Pf Magazine December 2020

SPECIAL EDITION

THE

NHS DECEMBER 2020

Partnerships easing pressures NHS Reset report

“ Your patient is my patient, your challenge is my challenge” Page 21

Patient trust & power PHARMAFIELD.CO.UK

N E W YE AR ,

NE W PF MAG A Z IN E Don’t miss our new dates February | June | September | December Our trusted industry voice will be hitting desks (or dining tables) at different times next year, with four issues dedicated to staying reactive and relevant to the industry during 2021. In between these bumper issues, www.pharmafield.co.uk will keep you up-to-date with daily news and web exclusives.

MAKE YO U R VO I C E HEARD

If you have something you would like to contribute, please get in touch. We are looking for key opinion leaders and influencers in pharma to provide insight, thought leadership and analysis of issues at the heart of the industry.

Topics will include: Pharma trends for 2021, Covid-19 vaccine analysis, Research & development, Tech trends, Supply chain and Sales & digital marketing.

If you would like to contribute an article or expert comment, contact emma.cooper@e4h.co.uk or call 01462 226128.

W

Hello.

HEAD OF MARKETING OPERATIONS

Emma Morriss emma.morriss@pharmafield.co.uk EDITOR

elcome to December’s Pf Special Edition.

As the last edition of the year before the Christmas break, it felt fitting that the focus was on the NHS. The winter months are upon us and this year’s festivities will probably look very different to the usual celebrations.

At the moment, daily talk largely consists of restrictions, hospital admissions, lockdown and vaccines. And, if you’re anything like me, whether it’s acceptable to have your lunch before midday when you work from home.

However, it is right that the seriousness of the winter months is at the forefront of people’s minds. There is huge pressure on the NHS at the moment, not only to cope with the current Covid-19 cases but to also deal with the backlog of treatments and services that the spring and summer months put paid to.

However, there are lots of things that people are not talking about that can help alleviate this pressure and point to some hope on the horizon. The pharma industry is working overtime in terms of innovation and collaboration, so much so, that the Pf Awards has included two collaboration categories for 2021. Head over to www.pfawards.co.uk to find out more.

This issue showcases the projects, ideas and initiatives that are happening up and down the country and our case study on page 12 demonstrates how pharma and the NHS are working together to improve cancer services and reduce the time patients spend in hospital.

Numerous initiatives are further embedding and integrating community pharmacy into NHS care pathways, as Deborah Evans details on page 4.

As these collaborations continue behind the scenes, it is essential that the trust between patients and pharma is re-enforced. With the mass roll-out of a Covid-19 vaccine imminent, it is apparent that public perception of our industry has never mattered more. Research highlighted

by Claus Møldrup on page 8 “shows that there is a real appetite for patients to engage with the industry and enter into a dialogue, but at the face of it, this doesn’t seem possible.”

The launch of National Patient Recruitment Centres seems set to provide opportunities for local patients to be involved with health research studies and trials, including the latest Covid-19 vaccines. Trust often precedes inclusion and stronger partnerships between pharma, patients and the NHS will only benefit us all.

We hope you enjoy this Special Edition and if it is not too early, I would like to wish you all a Merry Christmas. We will be back in February with our first edition of the year and if you would like to comment on anything in this issue, get in touch at hello@pharmafield.co.uk, tweet us @Pharmafield or say hello over on LinkedIn.

Emma Cooper emma.cooper@e4h.co.uk CREATIVE DIRECTOR

Emma Warfield emma@pharmafield.co.uk GRAPHIC DESIGNER

Olivia Cummins olivia@pharmafield.co.uk SENIOR EDITOR E4H

Amy Schofield amy@pharmafield.co.uk COMMERCIAL DIRECTOR

Hazel Lodge hazel@e4h.co.uk FINANCIAL CONTROLLER

Fiona Beard finance@e4h.co.uk Pf AWARDS

Melanie Hamer melanie@e4h.co.uk PUBLISHER

Karl Hamer karl@e4h.co.uk HEAD OFFICE

3 Waterloo Farm Courtyard, Stotfold Road Arlesey, Bedfordshire SG15 6XP United Kingdom NEWS DESK

newsdesk@pharmafield.co.uk www.pharmafield.co.uk www.e4h.co.uk ADVERTISING

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.

