The NHS QIPP challenge: A collaborative effort can drive success

By Chris Pepler, Senior Vice President, Global Commercial Solutions, Quintiles

The concept of joint working between the National Health Service (NHS) and the biopharmaceutical industry on a broad agenda for the benefit of patients is a promising one. The Quality, Innovation, Productivity and Prevention (QIPP) challenge aims to ensure that the NHS progresses from good to great, introducing a new drive towards a more preventative and people-centred service that is better for patients and also more productive, acquiring more for the public from a much-expanded and more capable and resilient system. The willingness by the NHS to work with the life sciences industry paves the way for the biopharma industry and service providers to prove the real-world value of medicines and improve patient care while driving the QIPP agenda.

To meet its joint working vision, the NHS will need to rely on trusted partners to deliver on key components of its programs. The question many are asking is: Which companies will be able to participate?  Are biopharma market leaders the best equipped to drive the QIPP agenda, or can smaller firms and service providers contribute as well?  In Quintiles’ view – serving as both a partner to the NHS directly through its Health Checks program in NHS Doncaster and for many other programmes, and as a service provider for global biopharma companies – both biopharma and service providers can play a significant role in meeting the QIPP challenge.

To date, most major NHS initiatives have been driven by “big pharma.”  These market leaders have much to contribute and gain from strengthening their partnerships with the NHS.  On one hand, the pharma sector sees an opportunity to provide expertise to the NHS to increase efficiency and meet patient and NHS needs with accessible, sustainable and cost-effective therapies.  For example, the collaborative NHS/industry project that involved AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Nycomed and Pfizer, helped to identify undiagnosed or misdiagnosed Chronic Obstructive Pulmonary Disease (COPD) patients. The project (which was delivered using Quintiles nurse advisers) demonstrates how transparency with stakeholder objectives and alignment of goals can build trust. It won a prestigious Association of the British Pharmaceutical Industry (ABPI) Joint Working award. 

For biopharma firms, there is also the incentive to add value to brand propositions to help drive drug adoption and usage through evidenced-based patient support and improvement of health outcomes.  Through joint working, biopharma companies will have a chance to build relationships with the NHS based on trust, which should help overcome an historical stumbling block to collaboration.  On the other hand, while there are strong motives for strengthening their partnership with the NHS, biopharma will also have to consider the extent to which they diversify their business model to engage in a more traditional service delivery role, and how such a model maps to their overall business objectives. 

Potential Role for Smaller Companies & Service Providers

With big pharma playing such a large role to date, many smaller pharma companies and service providers may question whether they can engage in a patient-centric strategy to assist the NHS, one that will also support their company’s position in the marketplace.  Yet, it is vital for smaller players to participate in joint working in order to ensure the scope of the NHS programs – and the accompanying solutions – remain broad based, and that competition for these services remains open to companies outside the traditional “market leader” definition. The fact is that the QIPP agenda provides many opportunities for a broad range of companies to engage with key NHS stakeholders to improve quality and productivity. One model that has the potential to improve governance is a syndicate or consortium of companies working together, with a service provider acting as an independent link in the relationship with the NHS.  Some partnerships may focus on a single disease state, while others could be broader, such as integration in the management of patients with long term conditions.  In this more holistic approach to a partnering model, a service provider can bridge the gap between the NHS’ need for “end-to-end” solutions – including diagnosis, treatment and/or referral of patients, measurement of patient outcomes and experience – and the biopharma sector’s focus on brands.  And, depending on the service provider’s geographical footprint, it also may be able to assist the highly-fractured NHS organisation (with 152 PCTs in England currently), by transferring insight and learnings across multiple geographies, and be able to rapidly scale to deliver solutions that will drive the critical productivity the NHS programme is demanding.  By doing these things, smaller providers, in turn, can establish a unique competitive advantage. 

