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2019 Opportunity, uncertainty & change


Cracking the NHS

“O ne thing that is certain is that uncertainty is likely to continue� Page 10

Trusting online medical information Living well with HIV PHARMAFIELD.CO.UK



STATE OF AFFAIRS What can pharma and healthcare expect in 2020? Trends and predictions • Digital health and emerging technology Emerging markets • Innovation in the NHS


Our Pf Magazine Special Editions cover the issues at the heart of the pharmaceutical sales and marketing environment, including expert intelligence, comment and analysis from industry insiders.

We are looking for key opinion leaders and influencers in pharma to provide industry intelligence for the Pf  Special Edition on The State of Affairs 2020.

If you would like to contribute an article or expert comment, contact or call 01462 226128.


Emma Morriss



ell, we’ve made it to the end of 2019, we’re still in Europe and we have a General Election to contend with. Given it feels like we’re on a political merry-go-round, some could argue that 2019 hasn’t see any major developments. But for industry there have been developments from the NHS Long Term Plan to NHS England’s commercial framework consultation, the introduction of the Voluntary Pricing and Access Scheme and Falsified Medicines Directive. It’s been a case of opportunity, uncertainty and change as our cover story explores. Community pharmacy has had an incredibly eventful year with new policy shaping the role of clinical pharmacists and their place within the new primary care networks. It ultimately means that community pharmacy is likely to have to change and adapt in 2020, creating challenges and opportunities for all involved. Deborah Evans summarises the key points. Our politics and commissioning articles this month consider 2020 from the developments of 2019. In Politics, Claudia Rubin asks whether the NHS will continue to be a commercially viable market for industry. In commissioning, Julie DasThompson looks at the clinical commissioning group mergers expected next year. Examining the NHS, Oli Hudson discusses the changes to cancer services that will bring them in line with January’s NHS Long Term Plan. This includes Cancer Alliances, rapid diagnoses and integration. With World AIDS Day on 1st December, our therapy area looks at living well with HIV, studies, treatments and developments which mean someone living with HIV and on effective treatment can’t pass on the virus. Finally, we have an exciting announcement to make about the Pf Awards. Next year, the Pf Awards mark their 20th anniversary; turn to the centre pages where we reveal our exciting host for this prestigious celebration.






Emma Hedges NEWS DESK


Fiona Beard Pf AWARDS

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The content of and information contained in this magazine are the opinions of the contributors and/or the authors of such content and/or information. Events4Healthcare accepts no responsibility or liability for any loss, cost, claim or expense arising from any reliance on such content or information. Users should independently verify such content or information before relying on it. The Publisher (Events4Healthcare) and its Directors shall not be responsible for any errors, omissions or inaccuracies within the publication, or within other sources that are referred to within the magazine. The Publisher provides the features and advertisements on an ‘as is’ basis, without warranties of any kind, either express or implied, including but not limited to implied warranties of merchantability or fi tness for a particular purpose, other than those warranties that are implied by and capable of exclusion, restriction, or modification under the laws applicable to this agreement. No copying, distribution, adaptation, extraction, reutilisation or other exploitation (whether in electronic or other format and whether for commercial or non-commercial purposes) may take place except with the express permission of the Publisher and the copyright owner (if other than the Publisher). The information contained in this magazine and/or any accompanying brochure is intended for sales and marketing professionals within the healthcare industry, and not the medical profession or the general public.

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December 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:




Pf Magazine




Deborah Evans FRPharmS FFRPS FRSPH is Managing Director of Pharmacy Complete, a training and consultancy company working with pharmacy and the industry.

Julie Das-Thompson is Head of Policy and Delivery at NHS Clinical Commissioners, the independent membership organisation for clinical commissioners in England.

Oli Hudson is Content Director for Wilmington Healthcare. He oversees material for training and education, consultancy services, network meetings, thought leadership, events and webinars. In previous roles at the company, he has worked with the NHS and industry on a wide range of training, access, collaboration and partnership projects.

In this issue CLAUDIA RUBIN 

Claudia Rubin is a Director at Decideum, one of the UK’s leading consultancies in healthcare policy and market access. She has over 10 years’ experience in healthcare advocacy and communications, supporting global pharmaceutical companies and small patient groups with integrated public affairs strategies.


Amy Schofield is Special Editions Editor at Pharmafield. She is an experienced journalist and editor of both digital and print content across healthcare, technology and careers. RAMYA SRIRAM 

Ramya Sriram is a Content and Communications Specialist at Kolabtree, the world’s largest platform for freelance scientists and researchers. Ramya’s experience spans 10 years in publishing, advertising, and digital content creation.



Bringing you the essential headlines

Community pharmacy’s eventful year




Opportunity, uncertainty and change, 2019 in review

Ending transmission and living well with HIV




The future of cancer care under the NHS Long Term Plan

Translating early science for patient benefit




Why the NHS is becoming a tough nut to crack

The power of teamwork in pharma




CCG mergers mark a rapid period of change for commissioning

Who’s moving where in the industry?



Who does the public trust more, Google or their GP?

New year, new job; are you changing career in 2020?




Roche’s role in encouraging talent across industry



30 32


Claudia Rubin, page 14




arly signs of lung cancer spread and that it may become untreatable can be picked up in samples of blood and tumour, according to a trio of papers published in Nature Medicine. The three studies are all part of Cancer Research UK’s £14m TRACERx project, which aims to understand how lung cancer cells change over time and become resistant to treatment. Together, the new findings provide clues as to which patients could be safely treated with milder therapies, such as surgery alone, and which may need additional treatments including chemotherapy. The discoveries could also help researchers develop new ways to treat the more aggressive forms of lung cancer.


IN FAVOUR Allergan’s shareholders have voted to approve the proposed acquisition by Abbvie. More than 99% of votes cast at both a special court-ordered meeting of shareholders and an extraordinary general meeting of shareholders were in favour of the transaction, representing (in each case) approximately 68.6% of the shares outstanding and eligible to be voted at each of the Allergan shareholder meetings held on 14 October. Under the terms of the agreement announced on 25 June, AbbVie will acquire Allergan in a cash and stock transaction for a transaction equity value of approximately $63bn, based on the closing price of AbbVie’s common stock of $78.45 on 24 June. The transaction is expected to close in early 2020, subject to customary closing conditions and regulatory approvals.

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Going global The National Institute for Health and Care Excellence (NICE) is to relaunch its not-for-profit NICE International division to deal with a growing number of enquiries from overseas health and social care bodies. NICE International is the division of NICE that provides an advisory service to international organisations, ministries and government agencies to support the use of evidence-based decision-making in health and social care systems. NICE International provides support in developing systems to improve health and social care evidence-based decision-making; embed health technology assessment to allocate resources in a cost effective, transparent and equitable way; and improve the quality of care and reduce variation of access.

P f N E W S : B R I N G I N G YO U T H I S M O N T H ' S E S S EN T I A L H E A D L I N E S




oorly implemented electronic prescribing and medicines administration (ePMA) systems in the NHS can result in potentially fatal medication errors, according to the Healthcare Safety Investigation Branch. Its report highlights that many NHS trusts across England are taking up ePMA systems to reduce medication errors, but that incomplete use of systems could create further risks to patient safety. The investigation found that often all the functions of ePMA systems aren’t being used and that staff switch between using paper record and digital records, increasing the likelihood of crucial information being missed. It also highlighted the routine lack of information sharing between NHS services, such as GP surgeries and pharmacies. The report identifies that the availability of a seven-day hospital pharmacy service is crucial to support a digital system and pick up any errors quickly. Pf View: Given the ongoing digital transformation of the NHS, this report shows that it requires full adoption, buy-in and infrastructure, otherwise it can lead to potentially life-threatening situations.


The predicted rebate level for

< 8% 64.2%

2020 MAY BE

2019: Opportunity, uncertainty and change, p10

Cannabis guide The National Institute for Health and Care Excellence has published guidance on cannabisbased medicinal products. The guideline covers prescribing of cannabis-based medicinal products for people with intractable nausea and vomiting, chronic pain, spasticity and severe treatmentresistant epilepsy. The guideline covers: • Cannabis-based products for medicinal use as set out by the UK Government in the 2018 Regulations • The licensed products delta-9tetrahydrocannibinol combined with cannabidiol (Sativex) and nabilone • Plant-derived cannabinoids such as pure cannabidiol (CBD) • Synthetic compounds which are identical in structure to naturally occurring cannabinoids such as delta-9tetrahydrocannabinol (THC), for example, dronabinol. It approves Epidyolex on the NHS for Lennox-Gastaut and Dravet syndromes which are rare forms of epilepsy. Sativex has been recommended on the NHS for multiple sclerosis.

of people turn to the internet for health information Google or GP: Who Does the Public Trust More? p20

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QUICK DOSES The European Commission (EC) approved M E R C K and P F I Z E R ’s BAVENCIO® (avelumab) in combination with axitinib for the first-line treatment of adult patients with advanced renal cell carcinoma. • The EC approved an extension of G S K’s intravenous Benlysta for children five years and older with systemic lupus erythematosus. • B AY E R announced that the EC has granted conditional marketing authorisation in the EU for the targeted oncology treatment Vitrakvi® (larotrectinib). • Draft guidance published by the N ATI O N A L I N S TIT U TE FO R H E A LTH A N D C A R E E XC E L L E N C E (NICE) doesn’t recommend atezolizumab, Tecentriq by R O C H E , for people with a type of breast cancer that has spread. • N I C E also rejected N OVA RTI S’ Aimovig (erenumab) for chronic migraine in final draft guidance. • C LOV I S O N CO LO GY’s Rubraca, designed to help maintain the effects of chemotherapy for women with relapsed ovarian, fallopian tube or peritoneal cancer, has been approved by N I C E for use in the Cancer Drugs Fund. • The S COT TI S H M E D I C I N E CO N S O RTI U M rejected R O C H E ’s breast cancer drug Perjeta®(pertuzumab) for use in combination with trastuzumab and chemotherapy for the adjuvant treatment of HER2-positive, early breast cancer. • N H S E N G L A N D secured a definitive agreement with V E RTE X P H A R M AC E U TI C A L S to make its UK-licensed cystic fibrosis drugs, Orkambi, Symkevi and Kalydeco, available on the NHS. • The S COT TI S H M E D I C I N E S CO N S O RTI U M recommended N OVA RTI S’ Kisqali® (ribociclib) in combination with fulvestrant for advanced breast cancer.