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M AG A ZI N E S PECI A L ED IT I O N | D ECEM B ER 2020 | 1

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: hello@pharmafield.co.uk

Contributors

@pharmafield

@pharmajobsuk

Pf Magazine

JOHNNY SKILLICORN-ASTON

DEBORAH EVANS

AMANDA BARRELL

Deborah is Managing Director of Pharmacy Complete, a training and consultancy company working with pharmacy, the NHS and industry. Deborah works in an independent pharmacy alongside a GP practice.

Pharma as the front door, page 4.

Amanda is a freelance health and medical education journalist, editor and copywriter.

She has worked on projects for pharma, charities and agencies, and has written extensively for patients, healthcare professionals and the general public.

NHS Reset report, page 18.

Johnny is Communication and Engagement Consultant with Conclusio. He is a communication professional, specialising in collaboration and partnership, working across complex organisations and sectors.

Working well with Trusts, page 21.

STEVE HOW

Steve is Programme Director at Wilmington Healthcare.

He has more than 20 years of experience working in the healthcare and pharmaceutical industries.

Funding and finances, page 6.

In this issue CLAUS MØLDRUP

Claus is co-founder of www.DrugsDisclosed. com and CEO of DrugStars.

A qualified pharmacist and former professor at the University of Copenhagen, Claus spent more than five years as an executive director for a large pharma company. Here, he realised that nobody from the pharmaceutical industry or the medical authorities was listening to patients.

Listen and learn, page 8.

STEPHANIE HILL

Stephanie Hill is Head of Patient Solutions for Ashfield UK. She has over 20 years of experience in the industry and has worked across multiple therapy areas, supporting patients with long term conditions and rare diseases. Since 2016, Steph has been supporting the design, implementation and management of patient support programmes for key brand launches across the EU. Catalysing pharma, page 24.

STEPHANIE HARVEY

Stephanie is a Quality Improvement Consultant with Eli Lilly and Company and leads Lilly’s NHS joint working projects across the UK. How the NHS and pharma are working together to improve cancer services, page 12.

MIKE PROCTOR

Mike is Non-Executive Chair of Conclusio Limited.

Prior to this, he was a highly experienced NHS leader, performing the roles of chief nurse, chief operating officer, deputy chief executive and chief executive.

Working well with Trusts, page 21.

CASE STUDIES

12

COMMUNITY PHARMACY

04

Partnership: How the NHS and pharma are working together to improve cancer services

Pharma as the front door: Why community pharmacy will prove critical this winter

STEPHANIE HARVEY

DEBORAH EVANS

22

21

Tackling avoidable strokes: AF Toolkit can save lives and strain on the NHS

Working well with Trusts: Community pharmacy creating capacity in Secondary Care

EMMA MORRISS

MIKE PROCTOR & JOHNNY SKILLICORN-ASTON

INSIGHT

THOUGHT LEADERSHIP

08

06

Listen and learn: Patient trust is key to successful Covid-19 vaccine

Funding and finances: How these are changing patient pathways

CLAUS MØLDRUP

STEVE HOW

10

National Patient Recruitment Centres: Empowering patients to take part in research

24

Catalysing pharma: New approaches to patient care STEPHANIE HILL

EMMA COOPER

16

Adherence: Why it matters with chronic conditions AMY SCHOFIELD

18

NHS Reset report: Digging deeper AMANDA BARRELL

MEDICAL EDUCATION

26

E4H: Top tips for virtual medical education EMMA MORRISS

28 Directory

PHARMA AS THE FRONT DOOR With winter pressures causing NHS strain, community pharmacy will prove critical.

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e’re facing a very tough winter.

No matter where you are, or what you do, the Covid-19 pandemic is affecting the health of us all.

As I write this1, daily cases of the virus are estimated to be around 100,000 and our hospitals are starting to fill. This is going to get worse before it gets better.

Difficult as it is to think beyond coronavirus, people will get acutely unwell from other infections and illness, will have exacerbations of existing conditions and worryingly, underlying (ill) health conditions will progressively decline.

The NHS has to be able to respond.