Essential Success Factors

Building these joint working arrangements will take place in a tough environment; the NHS will be required to save £15-20 billion from 2011 to 2014.  Therefore, a vital element for success for any partnerships between service providers, biopharma companies and the NHS is that they must  be structured based on a shared agenda for all partners.  Regardless of whether pharma and service providers collaborate through a consortium or work alone, there are several attributes that are essential in forging strong partnerships with the NHS:

•    Transparency and openness on objectives.
•    Detailed insight into NHS operations and priorities, particularly at regional and local level, where many decisions are made and implemented. Ensuring availability and entry of products/technologies expertise is particularly useful here. 
•    Service delivery excellence and scalability, with the ability to deploy resource cost-effectively at single or multiple sites on short notice.
•    Connectivity, with talent at co-ordinating a diverse range of services – such as call centres, clinical communications, complex data collections, health checks, service redesign and programme management. This will drive appropriate services to support evidence-based medicine, increase compliance and optimise resource utilisation.
•    A patient-centric approach to stewardship, with an unfaltering commitment to patient safety and optimum outcomes.
•    The willingness and ability to engage in a discussion about sharing risk, an increasingly important conversation as it relates to forging a strong relationship with the NHS.

What does the QIPP challenge mean for service providers like Quintiles, who can partner with its customers or go it alone?  Part of Quintiles’ commercial strategy in the UK is to help both the NHS and biopharma respond to the QIPP agenda via the Quintiles NHS Commercial Team.  The COPD initiative mentioned above demonstrates how a collaborative approach can work for many.  Both the NHS and our customers benefited from Quintiles’ existing structure to deliver efficient and cost-effective services. In addition, our participation removed the potential for conflicts of interest – therefore building trust – and provided the necessary structure to protect patient data.

The QIPP agenda presents the opportunity to spur cross-industry collaboration to ensure that new medicines address patient needs, optimise the quality and productivity of care, and provide real value to commissioners. Many companies – large and small – have a role to play in this collaboration.  Specifically, smaller companies should consider how they can participate in the QIPP challenge via a consortium approach with a service provider acting in a facilitator role.

Panel: Case Study: Successful Launch of UK Cardio Risk Assessment Program

The UK government has adopted a major shift for the NHS, moving from focusing predominantly on treatment and cure to one that looks first to prevention. In 2008, it announced plans for all citizens aged 40 to 75 to be offered free health checks for heart disease, stroke, diabetes and kidney disease. More than two million people will be assessed annually, and health ministers believe the checks have the potential to save 2,000 lives a year and prevent 9,500 heart attacks and strokes.

The NHS has undertaken an ambitious national program of cardiovascular disease risk assessment for the 40-75 age group.  Quintiles worked within a state healthcare service to risk assess large numbers of people in a particularly challenging environment. The results have been remarkable.

Focus on Prevention

Disadvantaged areas around the town of Doncaster were selected as “spearhead” regions for a pilot scheme; areas that suffer significantly higher death rates from circulatory diseases compared with the country average, often with a high
concentration of at-risk populations. 

Quintiles provides experience, resources and project management skills to ensure a successful conclusion in this extremely visible national pilot.  High service quality and the ability to scale-up services in a cost-effective way were key attributes.  Quintiles has built a strong relationship with National Health Service teams, gaining a unique insight into the NHS culture and priorities.  Key elements of the case study were: 

Challenge: A high-profile national pilot study to assess cardiovascular risk targeted a population unused to going to the doctor for preventive care.  Risk assessment targets were very high — 6,000 people from scratch within 12 months — and focused on a community of people who do not readily access established healthcare services. 

Solution: Quintiles teamed with the NHS to develop a campaign to motivate patients.  This used an accessible tone of voice, creating a viral momentum through various channels – including the web site, www.testyourheart.org.uk -- for the broadest outreach and appeal.   The marketing campaign has been described as a model in target involvement, driving residents to attend clinics. Over 7,000 residents have been assessed, with 7% identified as having a 20% or greater risk at 10 years.

Results: All Key Performance Indicators were met.  From Quintiles’ perspective, this experience with the NHS is transferable to any of England’s 152 NHS Primary Care Trusts, and places the company in a strong position to facilitate relationships for its clients.