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he National Audit Office (NAO) has published a report exploring the impact of Brexit on health and social care supply. It says that there is a risk of delays to supplies for health and social care if the UK leaves the EU without a deal. The Government has undertaken work to manage this risk, but the National Audit Office highlights that there is still significant work to be done. This includes improving the Government’s understanding of preparedness across the supplier base, putting in place sufficient freight capacity to carry priority goods, and improving the readiness of the social care sector. Pf View: With further delays to Brexit, let’s hope it gives all parties involved time to ensure there are no supply issues to health and social care, should Britain leave the European Union.


In 20 years, NICE has carried out


single technology


A tough nut to crack? p14

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Liquid revolution Nova Laboratories has unveiled details of its new liquid formulation of hydroxycarbamide. Xromi, used to treat sickle cell disease, has been in development for four years. The product was granted a license by the European Medicines Agency in July 2019 and is set to revolutionise the control of the disease in young children. Solid dosage forms of the drug have been used in the treatment of sickle cell disease since the 1990s. The liquid form of the treatment makes administering the drug to children as young as two-years-old easier. It will also enable doctors to personalise doses for young children. Nova Laboratories has invested around £5.2m in product development and trials of the liquid form of the drug.


GIVEN PERMISSION TO MERGE IN APRIL 2020 CCG mergers…coming together for populations, p16

he first NHS-funded patient with limbal stem cell deficiency (LSCD) caused by chemical eye burns has been treated with Chiesi’s stem cell treatment. Holoclar is the first advanced therapy medicinal product containing stem cells to be approved in the European Union. Chiesi’s stem-cell based therapy is a type of advanced treatment called a ‘tissue engineered product’ which consists of cells taken from the patient’s healthy limbus (at the edge of the cornea) during a biopsy. They are prepared and grown in a unique culture to create a new layer of healthy tissue. After at least 50 days, this layer of healthy tissue is delivered back to the treating hospital and implanted by a surgeon into the damaged eye helping it to heal and repair the damaged corneal surface.


Rapid results

A rapid diagnostic test for antibiotic resistance is in development. Scientists are developing a low cost, rapid diagnostic sensor test which aims to show the susceptibility of bacteria to antibiotics within 45 minutes. NHS laboratory testing of samples can take up to two days and the new test aims to allow doctors to be able to prescribe the correct antibiotic to a patient for an infection more quickly. In a research paper published in the journal Biosensors and Bioelectronics, the University of Strathclyde team has demonstrated the system is capable of showing results in less than 45 minutes.


GROWING PIPELINE New data on the Roche haematology portfolio and pipeline is being presented at the American Society of Hematology 2019 Annual Meeting in December. New data for Roche’s approved and investigational medicines across a range of blood diseases will be presented. Ten Roche medicines will be featured in more than 70 abstracts and 21 oral presentations. These data feature results in 15 blood diseases across numerous molecular targets and combinations, as well as different clinical endpoints that Roche is exploring.

M AG A ZI N E | D ECEM B ER 2019 | 7


HS England has published the NHS Commercial Framework for Medicines for consultation. The 2019 Voluntary Scheme for Branded Medicines Pricing and Access committed NHS England to publishing a commercial framework, setting out more operational detail on the commercial arrangements with industry. NHS England has a significant role to play in supporting patient access to clinically and cost-effective medicines by offering enhanced commercial arrangements where appropriate and practical. NHS England would like to hear views on this framework to ensure it has been informed by a broad range of voices. Those wishing to respond to the consultation can complete the online survey on the NHS England consultation pages. The consultation closes on 10 Jan 2020.


Public at risk Consumers are at risk of buying fake pharmaceutical products as new research finds 60% of online search results for pharmaceutical drugs leads to fake medication. The study by Incopro found that up to 60% of results returned by search engines for specific search terms offer consumers access to counterfeit and possibly dangerous fake drugs. Six out of 10 of Google’s firstpage results following searches for the antibiotic Bactrim were for locations ‘very likely to be operating unlawfully’. Leveraging its artificial intelligence and machine learning technology to examine millions of webpages, Incopro found that in pharmaceuticals, the traffic to infringing websites originating from product or brand search terms was 53.2%.


Cash to upgrade The 78 trusts to receive funding for cancer screening and diagnosis have been announced by the Department of Health and Social Care. £200m in funding has been earmarked for new cancer screening equipment in the hope that the new machines will improve patient experience and lead to earlier diagnosis. The funding, spread over two years, will allow the trusts to replace, refurbish and upgrade CT and MRI scanners and breast screening imaging and assessment equipment. The new equipment should also bring new capability, with many machines enabled for artificial intelligence.

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Pf View: It’s important that industry has its say on this commercial framework which will establish how NHS England will work with NICE and industry on commercial medicines activity.


92% 98% 97%




P f N E W S : B R I N G I N G YO U T H I S M O N T H ' S E S S EN T I A L H E A D L I N E S


Biomarker collaboration



STOP MS The MS Society has launched a hard-hitting public appeal to raise £100m to stop multiple sclerosis (MS). The campaign features adverts showing real people living with the condition. The Stop MS Appeal needs to raise the funds over 10 years to find treatments for everyone living with MS, which affects more than 100,000 people in the UK. The Stop MS Appeal will enable new projects, fund critical infrastructure, and deliver a first-of-its-kind MS clinical trials platform, which together could finally address the major unmet need in MS treatment.


Medopad has announced a strategic collaboration with Janssen Pharmaceuticals to validate, scale and potentially commercialise the ReVeRe® platform as a novel digital biomarker for Alzheimer’s disease. This deal was facilitated by Johnson & Johnson Innovation Limited. The ReVeRe™ platform, developed and clinically validated by Janssen, aims to enable reliable, remote and automated assessment and monitoring of verbal memory in individuals at risk of Alzheimer’s. ReVeRe™ automates, on an iPad platform, the administration and scoring of Rey Auditory Verbal Learning Test – along with other tests of attention and executive function known to be relevant in early stages of Alzheimer’s.

MAPPING NHS CHANGE IS KEY TO CUSTOMER ENGAGEMENT Simon Grime, of Wilmington Healthcare, explains how mapping NHS change through data and intelligence can help industry understand and engage customers in the new integrated care landscape.

MORE THAN JUST PRINT. Each month we publish daily news and exclusive articles on Here’s a look at some of the exclusive content you may have missed.

MIND THE GENERATION GAP IN PHARMA MARKETING AND MARKET RESEARCH Different generations have always had preferences in the way they communicate but in the world of marketing, what does this mean when speaking with customers? The British Healthcare Business Intelligence Association’s leading-edge insight on business intelligence activities which drive generational adaptive marketing.  Want to know the full stories? Find these and all the latest news at

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2019 Opportunity, uncertainty & change 10 | PH A R M A FI EL D.CO. U K



Have we been in a Brexit-related stasis? Or have pharma and healthcare been moving forward regardless of the stalemate in Westminster? We look back at January’s predictions, policy and commercial developments over the year.

WORDS BY Emma Morriss



In January 2019, we reported predictions for the year ahead and 2019 started with a bang when the NHS Long Term Plan was published on 7 January. It set out a blueprint for the future of the NHS including the use of technology, practical action on major conditions and investment in cutting edge treatments. This was followed closely in February by the announcement of NHSX to take forward digital transformation of the NHS to ‘create the most advanced health and care service in the world to diagnose diseases earlier, free up staff time and empower patients to take greater control of their own healthcare’. Such significant announcements set the tone for the year and other key policy developments followed, including: • A new GP contract • The Community Pharmacy Contractual Framework • A Prevention Green Paper • An antimicrobial resistance action plan • National Institute for Health and Care Excellence’s (NICE’s) Review of Methods and Process • The introduction of the Voluntary Pricing and Access Scheme (VPAS) • NHS England’s Commercial Framework consultation.

Leslie Galloway, Chairman of the Ethical Medicines Industry Group (EMIG), predicted that 2019 would be the “most significant year for change that many of us will experience in our lifetime”. Given that Brexit has not moved forward over the year and there’s a General Election on the way as we go to print, Leslie revisited his predictions and is clear that uncertainty remains. “Reflecting on my comments reminds me that I really shouldn’t make predictions. However, one thing that is certain is that uncertainty is likely to continue. “We have spent much of the last three and half years wrestling with Brexitrelated issues and are no further forward. The issue of leaving may be out of our control but our future relationship with the EU will require a great deal of work on the part of industry. Depending on the outcome of the General Election, Brexit may be a significant issue for 2020. But we must not lose sight of the many other issues that require our focus.” These issues include NICE’s Review of Methods and Process, the VPAS and NHS England’s Commercial Framework.