WORDS BY

4 | P H A R M A FI EL D.CO.U K

Deborah Evans

COMMUNIT Y PHARMACY

CHANGING BEHAVIOUR

To address increasing demand on limited resources, healthcare policy makers in England have for some years been talking about the role community pharmacy can play in treating people for minor conditions and keeping them out of GP surgeries and A&E. In a recent interview 2 , Health Secretary Matt Hancock said, “I think that pharmacists can do far more, and they are the front door to the NHS in the community.”

The pandemic has brought this issue into sharper focus and patients themselves are finding other ways to access healthcare.

People’s attitudes to health appears to be changing, with more taking responsibility for their health and looking after themselves if they get ill. Importantly, they are more likely to consult with a pharmacist.

CHANGING BEHAVIOURS

The Proprietary Association of Great Britain (PAGB) carried out a survey in June 20203 of more than 2000 adults and found that: • almost seven in 10 respondents (69%) who would not have considered selfcare as their first option before the pandemic, said they were more likely to do so in the future • almost one in three people (32%) have changed their attitude to the way they access healthcare services • among those who previously sought a GP appointment as their first option, more than half (51%) said they were less likely to do so after the pandemic • 86% agreed that A&E and GP appointments should be used only when absolutely essential • 31% are more likely to consult a pharmacist.

This is good news for the NHS who want more patients to use pharmacies, for pharmacies who want to offer more than dispensing and for the public who need quick access to healthcare when they are sick.

Following the initial pandemic crisis period to June 2020, we have seen a number of initiatives further embedding and integrating community pharmacy into NHS care pathways.

COMMUNITY PHARMACIST CONSULTATION SERVICE

Currently NHS 111 is referring patients to pharmacy through the Community Pharmacist Consultation Service (CPCS).

This national commissioned service offers a consultation on minor illnesses to patients as well as management of urgent supplies of medicines when a patient has run out. The service has been designed to provide patients an alternative to visiting their GP or an urgent treatment centre. Almost a quarter of a million minor illness referrals4 have occurred in almost one year of the service and are expected to accelerate with the national rollout of GP referrals into the scheme, starting November 2020. The roll-out will be managed by each NHS Region and implemented at Primary Care Network (PCN) level. Local collaboration between GPs and pharmacies will be critical in making this service a success, enabling pharmacy to see more acutely ill people as the first entry point into the NHS. STRUCTURED MEDICATION REVIEW

The 2020/21 Network Contract Directed Enhanced Service (DES) Specification includes requirements relating to delivery of a Structured Medication Review (SMR) and medicines optimisation service by PCNs. Guidance5 outlines the tools a PCN should use to identify and prioritise patients who would benefit from a SMR and must include patients in care homes; with complex and problematic polypharmacy (on 10 or more medications); on medicines commonly associated with medication errors, and using potentially addictive pain management medication. Within this guidance PCNs are required to work with community pharmacies to connect patients appropriately to the New Medicine Service (NMS) which supports adherence to newly prescribed medicines. The service currently supports people with the conditions outlined below, who have been prescribed a new medicine.

• Asthma • Chronic obstructive pulmonary disease (COPD) • Type 2 diabetes • High blood pressure (hypertension) • On anti-coagulants or anti-platelets.

The community pharmacy 2020/21 Pharmacy Quality Scheme (PQS) Part 2 6 further incentivises community pharmacy to engage with their PCN through a community pharmacy network lead. Pharmacies can earn points each worth a minimum £48 by engaging with PCNs on increasing the total number of patients over 65 who receive a flu vaccination through the community pharmacy NHS National Community Pharmacy Flu Vaccination Service. Protecting this high-risk group during the winter against flu is seen as a critical part of the NHS winter pressures strategy. PQS further supports community pharmacy to develop their skills in reducing antimicrobial resistance through antimicrobial stewardship and reduce risks associated with missing red flag symptoms and sepsis when undertaking a consultation for a ‘minor’ ailment.

DISCHARGE MEDICATION REVIEW

The final piece of the community pharmacy jigsaw for this winter is the imminent launch of the Discharge Medication Review (DMR) service, planned for January 2021.

I highlighted this important interface service between primary and secondary care in an exclusive article for Pharmafield website in March 2020 and, whilst the pandemic delayed implementation, it is now progressing. It will allow hospitals to digitally notify community pharmacies when patients who have recently been discharged may require advice on taking new medicines, as well as any changes to their prescriptions.

