Joint Working with the NHS

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Joint Working with the NHS
Joint Working between Pharmaceutical Companies
and the NHS and Others for the Benefit of
Patients An introduction to the ABPI guidance
notes
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Content

• This presentation is a brief summary of key
  issues in the ABPI Guidance Notes on Joint
  Working.
• Joint Working between the NHS and the
  pharmaceutical industry is a relatively new
  concept and companies are likely to have little
  or no historic experience. The purpose of the
  ABPI Guidance is to support appropriate Joint
  Working including how potential pitfalls might be
  identified and avoided.

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Quick Guide to the Guidance Notes

• Chapter Key content
• Purpose of this Guidance Outlines the need for a
  framework for joint working.
• Background to Joint Working Describes how NHS
  and pharmaceutical company relationships are
  evolving.
• Definition and Scope of Joint Working Patient
  benefit and pooled resources are core.
  Describes what is not Joint Working.
• Principles of Joint Working Need for patient
  benefit, mutual benefit, transparency and
  organisational level sign off.
• Examples of Joint Working Suggested types of
  activity that can be included in Joint Working
  projects.
• Joint Working Governance Transparency and the
  need to avoid inappropriate influencing of
  prescribers.

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Quick Guide to the Guidance Notes

• Chapter Key content
• The Mutual Benefits of Joint Working Describing
  patient, NHS and company benefits. Being
  clear about expected outcomes.
• Measuring Joint Working Affirms that measurement
  is required and suggests criteria that can be
  assessed.
• Deciding to Take Part in Joint Working Being
  transparent, how to calculate return on
  investment for all and the importance of
  patient
  benefit.
• Joint Working Agreements Need for a formal
  agreement and specific areas that should be
  included.
• Disengagement/Exit Criteria Need to define a
  clear end point at the outset. Reasons to
  exit an agreement early.

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Quick Guide to the Guidance Notes

• Chapter Key content
• Joint Working Projects and Clinical No
  inappropriate influencing of Guidelines
  prescribers. Supported guidelines must be
  independent.
• Communicating Joint Working Projects
  Consistency of message. Ensuring JW is not
  within the Company used as inducement by
  representatives.
• Using Data Obtained from Joint Working
  Outlines the various legislation that applies.
  Projects
• Competition and Commercial-In-Conference
  Applies when more than one company is Issues
  involved. Legal counsel may be required.
• Other Considerations Personal benefit must
  not come from joint working. Anti
  corruption rules.

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Other relevant documents

• Moving beyond sponsorship Interactive toolkit
  for joint working between the NHS and the
  pharmaceutical industry, Department of
  Health/ABPI (March 2008)
• Best practice guidance for joint working between
  the NHS and the pharmaceutical industry,
  Department of Health (February 2008)
• A Common Understanding Guidance on Joint Working
  between NHS Scotland and the Pharmaceutical
  Industry (2003)
• Guidance for Partnership Working between NHS
  Organisations, Primary Care Contractors, the
  Pharmaceutical Industry and the Allied Commercial
  Sector in Wales (2004)
• ABPI Code of Practice for the Pharmaceutical
  Industry (2008)

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ABPI Code

• Most relevant clauses Clause 18.
• Joint working must not be an inducement to a
  health professional to prescribe, supply,
  administer, recommend, buy or sell any medicine.
• Only informal guidance about the Code can be
  provided by the PMCPA.

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Whats in this presentation?

• Overview of content
• Definition of Joint Working
• Suggested audiences
• How to articulate benefits and return on
  investment
• Summary of mutual benefits
• Placing of initiatives (Targeting)
• Measurement
• Communication to sales forces and others
• Key differences between medical and educational
  goods and services and joint working
• Potential pitfalls

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Suggested Audiences

• This presentation is for those most likely to
  have a key role in the development and
  implementation of joint working projects such as
  
• Medical signatories
• NHS liaison team management
• NHS liaison teams
• Brand marketing teams
• Compliance officers
• Legal

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Definition of Joint Working

• Joint Working is defined in the DH/ABPI Joint
  Working Toolkit Moving Beyond Sponsorship as
• Situations where, for the benefit of patients,
  one or more pharmaceutical companies and the NHS
  
• pool skills, experience and/or resources for the
• joint development and implementation of patient
• centred projects and share a commitment to
• successful delivery.