Navigating the changing policy pathway has been a theme for the year.


Leslie, who sits on the Working Group for the NICE methods review, is acutely aware of what it involves. “There is a colossal amount of work to do. We need to constantly ask ourselves what difference any proposed changes will make to the patients who may be impacted. We also know there are limitations because the quality-adjusted life-year thresholds can’t change.” Although he adds that the medicines bill is protected by the VPAS: “The VPAS allows 2% growth and anything above is funded by industry rebates. So, we shouldn’t be concerned about other changes – the medicine bill won’t grow but the mix of technologies could vary.” Looking to 2020’s rebate level, Leslie is offering confidence to industry. “Some in our industry may be relieved that the predicted rebate level for 2020 may be <8%; below the current level of 9.6%.” But he says that raises the question of whether NHS England is committed to adopting innovation. “If it is, surely the rebate level would be higher?” He added: “A further consideration may be that the new(ish) NHS England Commercial Team is having an impact. I suspect it may be a combination of both.” NHS England’s Commercial Framework was published for consultation in November. Divided into four sections, including commercial flexibilities and circumstances where they could be considered, he said it is to be a “living document, that is updated over time”. However, it’s likely that it’s not what’s in the document that may matter, more than what is not. “NHS England has made it clear to the trade bodies that they want innovation, but not at any price. I have been critical of NHS England in the past and I believe this is a now a significant opportunity for companies to engage with NHS England in a partnership relationship.” The consultation runs until 10 January 2020 and is available on the NHS England consultation site. Beyond policy, 2019 has seen pharma coping with global trends and challenges, exacerbated by Brexit. “Economic slowdown, reducing returns on investment, pressure on showing value compared to other treatments, chasing smaller capital values in transactions” are all having an impact, explained Richard Phillips, Partner of VWV. “But the UK has the added local difficulty of the ‘B’ word which lengthens that list with regulatory uncertainty, trading uncertainty and the need to reposition in Europe.”

M AG A ZI N E | D ECEM B ER 2019 | 1 1



Despite all the uncertainty industry has had to operate within, negatives can become positives. “Disruption leads to innovation,” explained Richard. “Diminishing returns lead those who are forward-thinking to investigate and explore new avenues. The UK pharmaceutical and life sciences industry will adapt and thrive because it has a world class core strength; our mindset of creation and innovation allied with a natural inclination for trade and business will see to this.” Richard is confident that the UK’s mix of Big Pharma, small and medium-sized pharma, generics companies, start-up and early stage ideas businesses have been well placed to innovate, think about R&D in this faster moving world, as well as restructuring and outsourcing components. One example of this is the Stevenage Bioscience Catalyst where major organisations including GSK, the Cell & Gene Therapy Catapult, LifeArc and GE rub shoulders with academics and startup companies. Richard added: “Together, these individuals and start-ups have raised about £1bn in funding.” It’s also been announced as one of six new Life Sciences Opportunity Zones in the UK. So much has already been achieved in 2019, with Genomics England’s 100,000 Genomes Project and its involvement

The deep-seated opportunities will undoubtedly trump the inevitable practical difficulties of our time, which will take up energy to resolve, in 2020 as they have in 2019

in research projects such as DiscoverNOW and DATA-CAN, which Richard calls “world-leading”. Plus, thanks to UK Biobank’s whole sequencing of 500,000 people, with a view to enhancing predictive analysis, industry has proven that it can innovate in times of uncertainty. “A lot of innovation and development has been happening at a small scale, and Big Pharma is much closer to solving the practicalities of marrying up its leverage with next generation opportunities,” explained Richard. Although it hasn’t been without issues, “the difficulty has been aligning the cultural (and inevitable and often essential) governance and more bureaucratic elements of the acquirer with the fleet of foot entrepreneurial culture and light touch governance of the innovator.”


2019 has also seen companies identifying opportunities in drugs that are heading off patent. In February, Pf reported the potential of the biosimilars market and how momentum was crucial following the patent expiry of adalimumab in October 2018. “Over the year, we have seen entrepreneurial companies, small- and medium-sized, move to take advantage of certain products of a certain age,” reflected Richard. “The regulators have looked to examine these deals carefully and shut down anti-competitive actions which could or do follow, including price hikes. But improving the lot of the end patient whilst allowing a commercial upside for the provider is invigorating for the sector and allows products to take on a new lease of life.”

2020 and beyond A

s Brexit conversations continue into the New Year and a General Election result will be known shortly after this article is published, industry must keep its eyes open to what’s happening in the here and now. “Whilst we must continue to prepare for Brexit and explore possible opportunities in the future relationship negotiations, we must not lose sight of the day-to-day challenges that impact on our businesses and the patients we serve,” explained Leslie. “There are always challenges in business and the pharma sector is no different,” concluded Richard. “In my view, the deep-seated opportunities will undoubtedly trump the inevitable practical difficulties of our time, which will take up energy to resolve, in 2020 as they have in 2019.” Go to and

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The future of cancer care: Cancer Alliances, rapid diagnosis and integration How will diverse teams work together to transform cancer services in line with the NHS Long Term Plan?

Transforming cancer services: Identify patients at the right time & stage to optimise outcomes.

WORDS BY Oli Hudson Royal Oldham Hospital


ncreasing the proportion of cancers diagnosed at stages one and two, from around half now, to three quarters of cancer patients by 2028, is a key ambition of the NHS Long Term Plan. To achieve it, the NHS is putting new systems in place that will require diverse stakeholders to work collaboratively to develop and implement new pathways for cancer diagnosis and care.

The centres aim to provide a personalised, accurate and timely diagnosis of patients’ symptoms. They combine all existing diagnostic provision and use networked expertise and information. In 2019/20, all Cancer Alliances are expected to set up at least one RDC for patients with non-specific symptoms which could indicate cancer; as well as for a cohort of patients with site-specific symptoms who are currently served by an underperforming two-week wait or 62-day pathway.

Airedale General Hospital



North Middlesex University Hospital

St James University Hospital


University Hospital South Manchester LIVERPOOL


Southend University Hospital


Churchill Hospital




University College London Hospital




Royal Free Hospital

Queen’s Hospital


The NHS Long Term Plan gives the 19 Cancer Alliances – groups of cancer clinicians responsible for driving the development of cancer pathways at a local level – a central role. Cancer Alliances will be closely aligned with Sustainability and Transformation Partnership (STP) and Integrated Care System (ICS) footprints, as well as NHS England and NHS Improvement regions. They will advise ICS/STP board members on cancer services and help to ensure that local cancer strategies are delivered. They will also help to implement a new national faster diagnosis standard. RAPID DIAGNOSTIC CENTRES

Rapid Diagnostic Centres (RDCs), which were originally launched in pilot form in 2018, will underpin a radical overhaul of the way in which diagnostic services are delivered for patients with suspected cancer. RDCs comprise multi-disciplinary teams which provide a single point of access to a diagnostic pathway for all patients with symptoms that could indicate cancer.


The NHS Long Term Plan states that Primary Care Networks (PCNs) will be required to help improve early diagnosis of cancer in their neighbourhoods by 2023/24. We expect to see multi-disciplinary teams working within PCNs to deliver cancer services and this could mean more cancer specialists, such as cancer nurses, working in the community, as well as other specialists, such as gastroenterologists. Screening and diagnostic services will be increasingly provided in the community. It is also likely that some chemotherapy services, previously owned by NHS England, will begin to become the responsibility of ICSs, particularly homecare services. Overall, ICSs and PCNs will play a key role in supporting Cancer Alliances and RDCs to deliver local, targeted, population health-based strategies that will help to detect cancer earlier as this is key to improving patient outcomes. Oli Hudson is Content Director at Wilmington Healthcare. Go to

Discover how we can help you harness oncology insight to develop your value proposition. Visit our oncology resource centre:

Contact us: E: T: 01268 495600

M AG A ZI N E | D EC EM B ER 2019 | 13

A tough nut to crack? Claudia Rubin questions how long the NHS will be a commercially viable market for industry as she looks to 2020.


f you crack the NHS you can crack any other system in the world,” according to a senior figure at one of the UK’s leading artificial intelligence software companies, noting that while it is one of the most challenging, it is also one of the most important. But for how long? Has the last year shifted this basic premise and to what effect? The access and reimbursement landscape will be looked at next year and mechanisms for digital technology access are slowly improving. But, as steps are taken to ensure that the NHS gets a bigger bang for every buck of medicines expenditure, how will this impact on medical technology and pharmaceutical companies’ launch strategies in the coming years? In their reimbursement decisions, companies know that other countries look to what happens here. This has always been both an opportunity and a risk, but if the scales tip unfavourably, will fewer companies decide to choose the UK as an early launch market? And it seems that the scales are certainly changing, in two main ways. The nut is getting harder to crack, and moreover the prize that lies inside is becoming less rewarding too. The life sciences industry in the UK, even aside from the Brexit fiasco, is in an increasingly challenging place. Some pharmaceutical companies that would once have automatically seen the UK as a first phase launch site, now consider the UK as third or even fourth market. REIMBURSEMENT

Under pressure from shareholders, companies have to look at where and how they might be able to deliver returns on investment. With arduous obstacles to reimbursement, multiple squeezes on price and profit and fractured, inconsistent local commissioning, the UK’s commercial appeal weakens.