The service aims to reduce the number of hospital readmissions caused by side effects or complications relating to medicines prescribed while a patient is in hospital.

It seems that the vision for pharmacy within the NHS Long Term Plan is finally being realised, enabling community pharmacy to play its part in addressing demand on NHS resources. Deborah Evans FFRPS FRPharmS FRSPH is Managing Director of Pharmacy Complete.

Go to www.pharmacycomplete.org References 1 30 October 2020 | 2 LBC’s Call The Cabinet television segment (7 September 2020) | 3 www.pagb.co.uk/latest-news/ pagb-self-care-survey/ | 4 To 27 October 2020 NHSBSA | 5 www.england.nhs.uk/wp-content/uploads/2020/09/SMRSpec-Guidance-2020-21-FINAL-.pdf | 6 www.england. nhs.uk/wp-content/uploads/2020/09/B0039_Pharmacy_ Quality_Scheme_guidance_22_September_2020.pdf

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Funding arrangements & finances How the latest developments in NHS funding mechanisms are changing patient pathways.

C

ovid-19 has been a catalyst for change in NHS finance where a new ‘systemlevel’ funding arrangement has been introduced in England. This sees providers working together to determine how money should be spent locally.

The scheme, which supports integrated working by enabling large sums of money to be released to healthcare systems for distribution, rather than to individual providers, aligns with long-term plan ambitions for population-health management.

Together with other joined-up finance structures already in place, system-level funding will drive big changes in patient pathways as the NHS permanently moves away from payment by results (PbR).

SYSTEM-LEVEL FUNDING

WORDS BY

Steve How

Block contracts managed by NHS England and NHS Improvement (NHSE/I) replaced PbR in April, in response to Covid-19. However, a Phase 3 Covid-19 guidance letter from NHSE/I in the summer highlighted the need for increased system responsibility and management to help local health economies achieve financial balance.

In line with this, the lead Clinical Commissioning Group (CCG) in a health system will now manage the system budget, including the provider block contract and a large system allocation.

This allows greater freedom and encourages integrated working.

NHSE issued the financial allocations in September to cover the second half of 2020-21. The allocations will be subject to adjustments depending on how each system restores elective activity.

LONG TERM PLAN

System-level funding is aligned with the move towards collaborative, place-based working. For example, aligned incentive contracts have seen some provider trusts and CCGs working together to determine how best to use their combined funding and set incentives around quality.

A joined-up financial approach was also advocated by the Long Term Plan, which said that ‘reforms to the payment system will move funding away from activity-based payments and ensure a majority of funding is population-based’.

It also said the NHS would move to a blended payment model – a flexible framework that comprises a fixed payment with one or more of the following: • A quality or outcomes-based element.

• A risk-sharing element.

• A variable payment.

6 | P H A R M A FI EL D.CO.U K

THOUGHT LEADERSHIP

It has never been more important for pharma to consider how its products and services can benefit the whole system

The NHS funding system is changing

HOLISTIC APPROACH

CHANGES IN PRESCRIBING

The blended payment structure is currently rolled out for emergency, adult mental health and outpatients services.

Blended payments that cover currently contracted secondary care-led services may include lower cost drugs.

Research by Wilmington Healthcare has found signs that non-high cost drugs and primary care budgets are also starting to become integrated into the service contract in certain areas, such as Manchester. System budgets will aid this integration and focus more on patient outcomes and total pathway costs.

NHSE is considering a number of blended payment structure proposals where: • High cost drugs and genetic testing would remain outside the blended payment remit but there would be some changes to the list with a new category of innovative products included in blended payments.

• All non-high cost chemotherapy drugs would be reimbursed on a pass-through arrangement.

Another important development recently is that the Quality, Innovation, Productivity and Prevention programme (QIPP) has stopped, so whereas previously 20% of QIPP savings were related to medicines management savings, that is no longer happening.

However, cost pressures will continue to increase and local system cost improvement, including drugs, will be back on the agenda.

But it will be hard to implement a new cost saving value proposition against the standard drugs budget.

As payment structures change and the NHS thinks more holistically around cost and prescribing budgets, it has never been more important for pharma to consider how its products and services can benefit the whole system rather than a specific drugs budget for a hospital or for primary care.

