliver real-time information to patients from participating pharmaceutical manufacturers, hospitals, pharmacies and regulatory bodies. Product descriptions, administration instructions, photos, videos and medicine disposition details (information on absorption, distribution, metabolism, and excretion – {ADME}) could easily be made available. The increased level of support and reassurance this provides will have a hugely positive impact on patient adherence. If we imagine the anxiety around administering an injectable medication to an infant in a home environment – in an ideal world, a caregiver could scan the drug’s serialised barcode and instantly receive information on whether the vial has had any cold-chain excursions or even needs to be recalled, assuring them that it is safe to administer. The potential of an application-based approach to improve adherence when comprehensive information on a medication is available immediately is incredible. THE FUTURE

It is the shared mission of the entire healthcare eco-system to empower patients to use products more effectively and enjoy optimal health outcomes. There is little doubt that patients are wanting to better engage with their care – they increasingly want to do so digitally and are more willing than ever to share and receive information that will not only improve their own care, but that of others as well. mHealth and the digital information sharing pathways created by serialised data have created platforms that will enable patients to access and share their own data in ways never seen before. It is now up to pharma companies, their partners, and stakeholders throughout their supply chain to deliver on the promises of patient centricity. Nagore Fernandez is Head of Patient Solutions, Ashfield Europe & Canada. Go to www.ashfieldhealthcare.com

M AG A ZI N E S P EC I A L ED I T I O N | J U LY 2019 | 2 5

► Tara suffered from bowel problems for years, but has finally found a treatment that works for her.

THE COST

271,430

PEOPLE IN ENGLAND WERE ADMITTED TO HOSPITAL WITH CONSTIPATION IN

2017/18

196 EQUIVALENT TO

PEOPLE A DAY OF THOSE, AROUND

THREE QUARTERS WORDS BY Emma Morriss

– 52,715 – WERE UNPLANNED EMERGENCY ADMISSIONS, EQUIVALENT TO

144 PER DAY

Tackling the cost of constipation The Bowel Interest Group are working to tackle the human and financial cost of constipation, a condition that can have a devastating physical and mental impact on the lives of people who experience it.

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FEMALES

60% ACCOUNT FOR AROUND

OF ADMISSIONS

THE TOTAL COST TO HOSPITALS FOR TREATING UNPLANNED ADMISSIONS DUE TO CONSTIPATION IN 2017/18 WAS

£71 MILLION Source: HES Data 1.11.17-31.10.18, NHS Digital (https://digital.nhs.uk/data-and-information/ data-tools-and-services/data-services/ hospital-episode-statistics).

INSIGHT

oor bowel health and chronic constipation affects millions of people and this debilitating condition is currently preventing thousands of people in the UK from fully enjoying their lives. Many people are needlessly suffering with chronic constipation because of the taboo nature of the subject, combined with a lack of understanding of the issue. The condition affects both the physical and mental health of people, and the economic burden on the NHS is huge. £162m was spent by NHS England on treating constipation in 2017-18 alone. This is equivalent to the cost of funding more than 7000 newlyqualified nurses for a year 1. MANAGING CONSTIPATION EFFECTIVELY

New data shows that being unable to manage constipation effectively is leading to thousands of hospital admissions each year, often through A&E. The data shows that: • 271,430 people in England were admitted to hospital with constipation in 2017/18, equivalent to 196 people a day • Of those, around three quarters – 52,715 – were unplanned emergency admissions (equivalent to 144 per day) • Females account for around 60% of admissions. The total cost to hospitals for treating unplanned admissions due to constipation was £71m in 2017/18. This figure is likely to be much higher for total NHS expenditure on constipation when GP visits, home visits and prescriptions are taken into account.

£162m was spent by NHS England on treating constipation in 2017-18 alone

Aside from the costs to the NHS, constipation can leave patients with anxiety or depression. Chronic constipation can also cause debilitating psychological and physical distress such as chronic pain or urinary tract infections. If not dealt with early on, it can also lead to more complex problems. BOWEL INDEPENDENCE DAY

The Bowel Interest Group is launching the second edition of The Cost of Constipation report on Bowel Independence Day on 10 July. The research explores the cost of constipation to the NHS and the partnership is launching a new clinical pathway to help reduce its impact on patients’ lives. For more information on the Cost of Constipation report go to www.bowelinterestgroup.co.uk. The Bowel Interest Group receives an educational grant from Coloplast Ltd. The Bowel Interest Group operates in an independent capacity and Coloplast has no editorial control.

TARA’S EXPERIENCES

ara, 51, was born with Spina Bifida. Her spinal cord was fused to her spinal bones. Surgery was performed when she was 18-months-old, releasing the spinal cord, but damaging the nerves to the bladder and bowel. This left her doubly incontinent. Tara lives in London. “When I was young, I had no control over my bowels. You get the pulsating that moves the faeces throughout, but I'd have accidents. Nothing would move the faeces along, so I was given lots of strong laxatives. “As a child taking lots of medications and the laxatives, I hated it. I stopped the laxatives, because there were too many accidents. I’d rather be constipated and strained than have accidents at school or at home. I just couldn't deal with it. “The accidents were less as a young woman because I was heavily constipated. After my ileosis deplasty I would get bouts of diarrhoea. “My bowel isn’t right. I’m going from constipation to chronic diarrhoea within a day.

“It got so bad whatever I ate, I just had chronic diarrhoea. I went to my gastroenterologist because I was having accidents two or three times a week. I was still going to work and hiding it very well, because no one had any idea, but it was becoming intolerable.” Tara has been using a trans-anal irrigation system for the past decade. Before she started using the system, she suffered from frequent panic attacks. “It’s the panic of, is it going to happen? If it happens, where do I go? Have I got a spare set of clothes? Did I bring enough pants? “The panic attacks would be coming more frequently, and the anxiety, and the, ‘Why would anybody want to spend their life with me? What have I got to offer anybody?’ “As soon as I step out of that door, the coat of bravado on, I’m fine. I’m looking well, I’m dressing well, I’m happy, I’m smiling. If you take the coat off, I’m miserable and I don’t look good and I’m not happy and I’m crying,

1 https://fullfact.org/economy/pay-rises-how-much-do-nurses-police-teachers-and-mps-get-paid/

because I’m not like everybody else and I can’t fix it. I can’t get rid of it. If I could remove my bowel, I would, but I can’t do that.” Having struggled in the first few months to achieve a good evacuation with the transanal irrigation system, Tara made small tweaks to her routine, which makes the treatment more successful. She felt like everybody else, going to the toilet when she wanted to. She found it life changing. “It fitted in with my schedule, it enables me to hold down my job, and socialise and meet with friends and family, and do the things that I want to do now, whereas I probably would have restricted my life dramatically. “It’s given me back my life. I’m able to hold down a full-time job. I have a mortgage. I’m able to drive. It’s given me independence and it cuts out the panic of, ‘Am I going to have an accident?’ It’s given me quality of life and I think I deserve that.”

M AG A ZI N E S P EC I A L ED I T I O N | J U LY 2019 | 27