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Add to that the ominous context brought about as a result of the new voluntary scheme introduced this year, which elicited a commitment from all parties to ‘engender improvements over time to health gain relative to expenditure on new medicines across the NHS’. Gain more while spending less, not easy. The clinical evidence needed to secure NHS reimbursement is way beyond those required for regulatory approval. NHS England acknowledges that as the gap between payer and regulatory requirements expands, so the challenge in payer decision-making is exacerbated. COMMERCIAL FUNCTION OF NHS ENGLAND

The Government’s approach to dealing with these challenges over the past year, has been to beef up significantly the commercial function of NHS England. In post for just over a year now, Blake Dark’s leadership of the commercial directorate has brought about not only operational reforms but also changes in culture and tone of engagement with industry. The extensively drawn out negotiations over several high-profile medicines this year has left no one in any doubt of the determination of NHS England to drive a hard bargain. Where creative discount schemes were once flavour of the month,

we now know that the more complex the agreement, the more value the company is expected to give back. Further, that if a company wants these agreements to be confidential, it will be pushed into making even greater concessions. This goes to the question at the very heart of this piece – how far will companies go to get access to the UK market, and at what point does it not become commercially viable to do so? ACCESSING THE UK MARKET

We know companies are feeling very stung by the introduction of charges for National Institute for Health and Care Excellence (NICE) technology appraisals. From a European company’s point of view, the additional investment needed to prepare for NICE and Scottish Medicine Consortium submissions, further compounded by the NICE charge, which then leads them to having to offer a typical 50% to 60% discount just to get their product over the line, is making them think again. In the hostile Brexit environment too, the sense that the UK thinks it is deserving of special treatment puts our relationships on the continent under greater strain, as industry colleagues become less well-disposed to making that extra push for British patients.

We know that the UK is an exciting place to do business – our science base, our hospitals, our entrepreneurs and our clinical professionals all make the UK one of the best places to take on some of healthcare’s biggest challenges.


With its 20-year milestone in April this year, NICE maintains for now its world class reputation. The importance of this must not be taken for granted. While on the one hand, companies know that a positive recommendation here acts as a springboard for access across global markets, on the other hand it is increasingly likely that NICE approval comes with conditions attached. These conditions make the prize of reimbursement here less commercially beneficial, as well as potentially damaging to access strategies in far away markets.


To mark NICE’s 20-year anniversary, we conducted research into all 377 single technology appraisals (STAs) NICE has carried out and presented our findings in three posters at ISPOR this year. These show that 83% of all STAs were granted a positive recommendation (313/377). However, of the 313 positive recommendations, 177 (57%) were approved with either a patient access scheme or a commercial access agreement attached. 112/177 were with a recommendation for the full licensed population and 64/177 were with an optimised recommendation. Furthermore, only a little over half (202/377) of the total STAs received a recommendation to treat the full patient population, as stated in the technology’s marketing authorisation. In nearly half of all STAs, some patients who appeared to be eligible for a drug at the time of its marketing authorisation, are not granted access to it. Aside from the obvious patient impact, if fewer patients receive a drug than a company had expected, this will impact profitability. Our research suggests that discount schemes are becoming less of an exception and increasingly the rule. These discounts, together with an approved patient population smaller than those indicated by the label, represent a significant saving for the NHS, but a heavy cost for manufacturers. Go to


Claudia Rubin


However, we are some way off from speculating about the straw that may break the camel’s back, and turn to embrace the threats and opportunities that 2020 will bring. We know that the UK is an exciting place to do business – our science base, our hospitals, our entrepreneurs and our clinical professionals all make the UK one of the best places to take on some of healthcare’s biggest challenges. Proceeding down the path of mutual empathy and multi-stakeholder collaboration must be the way to achieve this. Claudia Rubin is a Director at Decideum. Go to M AG A ZI N E | D EC EM B ER 2019 | 15




t’s been almost a year since the publication of the NHS Long Term Plan, the document that set out the direction of travel for the NHS in England over the next decade. For clinical commissioning groups – the local organisations that plan and purchase healthcare at a local level – the most significant implications of the Plan have been the move towards more collaborative working and for Integrated Care Systems (ICSs) to cover England by April 2021. The NHS Long Term Plan specified that there would be ‘typically’ one CCG per ICS. It’s still unclear how many ICSs will cover England, but many CCGs are getting ahead of the curve by taking steps to work more strategically, at a larger scale, and more collaboratively. For some, this

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means sharing working arrangements (such as joint accountable officers), and others have begun the process to formally merge. Mergers are not new – the number of CCGs has reduced from 211 in 2012 to the current 191 in April 2019 – but the NHS Long Term Plan has prompted them on an unprecedented scale. At the time of writing, no fewer than 20 CCGs have been given permission by NHS England and Improvement to merge in April 2020, with more still awaiting approval and a significant number planning to merge in April 2021. ADVANTAGES OF MERGING

This move to commissioning at a larger scale brings with it a whole range of advantages, both for the NHS and, more importantly, for patients. Working at a larger geography, covering populations

of over 1 million, means more collaboration between partner organisations including health providers and local government to join up care and transform health and aligning commissioning policies across an area to reduce variation. It means that clinical commissioners can focus on population health – an approach which helps commissioners to plan for and intervene in long-term health conditions, target groups with common characteristics and address inequalities in care using a sophisticated knowledge of people’s needs. Working at this level also means that CCGs  reduce their management costs, they can benefit from economies of scale and do things once in the patch instead of two, three, or more times. This is about saving staff time and getting the best value from limited budgets.

“Mergers are by no means the end of CCGs; they are the beginning of a new breed of clinical commissioners” WORDS BY


Julie Das-Thompson


One example of this in action is in Leeds, where NHS Leeds CCG was recently formed after a merger of three CCGs. Their journey was driven by a need to seek better value and speak with ‘one voice’ across the city. They wanted to be able to work with their population to understand their specific health and care needs but knew they lacked the scale to do so as three smaller organisations. They worked with their local authority and providers across primary and secondary care to define one population, one set of outcomes and so one budget. However, merging CCGs isn’t simply squashing together the organisations that used to exist into a new form to do the same thing; we are creating brand new CCGs that are taking on a more streamlined, strategic approach, with some of the more transactional parts of the job being undertaken by integrated providers. Our members have been clear for a number of years that this is the right direction of travel. In Leeds, this included reviewing the CCG’s own commissioning functions and placing some of the more transactional elements with integrated providers in order to secure best value and expertise. This has meant the CCG has moved away from conversations about organisational processes to one about how they can best agree the commissioning priorities with the people of Leeds. SIGNIFICANT CHALLENGES

Although there are undoubtedly huge benefits, there are some significant challenges. We know that several merger proposals have been rejected, either by local GPs or by NHS England/Improvement, and some have been given strict conditions under which the merger would be approved. Once the merger has been approved, there is the short-term disruption of putting it into place. This entails ensuring that staff are on board with any changes, making sure that systems are in place and consistent across the new, large footprint, so that the day-to-day operation of the NHS continues to run smoothly.

Even working at this system level, clinical commissioners need to keep the links to smaller local populations at place (around 250,000 people) or neighbourhood (30,000-50,000 people) level. How this works in practice varies from system to system, but many of our members have maintained locality teams which mirror the pre-merger CCG footprints. This is to ensure a larger CCG doesn’t feel too distant to its communities. For lots of organisations that already have jointworking arrangements this may not be very different from how things currently operate, but for others this will be a marked change. RAPID PERIOD OF CHANGE

This is, therefore, a rapid period of change for the commissioning sector. For those in industries that work with the NHS – such as pharma – the merging of CCGs brings with it some key considerations over the next two years. These are about keeping up to date on: • the rapid changes to CCGs as organisations, with some commissioning functions moving to providers, • the way merged CCGs may need to innovate and change their prescribing approaches at a local level to seek best value at scale, • the relationship between CCGs and their providers as they encourage more integrated provision, and • the changing nature of CCG budgets in the move to more integrated delivery models. One year on from the NHS Long Term Plan, we are already seeing significant progress towards achieving its ambition for an integrated NHS. Mergers are by no means the end of CCGs; they are the beginning of a new breed of clinical commissioners. Julie Das-Thompson is Head of Policy and Delivery at NHS Clinical Commissioners. Go to M AG A ZI N E | D EC EM B ER 2019 | 17

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Who Does the Public Trust More?

WORDS BY Ramya Sriram

New research considers where the public goes for medical information and how they can identify the reliability of online medical content.


n August 2018, Google rolled out a core algorithm update known as the ‘Medic Update’. Some websites saw an immediate drop in rankings while others benefited. As with most Google updates, the Medic Update is shrouded in mystery to a certain extent. However, it’s fairly evident that the algorithm rewards websites with well-researched, accurate medical content and penalises those whose content is lacking in terms of credibility. The update links to E-A-T (Expertise, Authoritativeness and Trustworthiness). These three factors determine page and site quality. Websites who fall short of E-A-T drop in the rankings and, ultimately, receive fewer views. Why was Google Medic needed in the first place? The answer is simple – medical information online is unregulated. Anyone can create medical content and share it online. It doesn’t need to be verified by a medical professional or adequately researched. This content can be misleading and, ultimately, dangerous, when you consider how many people Google their symptoms or use the search engine to research specific conditions. Inaccurate information can cause people to put off visits to the doctor or lull them into a false sense of security. It’s important that the most accurate, most respected and most thoroughly researched medical content sits on the top of the search engine results. In light of this critical Medic Update, we looked into the public’s attitude, trust and reliance regarding medical content online. With this research, we can explore how important the update was in the first place and what demographics are more susceptible to medical misinformation on Google.