This involves thinking widely about key NHS priorities, such as keeping patients out of hospitals, where possible, and caring for them in the community and at home.

So, for example, managing early discharge and risk monitoring will be essential to prevent hospital admissions. It will also be important to empower patients to take greater control over their health.

Pharma also needs to think about how its solutions can enable the NHS workforce to operate more efficiently by reducing the need for regular contact with patients.

So, for example, how can it reduce the number of times a patient needs to go to hospital for drug administration or testing?

Where are the budgets sitting and who is making the decisions?

What’s the impact on formulary status?

Will your market share change?

SUPPORTING TRANSFORMATION

Integrated payment structures are having a profound impact on healthcare systems.

We are already beginning to see costs transferred between elements within blended contracts, and system-level funding will expedite the joined-up approach.

Financial changes are helping to drive major pathway reconfiguration across all pathways. This is not just in terms of where drugs are used but in terms of everything – from triage to follow-ups – as the NHS seeks to deliver on key Long Term Plan priorities and reset services.

It is essential for industry to monitor these changes, understand how its products fit into the new pathways and how services are contracted. This will enable industry to get involved in pathway reconfiguration and help the NHS achieve its transformation goals. Steve How is Programme Director at Wilmington Healthcare.

Go to www.wilmingtonhealthcare.com

Visit: wilmingtonhealthcare.com /informularyxd info@wilmingtonhealthcare.com #WilmHealth

M AG A ZI N E S P EC I A L ED I T I O N | D EC EM B ER 2020 | 7

&

LISTEN LEARN Why patient trust is key to the success of a Covid-19 vaccine.

vaccine en masse in the coming winter months. As the correct infrastructure and capabilities are hurriedly put in place for mass inoculation, there is something being missed which could hamper these efforts; public and patient concerns.

s the Covid-19 pandemic shows no signs of relenting, the number of patients and hospital admissions is again on the up.

Across the UK, cases rose to a seven-day average1 of 22,680 at the start of November, compared to 4,335 at the start of April, while the death toll has surpassed 50,000 – making the UK the fifth highest in terms of death toll2 after the USA, Brazil, India and Mexico.

As a result, lockdown measures across the United Kingdom have been enacted firstly in Scotland, Wales and Northern Ireland with England following suit with an initial one-month national lockdown in a bid to reduce cases and ease pressure on the NHS. To curb the number of cases, some, including former prime minister, Tony Blair, have called on the Oxford Vaccine to be deployed3 as it had been shown to have a degree of effectiveness.

However, more significant developments could now see the NHS administering a

HOPE ON THE HORIZON

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8 | P H A R M A FI EL D.CO.U K

During the week that I write this, pharmaceutical giant Pfizer has announced that a vaccine candidate it has helped develop with BioNTech was found to initially be 90% effective on 43,500 people in preventing Covid-19. This is due to undergo further testing before being submitted to the FDA for emergency authorisation.

There are hopes this vaccine could be the cure for the pandemic the world desperately craves, indeed, the EU has ordered 300 million doses alone. Whilst in the UK, Secretary of State for Health and Social Care, Matt Hancock, instructed the NHS to prepare for providing mass vaccinations from December 1st. It is an effort which would see up to 1,500 GP practices and drive through centres, as well as football stadiums, town halls and conference centres utilised to administer around 5,000 jabs a week.

Huge practical preparations are being made to prepare for the Pfizer and BioNTech vaccine to be rolled out, but the public trust issues and scepticism towards the pharmaceutical industry and a vaccine could limit these efforts for a rollout.

THE TRUST DEFICIT

For years, we’ve seen a mistrust of big pharma come to the fore. Events in recent months have stoked these fires, with thousands attending protests claiming that the Covid-19 pandemic is a conspiracy.

This uncertainty does not just roam in the domain of the so-called ‘anti-vaxxers’, but ordinary people too. DrugsDisclosed.com recently researched 1,022 people in the UK suffering from chronic illnesses.

The findings raised significant points which need to be addressed by pharma companies: • In total, 93% of patients questioned stated they do not trust advice from pharmaceutical companies about their medication.

• 81% feel ignored by these same companies.

• A n additional 68% of patients expressed a desire to be able to feedback their experiences to the pharma companies, but there was no way for them to do so.

