Improving access: The benefits and challenges of joint working
By: John Procter | June 16, 2016
A joint working approach allows biopharma to pool resources and collaborate with the NHS to improve patient care.
As part of the ABPI conference that recently took place in London, I was joined in a panel discussion by two biopharma industry representatives. The panel discussion focused on both the benefits and challenges of biopharma and NHS joint working and our aim was to explore the improvements these projects could make to patient care. This post reflects on the fascinating discussions held.
Joint working projects, where one or more biopharma companies collaborate with the NHS to improve the delivery of healthcare, can provide winning solutions for all stakeholders. While the benefits are clear, managing the projects can be challenging, and here a third party can provide the dedicated project support needed to make them work.
Improving access through joint working
Once a drug has gained approval from the European Medicines Agency (EMA) and is recommended for use in the NHS by NICE (National Institute for Health and Care Excellence), it can then be used by prescribers. But access and uptake is not always guaranteed. Although the new medicine is deemed effective, it may be more expensive than existing treatments, may require additional training and resources for administration, as well as different treatment pathways. Often services that were set up more than a decade ago are not able to accommodate new therapies and increasing demand.
A joint working approach allows biopharma to pool resources and collaborate with the NHS in order to address these challenges and ensure that the right patient receives the right drug, and that resources are allocated appropriately. The projects can enhance access to treatment for patients, streamline workflows for healthcare professionals, improve cost effectiveness or even cut costs for payers and providers. Most importantly they can deliver practical solutions and improvements.
Facing the challenges
There are a number of challenges for companies aiming to create joint working approaches with the NHS. One of the key barriers identified by the panel is a lack of understanding from within the NHS of how the internal approval processes function in biopharma and how long it can take, especially when a number of companies are involved. This can lead to frustration which has led to some proposed projects failing. Another barrier is the internal ‘sell’ within biopharma, as joint working projects need time and personnel commitment, as well as financial investments, and getting internal stakeholders on board can be time consuming.
Providing a solution: The Leeds anticoagulant project
Patients at risk of thrombosis traditionally received treatments such as warfarin via their local warfarin clinic. There have been a number of novel oral anticoagulants (NOACs) launched in recent years that provide similar or better outcomes for patients at risk of thrombosis, compared with current treatment options. Introducing these treatments requires a different service specification and patient pathway.
In the Leeds Teaching Hospitals NHS Trust (LTHT), the existing service was suffering from high patient volumes, with hospital visits increasing, home visits and community clinics booked to overcapacity and patients having to travel to distant clinics for blood tests. Furthermore patients were not getting immediate results and necessary interventions, due to blood samples having to be sent to the trust for testing and reporting. This resulted in longer waiting times and patients unable to book local appointments. The Trust recognized that this disruption put patients at risk and increased workplace stress for healthcare professionals and other staff.
As part of a joint working project to redesign the pathway and service, Quintiles acted as a third party between the NHS and four pharma companies, Boehringer Ingelheim, Bayer, Bristol Myers Squibb and Pfizer, coordinating the collaboration and bringing its own skills and expertise in pathway redesign. A third party can play a valuable role in such projects, acting as a coordinator and conduit for the individual pharma companies and the NHS, and ensuring that timelines and goals are achieved. Through measuring and reporting outcomes third parties can also help to persuade senior management on both sides that the investment is valuable.
In this case the parties worked together to redesign the service, creating in a ‘hub-and-spoke’ delivery service and a streamlined patient pathway. This created a ‘one-stop-shop’, including point-of-care testing and immediate results, followed by intervention by a trained health care professional as required, all within one clinic visit. This included NOAC therapy in line with NICE guidance if appropriate. This reduced waiting times, improved safety, enabled better and more convenient access to treatment for patients, increased uptake of NOACs and ensured that patients received optimized quality of care within NICE guidelines. While the Trust accepted that there was a financial burden associated with the project, it allowed them to address safety issues and improve outcomes for patients
The key take-home messages
Joint working projects need tight collaboration and clear and transparent objectives and processes. Above all, they need a common goal that provides a benefit across the board. While this can appear difficult, with the support of a third party like Quintiles, successful joint working projects can achieve significant and positive results for all of the stakeholders.