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We asked the UK public the following questions to get a better understanding of where they get their medical information, what websites they trust and how susceptible they are to medical misinformation. • Where do you get your medical information? • Do you think that platforms, such as Facebook and Google, should take steps to reduce the spread of medical information by people with little or no medical training? • When you feel ill or experience unusual symptoms, what do you do first? • Have you ever misdiagnosed yourself after reading medical content online? We also looked into people’s attitudes towards the regulation of medical content online.

Nearly two-thirds of the respondents questioned (59.4%) believed that platforms such as Google and Facebook should accept responsibility for the health content they showcase



Where do you get health information from? 938 answers from 622 respondents

The internet (results at the top of Google) The internet (trusted government websites) The internet (other sources) Your doctor Friends and family Social media networks None of the above 0


The first question of our study asked: ‘Where do you get your health information?’ The available answers were: • The internet (results at the top of Google) • The internet (trusted government websites) • The internet (other sources) • Your doctor • Friends and family • Social media networks • None of the above.






When filtering the results by age and gender, we got some interesting results. It turns out that more women (60%) than men (53.4%) are likely to use their doctor as a source of health information. When it comes to online content, women are marginally more likely to trust government websites while men are more likely to go to sites at the top of Google. We also noticed a generational divide. Older generations are more likely to get their medical advice from doctors, while younger generations tend to go to Google. This finding could indicate the Medic Update stands to protect young people more than seniors, as they are more likely to read it and be misled.

Before we get into the results, we would like to point out that people could (and generally did) vote for more than one source of information. The average number of options chosen was 1.5. This means most participants have more than one source of health content – for example, their doctor and internet results from trusted government websites. Thankfully, most of the recipients (56.7%) said their doctor was their primary source of information. The second most popular source (26.2%) are those sites at the top of Google. These are the sites that Google’s Medic Update deemed trustworthy and worthy of high visibility. A slightly smaller percentage (25.1%) claimed that, while the internet was also their preferred source of medical content, they went straight to authoritative government websites. A minority (8.4%), selected “The internet (other sources)” and only 4.5% admitted they got their medical information from social media networks. When we look at the data and add up sources of online content, we can see that slightly more people (64.2%) turn to the internet for health information than those who visit the doctor directly (56.7%). This is understandable – medical information is easily, quickly and freely available online. An appointment with a doctor to receive general medical information isn’t as quick and easy. The average person might wait weeks for an appointment. M AG A ZI N E | D EC EM B ER 2019 | 21




Do you think that platforms, such as Facebook and Google, should take steps to reduce the spread of medical information by people with little or no medical training?

When you feel ill or experience unusual symptoms, what do  you do first? 389 respondents

601 respondents



Yes No



Google my symptoms Call my GP

I’m not sure 60













The second question we asked was ‘Do you think platforms, such as Facebook and Google, should take steps to reduce the spread of medical information by people with little or no medical training?’. Respondents could answer ‘Yes’, ‘No’ or ‘I’m not sure’. This question delves into the responsibility of major platforms and whether they should be monitoring and regulating health content online. Nearly two-thirds of the respondents questioned (59.4%) believed that platforms such as Google and Facebook should accept responsibility for the health content they showcase. These people are concerned about the impact of content written by people who are not qualified to speak on medical-related matters. Only a small percentage (14.1%) of respondents said they didn’t believe these platforms should take any steps to prevent the spread of medical misinformation. It’s worth exploring why this is. It could be because the internet, by its very nature, is a platform that encourages and accepts free speech – some might be uncomfortable regarding regulation or censoring in this area. Or perhaps these respondents believe it is up to the individual, rather than the platforms, to decide who and what to trust. 26.6% of our respondents said they weren’t sure about the matter. The subject is complicated and nuanced, so it’s natural for there to be some uncertainty. When we look at the data in more detail, we can see more women (61.9%) than men (56.8%) are in favour of major platforms reducing the spread of medical information written by laypeople. Furthermore, we generally found the older the generation, the more in favour they are of monitoring medical information.

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Our third question asked, ‘When you feel ill or experience unusual symptoms, what do you do first?’. The available answers were: • Google my symptoms • Call my GP The results of this question might come as a surprise. It seems 56.8% of people call their doctor first when feeling ill or experiencing symptoms. Only 43.2% said they turned to Google. Despite the ease and convenience of the internet, it seems people would rather go to their doctor as their first port of call. This is a good sign. The internet can be useful as a means of information after a diagnosis. However, if people are concerned about their health, they should go to the doctor immediately, so that they can get a professional opinion on their symptoms. Again, we saw a divide in terms of gender and age. Women (50.9%) are more likely than men (35.3%) to Google their symptoms first. Men (64.7%) are more likely to go to their doctors first when compared to women (49.1%). Interestingly, younger generations are more likely to turn to Dr Google first. 56.7% of 18-24-year-olds Google first. We can compare this to the age group aged 65+, who Google first only 19.2% of the time. These figures show younger people have come to trust and rely on online medical content. Meanwhile, the older generations are less trustful and more conventional with regards to health matters.



Have you ever misdiagnosed yourself after reading medical content online? 383 respondents



Yes No








Finally, we wanted to look into how many people misdiagnosed themselves after reading medical content. Our final question asked ‘Have you ever misdiagnosed yourself after reading medical content online?’, to which respondents could answer either ‘Yes’ or ‘No’. Comfortingly, most people (73.1%) have never misdiagnosed themselves after reading medical information online. This leaves 26.9% of our respondents who have, at some point, misdiagnosed themselves as a result of  reading health content online. As you may have guessed, generational divides present themselves here yet again. Nearly half (44.1%) of 18-24-year-olds have misdiagnosed themselves online at some point when compared to only 10.6% of those aged 65+. Of course, we’ve already established this age group is less likely to read and trust online health content. They are also unlikely to use it to diagnose themselves, preferring instead to go to their GP. The combined results of our survey paint an interesting picture. There is an overriding belief that older generations are most susceptible to medical misinformation. However, our results show the Medic Update serves to protect the younger generation, as these are the people who have grown up with the internet. They trust content online. They go to it as a source of information and not everyone will be able to identify legitimate and trustworthy sources. In this sense, the Medic Update is adapting to protect Google’s most loyal users, to keep them healthy and well-informed. Ramya Sriram is Content and Communications Specialist at Kolabtree. Go to



QVIA is the leading global provider of advanced analytics, technology solutions, contract research and commercial services to the life sciences industry. As we continue to grow our Contract Sales and Medical Solutions (CSMS) business, it is vital for us to engage effectively with our future employees and, in line with our values of continuous improvement, we have significantly enhanced the dedicated CSMS careers website experience. You can now create your own account and – with the help of personalised job shortlists, alerts, and intelligent search functions – stay up to date with the latest positions that match your preferences, to find the right role for you. We invite you to familiarise yourself with the recruitment process, communicate with our Talent Resource Managers and explore a wealth of relevant articles from internal and external subject matter experts to support your application to ensure your approach guarantees you the best career opportunities. Adam Templeman, Head of Talent Acquisition (CSMS), says “We are passionate about recruiting the right individual to the right role. It is all about a great experience for the candidate and forging a true partnership. At IQVIA working together is key in achieving both our and our client’s success.” IQVIA – Brave Minds For A Healthier World Visit the website now: www.

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W ENCOURAGING TALENT ACROSS INDUSTRY Andrew Armes shares Roche’s motivation for supporting and entering the Pf Awards.


At Roche we believe life is incredibly precious and every day we strive to solve some of the greatest and most complex health challenges facing humanity. We discover, develop and manufacture innovative solutions which detect and treat disease where there is the greatest medical need. Our core diagnostics and biotechnology businesses work collaboratively and use data in novel ways to deliver personalised healthcare, which can be tailored to meet the specific needs of individual patients. We help millions of people all over the world live longer and better lives every hour of every day and we’ve been writing scientific history for over 120 years. Diversity and inclusion are a high priority at Roche and are the engine of our innovation. We think beyond physical characteristics to the qualities that make each person unique. We’ve created an inclusive workplace where each individual is respected and can contribute their skills, experiences and perspectives fully. This directly enhances our passion for bringing targeted treatment to patients. WHY DO YOU ENTER CANDIDATES INTO THE PF AWARDS? We enter

candidates into the Pf Awards to celebrate this brilliance in service of Roche’s purpose. We want all employees to be developing towards being the best version of themselves as well as enjoying that journey. These sorts of opportunities are a great way to show our strengths and passion and inspire others to shine, find their passions and understand that as much as we are doing deeply important work for patients across the world, we need to celebrate and enjoy our efforts as well. The Pf Awards are also a great way to broadcast to the wider world the work that Roche does and why. If talented individuals are perhaps considering their next career move, seeing the awards we win might just make them think about joining Roche when they might not have. It’s also a talent marketing channel for us.