These findings reveal that beyond the ‘antivaxxer’ group, many patients have a degree of mistrust of the pharma industry and feel ignored and disconnected to the companies, despite being the real-world end-users of the products they are producing.

On a positive note, these statistics also show that there is a real appetite for patients to engage with the industry and enter into a dialogue, but at the face of it, this doesn’t seem possible. This is creating a wedge between the two groups.

INSIGHT

PUBLIC PERCEPTIONS

Significant groundwork is being carried out to get the infrastructure for a mass vaccine rollout in place, but this could be undone by overlooking one simple factor: the patients themselves.

Throughout all of these efforts, we’ve seldom seen patient concerns addressed or listened to. Now we’re expecting them to turn up in droves for this vaccine, which many are likely to be sceptical of.

Recent research of UK patients with chronic illnesses and those most at risk from Covid-19, revealed that vaccine hesitancy will be a significant hurdle to overcome in order to ensure its effectiveness.

The findings revealed 54% of patients would not take a vaccine until at least a year of testing while 74% would not allow their children to be vaccinated until it was tested for a year. Elsewhere, a newspaper poll 4 found that 40% of the UK public wanted politicians to take this new vaccine before they would consider taking it.

With such a significant level of hesitancy, the government and big pharma companies such as Pfizer need to heed patient concerns to maximise the effect of a rollout.

Throughout all of these efforts, we’ve seldom seen patient concerns addressed or listened to. Now we’re expecting them to turn up in droves for this vaccine, which many are likely to be sceptical of

WORDS BY

Claus Møldrup

BRIDGING THE GAP

Pharmaceutical companies and governments are in a hurry to get a new vaccine on the market with no dialogue exchanged with those that will need to take it. Perhaps the Pfizer and BioNTech vaccine is the silver bullet the world needs to defeat the pandemic, but we need to address patient scepticism and hesitancy first. This is not a trust in government issue, moreover, it is a trust in the pharma industry issue.

Pharmaceutical companies opening themselves up to patient insight will help dispel hesitancy with taking a vaccine. What is crucial, is that they must start today rather than waiting until the vaccine is ready to deal with this issue. With this likely to be soon, time is quickly running out. Claus Møldrup is co-founder of DrugsDisclosed.com and CEO of DrugStars. Go to www.drugsdisclosed.com

References 1 https://tinyurl.com/y6my8946 | 2 https://tinyurl.com/qrn8b6p 3 https://tinyurl.com/y5fj5e68 | 4 https://tinyurl.com/y4o2scb7

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National Patient Recruitment Centres Helping life science companies deliver late-phase clinical research.

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ew National Patient Recruitment Centres (NPRCs) are set to provide opportunities for local patients to be involved with invaluable health research studies and trials. As the world sets its sights on a Covid-19 vaccine, these NPRCs will enable more late-phase, large scale clinical research to be delivered within the NHS and make it easier for people to take part in studies.

The NPRCs are managed by and funded through the National Institute for Health Research (NIHR) and run locally by NHS trusts. They are the first NIHR-funded research infrastructure wholly dedicated to delivering commercial research.

10 | P H A R M A FI EL D.CO.U K

Located at NHS hospital sites across England, the five regionally based NPRCs are funded through a £7m investment as part of the Government’s Life Sciences Industrial Strategy and Sector Deal 2 – a series of measures to strengthen the UK environment for clinical research.

INCLUSIVE INVOLVEMENT

This new patient-centric approach to pharmaceutical research is designed to make it quicker and easier for life science companies to deliver late-phase clinical research at scale and pace through the NHS. In turn, the centres will increase the number of commercial studies that can be delivered within the UK – benefitting patients who will gain earlier access to innovative new treatments and diagnostics,

as well as the NHS and wider economy, by attracting additional investment from the global life science industry.

To optimise the speed and consistency with which commercial studies can be delivered through the NHS, each centre is equipped with purposedesigned facilities, clinical expertise and ready access to NHS support services including pharmacy, radiology, and pathology. These dedicated resources – together with a collaborative operating model focused on close partnership working with local hospitals and primary and community health providers across each region – will enable expedited set up and delivery of late phase commercial studies at a rate and scale not previously achievable within the NHS.