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The key requirements from this definition are
that

• the Joint Working project must be focused on
  benefits to patients and
• there must be a pooling of resources between
  the pharmaceutical company/ies and the NHS
  organisation(s) involved.

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Key requirements continued

• Each party must, therefore, make a significant
  contribution to the Joint Working project to
  avoid the arrangement being construed as merely a
  gift, benefit in kind, donation or some other
  non-promotional/commercial practice.
• Resources may come in various forms, including
  people, expertise, equipment, communication
  channels, information technology and finance.

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Joint Working must

• benefit patients (expected to also mutually
  benefit the parties).
• be conducted in an ethical, open and transparent
  manner overall arrangements made public.
• take place at a corporate organisational level
  and not with individual health professionals.
• be in accordance with the ABPI Code, government
  guidance, NHS rules and relevant professional
  codes, etc.

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Investment

• Joint Working projects are likely to be of
  significant scope and size, involving resources
  in the region of 15 - 20k or more and lasting
  six months or longer. Lower figures may be
  applicable depending on circumstances. The key
  determinant is whether a project follows the
  principles of joint working.

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Benefits of Joint Working

• When describing the benefits of a specific joint
  working project one must be able to
• Clearly define patient benefits
• Show how the NHS will benefit
• Describe how the company will benefit
• Ensure that both parties are comfortable with the
  arrangements
• As these are business to business arrangements
  it is both reasonable and appropriate for both
  parties to consider return on investment (ROI)
  before committing to any project.
• Commercial benefit to either party must not be
  the sole benefit.

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Benefits of Joint Working

• Pharmaceutical companies can calculate ROI
  provided governance arrangements are in place
• ROI calculations should be set out in the context
  of patient care and shared with the parties
• The aim of conducting ROI analysis should be made
  clear eg to make decisions on resource
  utilisation
• Companies should not terminate a project solely
  on the basis of a negative ROI for its medicines
• Both parties, the NHS and company, should be able
  to articulate their ROI in clear and measurable
  terms

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Benefits of Joint Workingfor patients can
include

• Care closer to home
• Fewer hospital admissions
• More equitable and consistent care and access to
  care
• Better information about conditions and treatment
  options
• Clearer and improved care pathways
• Better experience of the healthcare system

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Benefits of Joint Workingfor the NHS can include

• Higher quality, more consistent care achieved
  more rapidly
• Services configured around patients needs
• Better health outcomes
• Better use of resources, more value for money,
  lower costs
• More people treated appropriately (eg in line
  with national guidelines)
• Lower costs of hospital admissions
• Support towards achievement of performance
  targets
• More creative approaches to problems
• Better cross-sectoral working
• Better skilled personnel

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Benefits of Joint Workingfor the pharmaceutical
company can include

• Market expansion and/or more appropriate use of
  medicines, including the companys medicine(s)
• Better understanding of customers and patients
  needs
• Improved reputation
• Faster NHS implementation of policy which may be
  relevant to the companys business

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Deciding to take part

• It is acceptable to target Joint Working
  geographically according to
• Identified patient need
• Availability, experience and commitment of
  relevant personnel to deliver the project
• Areas where the NHS has expressed a need or
  desire to improve benefits to patients by working
  together with the pharmaceutical company/ies
• When targeting a project to a location ROI for
  the company must not be the sole or primary
  criterion

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Measurement

• The outcome of every project should be measured
  and baseline measurements might be helpful to
  track success, particularly patient outcomes.