Emma Morriss


sponsor the Pf Awards as well for several reasons. On one level, we want to show our commitment to encouraging all talent across the healthcare industry to stretch themselves, to grow, and to be recognised for that commitment to excellence in our industry. On another level, it allows us to connect with other influential individuals and organisations in the healthcare system through Pf, the Pf Awards and the Pf Awards Steering Group. We know the team behind Pf and the Pf Awards are passionate about excellence in the field and being part of this group allows for ‘spin-off’ co-creative initiatives and ideas to develop. And, of course, after all the hard work, it’s nice to join others across the industry, put down the commercial considerations, the purpose of our work, and have a great night. Andrew Armes is Head of Talent Acquisition at Roche UK. Go to

R E A D Y F O R A L I F E - C H A N G I N G W I N ? V I S I T W W W. P F A W A R D S . C O . U K T O F I N D O U T M O R E

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Community pharmacy in 2019 Deborah Evans reflects on how 2019 has shaped the face of community pharmacy.


019 has been an eventful year for pharmacy, most notably with the launch of the NHS Long Term Plan1 and new GP contract 2 , which together firmly embed the role of clinical pharmacists in primary care, specifically within the new primary care networks (PCNs). Additionally, the NHS has committed to delivering an expanded role of community pharmacy in prevention of diseases and to become the first port of call for urgent minor illness. Furthermore, a consultation on the reimbursement of medicines is likely to change the way pharmacies are paid for the drugs they supply 3 with the Government clear that it wants to improve transparency and equity whilst reducing costs associated with dispensing. In July, the Government set out a new community pharmacy contractual framework 4 that redefines the integral role community pharmacies play in delivering healthcare over the next five years. Pharmacy teams will be trained to provide a wider range of health advice and support, including the potential to identify and refer patients with unidentified health conditions, such as heart disease. Contingent on successful testbed programmes, more services will be commissioned from community pharmacies, all of which must be Healthy Living Pharmacies.5 WORKING WITH GPS

Integration of pharmacy as a full partner in local PCNs will be key, and alignment of the pharmacy and GP contracts are a good first step to enable better use of workforce. To facilitate this, the GP Contract Network Directed Enhanced Service 6 will require GP practices to engage and include community pharmacy from April 2020.

Pharmacists are expected to play a key role in supporting delivery of the Directed Enhanced Service specifications within the new networks including tackling over-medication of patients, inappropriate prescribing of antibiotics and the deprescribing of medicines no longer deemed necessary. Structured medication reviews by PCN pharmacists are expected to reduce avoidable A&E attendances, hospital admissions, avoidable outpatient visits and over-medication. Community pharmacy will play a major role in relieving urgent care pressures, specifically with the launch in October 2019 of the new Community Pharmacist Consultation Service. Following an assessment by an NHS 111 call adviser, patients are transferred for a consultation for a minor illness or urgent medicine supply with a community pharmacist instead of being booked elsewhere in the system. Additional pilot phases are underway whereby patients can be referred into the service by general practice reception teams working with care navigators. This could change the way patients access the NHS. THE FUTURE

This past year has ended a period of uncertainty for community pharmacy, providing a vision of how pharmacists and their teams can contribute to urgent care and prevention of disease. However, turning this into reality requires significant cultural and operational change and this is at a time when workplace pressure is high, and funding has been reduced. Fewer pharmacies are the likely result of a shift in funding from a traditional dispensing model, reduced margins on supply and patients opting for online provision.

Structured medication reviews by pharmacists are expected to reduce avoidable A&E attendances, hospital admissions, avoidable outpatient visits and over-medication


Deborah Evans

However, there are significant opportunities for those who commit to a future which is more clinical, involves much closer working with others and responds to the changing needs of their local population. Ever the optimist, the future for pharmacy is (and must be) positive. Deborah Evans FRPharmS FFRPS FRSPH is Managing Director of Pharmacy Complete, a training and consultancy company working with pharmacy and the industry. Go to 1 | 2 https:// gp-contract-2019.pdf | 3 government/consultations/community-pharmacy-drugreimbursement-reform | 4 https://assets.publishing. attachment_data/file/819601/cpcf-2019-to-2024. pdf | 5 Advancing our health: prevention in the 2020s – consultation document July 2019 | 6 https://www.england.

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o mark World AIDS Day 2019 there are a number of initiatives happening around the world. The Terrence Higgins Trust is campaigning to end HIV transmissions in the UK by 2030. The National AIDS Trust is encouraging people to Rock the Ribbon Together and wear their red ribbon to take the isolation out of HIV, show support for people living with HIV and commemorate those who have died from an AIDS-related illness. The World Health Organization and UNAIDS are recognising the essential role of communities in the AIDS response at international, national and local levels. WHAT ARE HIV AND AIDS?

WORDS BY Emma Morriss

Human immunodeficiency virus (HIV) affects the body’s immune system and damages the cells. The virus continues to affect the immune system which leads to immunodeficiency. This makes people with HIV more susceptible to infection and disease as the immune system cannot fight them.

Acquired immunodeficiency syndrome (AIDS) is the collection of illnesses, symptoms or infections that can affect the individual when their immune system has been severely affected by HIV. These can be life-threatening. SYMPTOMS AND INFECTION

If people are not receiving effective treatment, HIV can be transmitted via some body fluids, including through condomless sex, blood transfusion, contaminated needles, and vertical transmission (from mother to baby during pregnancy or through breastfeeding.) People may not be aware that they have acquired HIV because they may only experience flu-like symptoms. This is called a seroconversion illness and common symptoms include sore throat, fever and a rash. According to the Terrence Higgins Trust (THT), seroconversion is a sign that the immune system is reacting to the presence of the virus in the body. It’s also the point at which the body produces antibodies to HIV. Once seroconversion has happened, an HIV test will detect antibodies and give a positive result.

Living well with HIV 1st December is World AIDS Day which raises awareness of HIV and AIDS around the world. There have been huge leaps in the treatment of HIV and AIDS in recent years but it’s still important to raise awareness and support people to live well with HIV. 2 6 | P H A R M A FI EL D.CO.U K






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Seroconversion illness happens to most (but not all) people shortly after infection. It can be severe enough to put someone in hospital, or so mild that it’s mistaken for something like flu – although a blocked or runny nose is not usually a symptom. If a person has recently acquired HIV and has not been diagnosed and started treatment, some of their body fluids (eg blood, seminal fluid, vaginal fluid) can be infectious in the early weeks and months after transmission. However, once a person has been diagnosed and is on effective treatment, their viral load becomes undetectable, which means they cannot pass on HIV. It can take up to six months from starting treatment to becoming undetectable, but many patients achieve an undetectable viral load much sooner than that.

2019, which is recruiting 26,000 participants who are at high risk of HIV. The trial is to assess the need for PrEP in England, not the effectiveness of PrEP, which has already been established in earlier trials. RIVER study The RIVER study was a clinical trial designed to ‘wake up’ and then ‘kill’ the HIV virus in people in whom it was controlled by antiretroviral treatment, in the hope that by doing so, researchers would be able to cure HIV by completely eradicating the virus from the body. The RIVER study ran from 2015 to 2018 and was led by investigators from Imperial College London, the University of Oxford, MRC Clinical Trials Unit at UCL, and the University of Cambridge. On publication of initial findings, RIVER Chief Investigator, Professor Sarah Fidler of Imperial College London, said: “In the RIVER study, we found that all the separate parts of the kick and kill approach worked as expected and were safe…but the study has shown that this particular set of treatments together didn’t add up to a potential cure for HIV, based on what we’ve seen so far.”


There are more than 25 anti-HIV drugs, divided into six classes. Each class works against HIV in a specific way with most people on a fixed dose combination pill. THT classes these as: • Nucleoside reverse transcriptase inhibitors (NRTIs or ‘nukes’). • Nucleotide reverse transcriptase inhibitors (NtRTIs). • Non-nucleoside reverse transcriptase inhibitors (NNRTIs or ‘non-nukes’). • Protease inhibitors (PIs). • Fusion and entry inhibitors. • Integrase inhibitors. Antiretroviral therapy Antiretroviral therapy (ART) is medication which stops the virus from reproducing in the body. It can reduce the amount of virus in the blood to undetectable levels meaning it cannot be passed on. It is recommended that people start antiretroviral treatment as soon as they are diagnosed with HIV. PrEP PrEP, or pre-exposure prophylaxis, is a drug taken by HIV-negative people to reduce the risk of getting HIV. PrEP is a two NRTIs combination drug, which blocks HIV and considerably reduces the risk of transmission. PrEP is taken either on a daily basis or as event-based therapy (on the days before, of, and after condomless sex). However, dosing recommendations will depend upon the type of sex (anal or vaginal). There is currently a PrEP IMPACT Trial taking place in England until the end of

Remission There have been two confirmed cases of HIV remission reported. The first case, the ‘Berlin Patient’ received a stem cell transplant from a donor to treat leukaemia. The donor had two copies of the CCR5 Δ32 allele, a genetic mutation that prevents expression of an HIV receptor CCR5. In March 2019, news was released that HIV remission had been achieved in a second person. The case, published in Nature and carried out by scientists at University College London, Imperial College London, the University of Cambridge and the University of Oxford, said a second person had experienced sustained remission from HIV-1 after ceasing treatment. The male patient was diagnosed with HIV infection in 2003 and had been on antiretroviral therapy since 2012. Later in 2012, he was diagnosed with advanced Hodgkin’s Lymphoma. In addition to chemotherapy, he underwent a haematopoietic stem cell transplant from a donor with two copies of the CCR5 Δ32 allele in 2016. Despite these two cases, researchers say the treatment is not considered appropriate due to the toxicity of chemotherapy. However, understanding the mechanisms behind these cases may lead to a potential cure in the future.