INSIGHT

Dr William van’t Hoff, Chief Executive of the NIHR Clinical Research Network commented: “The new National Patient Recruitment Centres will significantly increase our capacity and capability to support the delivery of late-phase commercial research through the NHS. By offering a streamlined, consistent and collaborative approach to study set-up and delivery, the centres will also make it quicker and easier for the life science industry to bring late phase studies to the UK and run these at pace and scale across our NHS. “Most important of all, the centres will play a key role in helping people across the length and breadth of the country to take part in and benefit from innovative treatments through late phase commercial research – including the latest Covid-19 vaccines. With Covid-19 infections rising significantly across the UK, coinciding with an increasing number of vaccines ready to move into late phase trials, the launch of these new research centres will prove a timely and valuable asset in our urgent research response to the pandemic.”

NPRCS IN DETAIL

The new centres are spread across England with a wide geographical catchment area to increase opportunities and make it easier for people in regions across the country to take part in studies and potentially benefit from innovation through clinical research.

The NPRCs specialise in recruiting non-hospitalised patients with common chronic health conditions, such as asthma, type 2 diabetes, and cardiovascular disease. These conditions are typically managed by primary and community health services. Through the use of innovative recruitment strategies, alongside close collaboration with local and regional primary and community care providers, the centres will extend the reach of recruitment beyond hospitals and specialist clinics – enabling a wider cohort of participants and patients to take part in and benefit from late-phase research.

The centres will also play a pivotal role in delivering and helping people take part in vital commercial Covid-19 vaccine studies.

The Novavax Phase 3 Covid-19 vaccine trial is already underway at three of the NPRCs – in the North West, South West, and in Yorkshire and Humber – with a significant number of participants already recruited to the study through the new research centres.

Other high-profile vaccine studies are also set to be confirmed for delivery through the NPRCs over the coming months.

The five NPRCs, which are now operational and recruiting participants to studies, are based within the following NHS trusts: • Blackpool – Blackpool Teaching Hospitals NHS Foundation Trust • Bradford – Bradford Teaching Hospitals NHS Foundation Trust • Exeter – Royal Devon and Exeter NHS Foundation Trust • Newcastle – The Newcastle upon Tyne Hospitals NHS Foundation Trust • Leicester – University Hospitals of Leicester NHS Trust.

CASE STUDY

The NPRCs operate through a franchise-like model – an evolution in the way commercial research is delivered through the NHS. All five centres provide a uniform approach to research delivery which enables companies to benefit from the same level of dedicated facilities and staff at each location – resulting in quicker, easier, more consistent delivery of studies. To further increase the speed and efficiency by which studies can be set up, costed and contracted for delivery within the NHS, all five NPRCs also adhere to the new national contract value review process.

This uses standardised costing and contracting processes and uniquely, operates a single costing model which requires just one costing negotiation for all five centres, with minimal local variation.

The launch of these new research centres will prove a timely and valuable asset in our urgent research response to the pandemic

WORDS BY

Emma Cooper

T

he NPRCs use innovative and proactive recruitment strategies to reach out into the local community and empower patients to take part in research. An example of innovation within this area is already underway at the Patient Recruitment Centre (PRC) in Newcastle, which is running one of the UK’s first virtual interventional commercial clinical trials – utilising digital technology to enable participants to take part in studies remotely, from the comfort of their own homes, rather than by routinely attending clinical settings.

The RELIEVE IBS-D study is testing a new treatment for IBS with diarrhoea (IBS-D) and members of the public have been invited to take part in the study through the PRC via a consent for contact registry and digital media campaign.

The PRC: Newcastle team registered their first patient just three days after launching the virtual study, with 81 participants consented from the site after only seven weeks – roughly twice the rate achieved by 28 UK sites using traditional face-to-face processes.

This demonstrates the effectiveness of virtual trials, which allow recruitment without geographical exclusion.

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Partnerships easing pressure How the NHS and pharma are working together to improve cancer services.

WORDS BY

Stephanie Harvey

D

espite a difficult year, cancer survival rates are improving in the UK, and it is vital that all parts of the system continue to provide innovative solutions to help maintain this trend and enable more people to survive the disease. The NHS supports more than 360,000 people diagnosed with cancer each year and provides several medical interventions to treat the 200 different types of cancer that exist.