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Exit Criteria

• Must be agreed and included in the Joint Working
  agreement.
• Either party should be able to exit an agreement
  if patients are not benefiting and must do so if
  the project is detrimental to patients.
• A pharmaceutical company may not terminate a
  Joint Working project solely on the grounds that
  prospective ROI is not met.

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Joint Working Agreements must include

• Name, parties, date and term.
• Expected benefits for patients, the NHS and
  pharmaceutical company.
• Outline of the financial arrangements.
• Roles of the parties, how success will be
  measured.
• Contingency arrangements.
• Summary of Joint Working agreements to be made
  public by the pharmaceutical company.

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Communication within thecompany

• Companies should consider how sales
  representatives and other personnel are briefed
  to ensure that the Joint Working agreement is not
  infringed and that the project is not used
  inappropriately by sales representatives to gain
  access to customers or to influence prescribing
• The importance of consistent communication within
  a company regarding Joint Working initiatives
  should not be underestimated

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Potential pitfalls

• Joint Working is different to the provision of
  Medical and Educational Goods and Services (MEGS)
  that enhance patient care or benefit the NHS and
  maintain patient care.
• It is very unlikely that the provision of MEGS
  would ever meet the definition of Joint Working
  as they are mainly provided by a pharmaceutical
  company in circumstances where there is no
  pooling of resources.

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Key Differences between Medical and Educational
Goods and Services and Joint Working

• MEGS JW
• NHS/Pharma company pool resources x P
• Detailed JW agreement x P
• Outcomes must be measured O P
• Shared commitment to successful delivery P
  P
• Details of arrangement made public O P
• O Optional

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Is a proposal for Joint Workingin line with ABPI
guidance?

• Chapter Features of proposal
• Definition and Scope Able to describe how
  patients, the NHS and of
  Joint Working the company are likely to benefit.
  There is a clear and significant pooling of
  resources between the company and the NHS.
  Certainty that this is not just a traditional
  MEGS activity.
• Principles of Joint Working Patients are the
  principal beneficiary. A written agreement
  will be in place.
• Joint Working Governance The project is
  transparent. Have ensured that the project
  has been agreed at an organisational level so
  that inappropriate influencing of prescribers
  has not occurred.

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Is the proposal for Joint Workingin line with
ABPI guidance?

• Chapter Features of proposal
• Measuring Joint Working Have a range of
  measures that are specific to the patient,
  NHS and company. Have expected outcomes
  for this project and an agreed schedule for
  measurement to ensure these take place.
• Deciding to Take Part in Have considered a
  balance of benefits for all parties and can Joint
  Working clearly show that decisions have been
  made at an appropriate level in the
  company. Any ROI calculations have been
  made to support resource allocation
  decisions.
• Joint Working Agreements Have a formal
  agreement in place that is very clear about
  what all parties have agreed. Have not started
  the
  project prior to having this agreement.

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Is the proposal for Joint Workingin line with
ABPI guidance?

• Chapter Features of proposal
• Disengagement/Exit Criteria Both parties know
  exactly when and why the project will end. All
  know what interim steps must be
  achieved in order to reach the
  project end and can describe the circumstances
  that will end the project
  earlier
  than planned.
• Joint Working Projects and Any clinical
  guidelines being followed are
  Guidelines independently approved. If the
  company previously supported their development
  can independence from the project be
  demonstrated? Guidelines are not a disguised
  switch programme.
• Communicating Joint Working Everyone in the
  company who has contact with Projects within the
  Company any customer affected by this project
  understands their role. All have clarity about
  the expected outcomes and know that the project
  must not be used to influence prescribing.

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Further advice

• ABPI - Martin Anderson (Director, NHS Policy and
  Partnerships) on 020 7747 1401 or
  manderson_at_abpi.org.uk
• ABPI Extranet
• PMCPA Heather Simmonds, Director on 020 7747
  1438 or info_at_pmcpa.org.uk