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MSD has been at the forefront of several break throughs in the HIV field


An important breakthrough in HIV research looks at transmission from an HIV positive person to an HIV negative partner. Two studies, PARTNER 1 published in July 2016, and PARTNER 2 published in 2018 and reported in the Lancet in May 2019, both report zero HIV transmissions from a positive partner on ART to their negative partner through sex without using a condom. In PARTNER 1, this was after nearly 900 couples, both heterosexual and gay, had sex more than 58,500 times without using condoms, and in PARTNER 2 almost 800 gay couples had sex more than 77,000 times without using condoms.

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Together, these studies contributed to the evidence that led to Undetectable = Untransmittable and support U=U. This means there is zero risk of transmitting HIV when viral load is undetectable. The 90-90-90 UNAIDS targets call for 90% of those living with HIV to be diagnosed, 90% to be on treatment and 90% of those treated to have an undetectable viral load. By November 2018, public health data suggested that the UK was doing well against these targets – with 92% diagnosed, 98% on treatment and 97% having an undetectable viral load. THT’s ‘Can’t Pass It On’ campaign to end HIV transmission altogether and end stigma about the virus, is raising awareness of the facts around HIV and effective treatment, communicating that someone living with HIV and on effective treatment can’t pass it on.

MSD has been at the forefront of several breakthroughs in the HIV field including being the first to publish the crystal structure of HIV protease. New scientific innovation remains crucial – but beyond this, MSD continues to stand alongside the global community of people living with HIV. Living well with HIV starts with a person knowing their status and accessing effective treatment, but the needs of the HIV community go well beyond this. In the UK, MSD continues to partner with the community to tackle stigma and inequalities and help put people at the centre of their own care. The ‘Whole Person Care Partnership’ is a group of leading HIV organisations which have worked with MSD to establish the importance of sound public policy in these areas. Anyone whose HIV is undetectable in the blood cannot pass on the virus sexually. This concept is known as ‘Undetectable Equals Untransmittable’ or U=U. MSD recently collaborated with its ‘Whole Person Care’ partners in a U=U social media campaign, reaching more than half a million people. The campaign draws links between U=U and stigma, self- management, care planning and inequalities. Such initiatives are just a start and the short films making up the campaign can be found on the MSD-in-theUK YouTube channel. The aim for everyone involved in the HIV field is to make ‘living well with HIV’ a reality, one day, for everyone.


HIV treatment has progressed significantly in recent years meaning that people living with HIV and receiving appropriate treatment can expect a normal life expectancy


HIV treatment has progressed significantly in recent years meaning that people living with HIV and receiving appropriate treatment can expect a normal life expectancy. Work still needs to be done but organisations from the pharmaceutical industry to THT and the World Health Organization are working hard to change the landscape. With thanks to British HIV Association and Terrence Higgins Trust Go to and Sources | | world-aids-day-2019-communities-make-the-difference | en/resources/campaigns/WAD_2019 | | | | uk/government/uploads/system/uploads/attachment_data/file/813168/HIV_annual_ report_2018_-_Summary_key_messages_and_recommendations.pdf | https://www. | BHIVA-encourages-universal-promotion-of-U-U | news/187372/trial-kick-kill-approach-hiv-cure/ | hiv-remission-achieved-in-a-second-patient/ | | | | http://i-base. info/htb/34604 |

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All in translation Melanie Lee CBE is Chief Executive of LifeArc, a self-funded medical research charity that is working in collaboration to translate early science for patient benefit.



ell me about LifeArc As a selffunded medical research charity, I believe LifeArc is unique. With a 25-year legacy of collaborating with scientists, academics and industry on diagnostics and therapies, LifeArc enhances and protects innovation. Ultimately, we advance promising research that can benefit patients in the future. We do this in a few different ways. We help advance medical innovation through our own lab-based research, the support and advice we provide to our partners, the funding we make available and by developing people with expertise in medical translation. What’s your history? I have worked in the healthcare sector for over 30 years. I started my career as a scientist in the laboratory. It was a great environment at the start of my career as I had the freedom to conduct my own research. It was exciting but I was always looking for the next challenge. This is what led me to make the transition into industry and a role in research and development. Learning the processes and corporate way of life was a slight shock after academia. But as my understanding grew, I began to enjoy the structure and more importantly, having a goal to aim for through my work.

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I previously held Chair and Deputy Chair Trustee appointments at Cancer Research Technology and Cancer Research UK respectively, so when I joined LifeArc a year ago, I already understood the medical research charity sector. As a charitable organisation, LifeArc can take a more long-term approach to translational science than many commercial companies and that ethos was very attractive to me. It’s been an exciting first year at LifeArc, taking the charity through monetisation of our royalty interest in the product Keytruda® (pembrolizumab), a significant financial milestone, and developing our long-term strategy. We now have a tremendous opportunity to support life sciences research and accelerate the development of new therapies, diagnostics and devices for those in greatest need. What are your aims and objectives? We focus on translation – taking early ideas from first discovery principals into commercial or useable product the industry will recognise. We recognise that the world we deliver products into doesn’t stand still. Healthcare, science and technology are ever-changing. We are forced to constantly broaden our understanding, our information, and our skills to embrace the future of healthcare. For this reason, we’re starting to shift our focus to cover what we call the ‘four Ds’: Drugs, Devices, Digital and Diagnostics.

We look to encourage the drug and devices industry to be more interactive with digital and pay more attention to diagnosis. In this way, we can bring together a more complete package of information to meet the future requirements of medicine and potentially change how we treat disease. You work on a collaborative basis; who do you collaborate with, on what and why? We collaborate with a broad range of groups including medical research charities, research organisations, industry and academic scientists, to get to a place where their work is attractive to commercial organisations. Each collaboration is built with patient benefit in mind whether it is to support the creation and development of a start-up or to progress a new therapy. An example of this is our multi-year partnership with Cancer Research UK and the Japanese pharmaceutical company Ono Pharmaceutical to develop new immunotherapy drug targets. The collaboration will identify targets for the development of both antibody and small molecule therapeutics.


We advance promising research that can benefit patients in the future

What are your capabilities? We work in three core ways within translational science: advice, science and funding. Firstly, we offer high-quality advice to academia and charities to enable them to translate early science into patient benefit. We also conduct translational science leveraging our own drug discovery and diagnostics development facilities, supported by experts in technology transfer and intellectual property. Finally, we provide funding to support the development of innovative science, either philanthropically to drive reputation and impact, or with the aim of creating a sustainable return for LifeArc. What type of investment do you offer? As a charity, we’re in a unique position where we can consider investing in projects with a high degree of risk or where commercial returns may be low. This means we can fill a funding gap that commercial organisations may see as too ‘risky’. We have two funds in place to help us achieve our purpose. Our Philanthropic Fund provides grants to researchers for advancing new treatments for rare diseases; our Seed Fund makes investments and provides expertise for early stage spin-out companies within the UK and we are setting up a venture capital fund with Bridge Valley Ventures. What’s your disease area focus? We’re very interested in immunology and immunooncology, neurology and anti-infectives and we remain active in rare disease. Of course, these are all very popular fields, so we’ll have to decide what to do in-house and where we should work with others to ensure we get new treatments to patients. It’s important to consider that the rapidly changing, cost-contained healthcare environment is demanding more targeted treatments to justify spending on innovative medicines. With this, we’re seeing industry focus switching from treating diseases in silo to person-centred approaches. Pharmaceutical companies will still need validated therapeutic opportunities.

But to be differentiated in the future, the products will need to carry more information. Diagnostics will be able to identify patients likely to develop a condition much earlier. Advances in data analytics and genomic information will enable greater targeting of medicines. What breakthroughs have you played a part in? At the start of my career, my laboratory work included fundamental research on the cell cycle. This earnt me my CBE and ultimately, led to new therapeutic entities now helping patients. Sir Paul Nurse and his team continued this research and was awarded a Nobel Prize for Medicine for it. He was extraordinarily inclusive and generous when he received the prize as the whole team was invited to the ceremony in Sweden in 2001. In the last few decades, LifeArc has had some fantastic success in translating therapeutics and has become a specialist in humanising antibodies – with over 60 in our history. The result of LifeArc’s work can also be seen through four licensed medicines: Keytruda [pembrolizumab] in oncology, Tysabri® [natalizumab] in multiple sclerosis, Actemra® [tocilizumab] in rheumatoid arthritis and Entyvio® [vedolizumab] in Crohn’s disease. A diagnostic for antibiotic resistance is also on the market and a number of molecules are currently being investigated in clinical trials. We are excited about what’s to come for LifeArc as we progress our areas of expertise – and expand into new!

