How will the legislation of Integrated Care Systems in July 2022, and the ‘New NHS’ impact on Pharma market access?
NHS England is going through its most significant changes for 30 years, which will have a substantial impact on current roles and responsibilities and decision-making processes. From Pharma’s perspective, these changes will define who they interact with and how they should go about doing so. In essence, the NHS is moving towards being ‘one locally managed system’ with a single pot of money per Integrated Care System (ICS).
We recently spent a day with seven of our NHS Associates discussing their roles, responsibilities and priorities, and attended a session run by Karen Cooper, a key member of Mtech Access’ NHS Insight & Interaction team with first-hand experience of leading multiple Key Account Manager (KAM) teams. Drawing on our learnings from these sessions, we outline recent changes to NHS structures set to impact Pharma market access, including:
Integrated Care Systems
What are ICSs?
ICSs are partnerships between NHS organisations that deliver health and care needs across geographical areas, with the aim of improving population health and reducing health inequalities. They aim to break down the barriers between traditional providers of care, and incorporate local authorities, the voluntary sector and social services to improve care for individuals and communities.
Decision making and finance systems in ICSs
Each ICS will be led by an Integrated Care Board (ICB) that will have overall responsibility for NHS services and budgets; however, the majority of local decisions will be made at place level.
Finance systems are undergoing transformation, with a move away from payment by activity and more towards block payments and ‘bundles’ of care, referred to as ‘Aligned Payment and Incentive Agreements’. These financial changes aim to ensure the best use of system resources and help to address the challenges associated with fragmented payment systems.
So, what does this mean for Pharma?
At ‘place’ level there will be a greater focus on population health management and delivering care that best meets the needs of the local population, and less focus on treating individual conditions separately and seeing secondary care as the prime location for treatment. ICSs will be looking more holistically at how patient access to care can be improved, including:
- What services should be available in the community to meet patients’ needs
- How patients’ overall health and well-being can be improved
- How patients can be kept out of hospital where appropriate treatment can be delivered in a convenient way, elsewhere
As a result, Pharma need to understand the demographics of each ICS, and how their products add value in the context of the ‘bigger picture’. For example, value propositions could place more emphasis on releasing capacity, supporting patient flow and freeing up workforce, rather than hospital cost savings. This would be supported by Aligned Payment and Incentive Agreements, which provide a financial incentive to move away from increased activity within hospital trusts, and more towards community/off site activity.
Place-based partnerships & provider collaboratives
What are place-based partnerships?
Place-based partnerships are collaborative arrangements formed by the organisations responsible for arranging and delivering health and care services either in a locality or a community. They aim to:
- Create a shared local vision
- Build new relationships within communities to create opportunities for health and care organisations to improve local services
- Support joined-up resource management
- Embed effective place-based leadership
What are provider collaboratives?
Provider collaboratives are partnership arrangements involving at least two provider organisations working across multiple places, with effective decision-making arrangements and a shared purpose. Their aim will be to reduce unwarranted variation and inequality in health outcomes and to improve patient experience and access to services.
So, what does this mean for Pharma?
Place-based partnerships are likely to be where the majority of local decisions are made and, therefore, where Pharma need to focus their attention.
The footprint for formularies and APCs may well change in the future to cover Provider Collaboratives or even sit at ICS level, meaning there is the potential for products to lose formulary status across large areas. It is essential, therefore that KAMs understand their territories, who their new customers are, how the trusts within provider collaborative(s) work together, who makes the decisions, and how they can plan and tailor their conversations to suit each local area.
Place-based partnerships and provider collaboratives will drive transformation of care pathways across systems, places and neighbourhoods, meaning that Pharma and KAMs in particular should be aware that patient flow is changing, as well as when and where care is taking place.
Specialised services
Specialised services will continue to be funded by NHS England throughout 2022–23; however, ICB plans must cover specialised commissioning, with a requirement for these plans to be published from July 2022. It is thought that some specialised services may be delegated to ICBs as of 2023, but what this will look like in reality is still unknown.
So, what does this mean for Pharma?
While there is no immediate impact, Pharma will need to be ready for this change in funding as it will involve a substantial shift in the way things are currently operationalised. It will be increasingly important to keep abreast of any policy documents and guidance, to ensure full understanding of the impact and implications of any changes.
Primary Care Networks
What are PCNs?
PCNs are groups of practices working collaboratively to focus local patient needs and patient care with primary care as a whole, moving to a more collaborative way of working. PCNs are lead by Clinical Directors (individuals who usually hold a professional clinical role in general practice) are working to understand what PCNs could be in the future, whilst ensuring that all roles within each PCN are aligned to the same vision and set of objectives.
Key changes in primary care (1) – The Additional Roles & Reimbursement Scheme
The Additional Roles & Reimbursement Scheme (ARRS) was introduced to make general practice more resilient and to support delivery of new ways of working, and has resulted in a more diverse workforce. Pharma should look to understand which roles are used in their accounts. The relevant individuals may not currently be known to their KAMs so Pharma will need to find new ways to identify and drive engagement with them.
Key changes in primary care (2) – Directed Enhanced Services contracts
Directed Enhanced Services (DESs) contracts set out core requirements and entitlements for a PCN and underpin their role in improving the effectiveness of primary care services. Since the DES contract brings income into general practice, primary care decision makers will be looking to meet the requirements of the contract. During 2021/22 the contract focussed on:
- Cardiovascular disease (CVD) diagnosis and prevention
- Tackling neighbourhood inequalities
- Personalised care
- Anticipatory care
In addition to these areas in 2022/23, there will be a focus on:
- Extended hours access and Enhanced Access
- Medication Review and Medicines optimisation (for care homes/complex and problematic polypharmacy/medicines commonly associated with medication errors and for patients with severe frailty)
- Enhanced health in care homes
- Early Cancer diagnosis and
- Social Prescribing services
For industry, understanding how products are aligned to the DES contract will be key, since anything that supports delivery will be high on PCNs’ agendas.
Key changes in primary care (3) – Investment and Impact Fund
A PCN is entitled to additional funding by virtue of the Investment and Impact Fund (IIF). The indicators within this funding pot consist of the following domains, with some of the detailed indicator measures within these being highly relevant to some of our clients, giving rise to various opportunities for collaborative working:
- Prevention and Tackling Health Inequalities (includes vaccination and immunisation; Tackling health inequalities and CVD prevention)
- Providing High Quality Care (includes Personalised Care, Access, Enhanced Care in care homes, Anticipatory care, Cancer, Structured medication reviews and medicines optimisation)
- Sustainable NHS (includes Environmental sustainability)
So, what does this mean for Pharma?
With population management and tackling neighbourhood inequalities being key areas of focus for PCNs, Pharma will need to demonstrate an understanding of the needs of the population within each PCN’s remit. As such, a move to more tailored value messaging will be crucial as well as the need to remain one step ahead of the changes and key drivers in the current NHS environment ensuring each interaction with the NHS is relevant and impactful.
Summary
The ‘New NHS’ signifies a major shift in how health and care services are planned and delivered, in a move away from the competition previously experienced, towards a collaboration between services.
At Mtech Access, we want to help our clients understand the significant changes the NHS is undergoing, and the impact this has on shaping value communication materials and market access strategy.
If you’d like to learn more about our understanding of the evolving NHS environment and the impact this may have on your market access and NHS engagement strategies, please email info@mtechaccess.co.uk.