We now have a tremendous opportunity to support life sciences research and accelerate the development of new therapies, diagnostics and devices for those in greatest need

What else do you do? We recognise the importance of our people at LifeArc and the skills and expertise they bring. They are a key part of our future success. One of my day-to-day objectives is to build the next generation of translational researchers. We have various training schemes which were created to attract and retain the best talent in translational research, including two technology transfer Fellowship programmes and industrial placement opportunities for UK university students. Go to M AG A ZI N E | D EC EM B ER 2019 | 31

THE POWER of TEAMWORK Dave Lampard, Lampard, winner of the Pf Awards 2019 Field Manager Award discusses his win and how the performance of his team gave him confidence. INTERVIEW BY Emma Morriss

► From L to R: Lee Gittings, Dave Lampard and Pf Awards 2019 host, Hugh Dennis


ell me about you and your career I’ve always been involved in selling. I started in retail, but I felt that there wasn’t enough scope for strategy or expert selling. Like many people who join our industry, I was lucky enough to meet someone who was a representative already and who let me shadow her for a day. This felt more like the type of selling I wanted to do, so I applied for roles and joined Merck (Merck Serono) in 2002 as a mobile representative. I worked there for a few years before moving to Bristol-Myers Squibb, initially as a hospital specialist and then as the UK training manager based in the Uxbridge Head Office. After a couple of years, I was promoted again to National Field Operations Manager. After my daughter was born, my wife and I moved back to the North East where I worked in the field again, before being offered a training role with Thornton & Ross. Whilst there, the Regional Business Manager for the north of England and Scotland retired and the National Sales Manager approached me about taking on the role. Of course, I said yes. I held that role until May of this year when I took on a new post at Thornton & Ross as Head of Business Development.

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► From L to R: Dave Lampard accepting his Pf Award from Lee Gittings

Congratulations on your Pf Awards 2019 win, how did you feel when your name was announced? Honestly, it was brilliant, but I was entirely shocked, too. I was pleased simply because my name was on the screen of finalists. I thought ‘I can walk away with my head held high’. I assumed that was the end of it, so I almost stopped listening. It was the reaction of the people around the table that woke me up when they announced my name. I was completely surprised, but utterly delighted. Why do you think you won? It’s difficult to say, the level of talent was very high. I chatted to some of the other colleagues from across the industry at the Pf Awards Assessment Day. There was one lady I spoke to at length and I thought she’s probably in with a very good chance of winning. I don’t know what made me stand out, because you don’t get to see what everyone else does. I would hope that it was a combination of performing well in my coaching with the underlying knowledge that the team and I had a great year. I like to think coaching is one of my strengths given my learning and development background. I don’t view it as a challenge, I see it as a way of getting to know somebody new and us finding a way to work together to achieve success, not so different from successful selling. I think it helps that I don’t really get stressed or overwhelmed by things, which can be a help in a competitive environment. Also, as I said, coming into it knowing that the team and I were doing well was a definite

advantage. I knew that what we are doing in the field is working, and that as their field manager, I’m adding to that. So, representing them and our success at the Pf Awards gave me confidence. Has winning the Pf Award helped your career? It definitely hasn’t harmed it! There’s certainly a link. We underwent a recent restructure and having won the Pf Award put me in a good position to achieve a role in the restructured organisation. This business development role came available as part of the restructure, it was a brand-new role, I went for it and got it. My Pf Award is for management, which is such a transferable skill, it means I can demonstrate I’m a good manager both internally and now externally. Also, for one year following the Pf Awards, I can say, with my tongue firmly in cheek, I am the best manager in the UK. What’s been the best achievement of your career so far? I would suggest it’s leading the team to success, which has a part to play in winning the Pf Award. This is the first time I can hand on heart say it’s me and a team of people moving from place A to place B with success. I’ve had some great experiences in my career, but it is different when you bring the team with you. We can do so much more as a team, with a clear goal and a well-defined strategy. What motivates you in your work? To keep learning and challenging myself. It is one

of the reasons I worked in learning and development. I enjoy finding solutions to problems and seeing other people develop and grow both personally and professionally. Our industry is quite a select group of people. It contains some of the most intelligent people in the UK and being surrounded by those people is an enlightening experience. You’re in a position to constantly develop and share ideas. Longer term, it’s the learning and seeing other people learn and develop that keeps me going, but the day to day interactions with really bright people, all of whom care deeply about doing a good job, is what makes it work. What does the future hold for you in your career? I’m fairly new to this role, so the immediate future is set out for me. I’m deeply committed to making sure that the generics and branded prescription sides of Thornton & Ross develop over the foreseeable future, because they’re crucial growth areas for us. Longer term, I really don’t know. For me, it’s about continuing to learn and to challenge myself. Doing the things that keep me interested and entertained and challenging myself to do more and bigger things. I always want to do the best in the job I’ve got and demonstrate that success through sales growth. Dave Lampard is Head of Business Development at Thornton & Ross. Go to Looking for a career-changing win? The Pf Awards 2020 are now open for entries. Go to

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Hannah Alderton



David Peacock

Matthew Homent

David Peacock has succeeded Louise Houson as Managing Director of MSD in the UK and Ireland. David brings a broad range of experience and perspectives from senior roles with the company in the United States, Singapore, Vietnam, and Japan.

Mundipharma has named Matthew Homent its Ireland Country Manager, a position he has held on an interim basis since April 2019. His previous role was Director of Commercial Operations at Mundipharma’s sister company Napp Pharmaceuticals in the UK.


Stephanie Hill


Louise Madden Louise joins H.E.L. Group as Chief Executive Officer from Applied Photophysics. Her experience within the analytical instruments field spans more than a decade, having been Global Service Manager at Biolin Scientific AB, and previously Finance Director at Farfield Group Limited.

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Ashfield has appointed Stephanie Hill as Head of Patient Solutions in the UK. She has over 17 years’ experience in the industry. She first joined Ashfield in 2002 as a Nurse Advisor and has worked across multiple therapy areas. After a period of working in both client and provider roles, Stephanie re-joined Ashfield in 2016 as International Programme Director.



Lorraine Nolan The European Medicines Agency's Management Board has elected Lorraine Nolan as Vice-Chair of the Board for a three- year period. Dr Nolan is Chief Executive of the Health Products Regulatory Agency (HPRA) in Ireland, a post she has held since January 2016. She has served as a member of EMA’s Management Board since March 2016.

Distinctly different PHARMA

Will Downie Vectura Group has appointed Will Downie as Chief Executive Officer and Executive Director. Prior to joining Vectura, Will spent 10 years as the Senior Vice President, Global Sales and Marketing at Catalent Inc. AGENCY

Dal Singh Triducive has hired Dal Singh as Agile and Organisational Capabilities Director to head up the consultancy’s Agile offering. Dal joins Triducive from MSD where he was Head of Sales and Marketing. He has experience in a variety of therapy areas including haematology, cardiovascular, anaesthesia and women’s health. HEALTHCARE

Graeme Tunbridge Graeme first joined the MHRA in 2011. In his new role of Director of Devices, he will lead the division that is responsible for the operation of the regulatory framework that ensures the safety and performance of medical devices in the UK.

We specialise in Pharmaceutical and Healthcare careers. Please get in touch to find out what we can do for you.

0131 553 6644

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NEW YEAR, NEW JOB As 2019 comes to a close, your thoughts might be turning to searching for a new role. We asked expert pharma recruiters for their advice on levelling up your career in 2020. WORDS BY

Amy Schofield

Book in a call with a recruiter for some free career advice


New Year, new job? That could be a good idea, but equally don’t be led just by the changing of the calendar! Our best advice, at whatever time of the year, is to start by reflecting on how you’d like to move forward. Speak to those who you trust and who know you the best. Spend time thinking about it – be honest with yourself! Talking this through with a variety of people will be a massive help, and it may lead you to decide that you’re okay where you are. However, if you decide that pastures new are for you, speak to an experienced and knowledgeable recruiter and work with them to craft a plan to find you something different. Whatever your situation there will be something for you to consider. Your consultant will ensure that your CV is fit for purpose and will provide full support and guidance as you progress through the selection process. Nothing’s ever perfect, but if you feel positively about working in pharma or healthcare and just need to freshen things up, you’re unlikely to regret giving new things a go and working hard to be a success. Go to

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To prepare yourself for a career move in January, we’d recommend ensuring your CV is as up-to-date as possible, before sending a copy across to one of our specialist consultants – we’re always more than happy to advise on any improvements or amendments. Getting your LinkedIn profile up-to-date is also vital, as this will allow recruiters to easily see where you’re currently working and what experience and skills you can offer – you might just be the perfect fit for a role they’re working on. We suggest you also book in a call with a recruiter for some free career advice! From this you’ll be advised on how buoyant the market is, if your salary is above or below market rate, what kind of companies would be interested in your experience and if there are any new team builds or openings coming up that may suit your background. With so many new roles coming to the market, working with a recruiter will allow you to weigh up different and interesting options you may not have been aware of previously. Go to


Think about your career path and if you’re happy with your plan. It can be easy to continue in your role because it’s what you know, and not give yourself time to reassess and make sure that you’re heading in the right direction. Go through your CV and answer a few questions. Is there anything you could add, such as experience or courses you’ve attended? Could it be worded better? That synonym for ‘hardworking’ may have sounded good at 3am when you chose it, but I’ll bet it doesn’t read as well now. What are the attributes that potential employers in your industry are looking for, and have you brought those to life in your CV? When you’re happy, make sure that you update your LinkedIn profile to keep things consistent, and ensure specialist recruiters can contact you with potential opportunities. Specialist recruiters could help you establish what you’re looking for in your career and find your ideal role, taking the time to understand your ‘wants’ and ‘don’t wants’. Plus, choosing to work with a recruiter means that you’ll have the advantage of their vast industry knowledge and extensive client relationships, built on quality service and trust. Go to

Novartis UK

Changing the practice of medicine At Novartis, we harness the innovation power of science to address some of society’s most challenging healthcare issues. Our researchers work to push the boundaries of science, broaden our understanding of diseases and develop novel products in areas of great unmet medical need. We are passionate about discovering new ways to extend and improve patients’ lives.

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Profile for Pf Magazine

Pf Magazine December 2019