However, the availability of pioneering new cancer therapies has inevitably put additional pressure on already overstretched NHS cancer services. There are concerns about the NHS’ ability to

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deliver more innovative forms of care at a time when it is already under pressure, particularly as a result of the Covid-19 pandemic. Despite these challenges, one team wanted to give people living with terminal cancer more time to be with their loved ones, and less time spent in a hospital.

IMPROVING EFFICIENCY

The Beatson West of Scotland Cancer Centre (the Beatson) in Glasgow is one of the largest specialist cancer units in the UK. The team there noticed that patients attending the hospital for same day, outpatient treatment were spending too long waiting for their chemotherapy, something that was only going to increase with the introduction of new treatments.

C A S E S T U DY

When attending day-case chemotherapy appointments, people with Soft Tissue Sarcoma (STS) reported that they spent between 8-12 hours in hospital, and treatment was consistently administered later than their planned appointment time.

As people living with a terminal cancer, they did not want to spend a whole day in hospital waiting for treatment.

The Beatson identified the need to improve the efficiency of their chemotherapy clinic to protect patients’ access to new forms of treatment and sought to reduce the unnecessary hours that patients spent waiting in hospital for day case treatment.

Delays were caused by both an increased number of clinic visits per patient and a higher number of treatments administered in the chemotherapy day unit. Additionally, there was greater demand on hospital pharmacies in terms of both checking prescriptions and making up the drug in the aseptic pharmacy.

This is common throughout the NHS and also applies to other therapy areas, including dermatology and rheumatology.

As a large centre, the Beatson had the patient numbers needed to evaluate the scale of this problem and measure the results of any interventions. To investigate how they might reduce waiting times and improve the patient experience, the Beatson entered into a Joint Working Agreement with pharmaceutical company Lilly. For more than five decades, Lilly has been dedicated to delivering innovative solutions that improve the care of people living with cancer.

Lilly and the NHS team walked through the clinic flow and mapped out the patient journey. Supported by data provided by the Trust and patient diaries, the main areas of delay were identified, and a new process was developed to overcome these issues.

utilised the new CNS service when attending for systemic anticancer therapy (SACT).

Despite the impact of the COVID-19 pandemic in March 2020, the team ensured the project stayed on course and were able to deliver promising results. They saw a reduction in time patients spent in hospital, from an average of 8 hours 31 minutes to 3 hours 57 minutes – a drop of more than half (53.6%). Beyond the numbers, this gave people with a terminal diagnosis half of their day back and reduced time spent in an environment dealing with coronavirus.

Dr Jeff White, Medical Oncologist said “This work has gained more importance in the light of the Covid pandemic, as important priority for all organisations particularly those in healthcare is to minimise waits, delays and contact with other individuals to reduce the potential risk of in hospital transmission of coronavirus.”

SHARING SKILLS

This project highlights how the NHS and pharmaceutical industry can share skills and resources to partner successfully and improve patient care. The importance of this is clear, particularly at a time when patients may not want to be sitting in a hospital all day, and the NHS needs to work as efficiently as possible.

From process mapping to the development of data collection plans, these principles can be applied and used within any clinical pathway and are not limited to chemotherapy services.

This approach to improving clinic efficiency could be beneficial in reducing strain on the system, particularly at a time when the NHS tries to care for the backlog of patients caused by the pandemic. Stephanie Harvey is Project Manager and Quality Improvement Consultant at Eli Lilly and Company.

PATIENT FEEDBACK

The main aim of the project was to reduce unnecessary time in hospital, however a person’s own experiences of visiting the service and receiving treatment was also critical, so the team collected feedback through a detailed questionnaire. A further measure of success was the ability of the Band 7 clinical nurse specialist (CNS) to carry out the role in line with a specifically developed clinic Standard Operating Procedure (SOP), without requiring additional support from clinicians. For 12 months, patients with STS

Acknowledgements: The core clinical project team from The BWOSCC for leading and implementing the project are Dr Jeff White, Dr Ioanna Nixon & Miriam Brady. Clinical support from Dr Jordan Kelly. Quality Improvement support from Nadia Eley (Lilly UK). The senior management team at The BWOSCC are Maureen Grant (Lead Nurse), Melanie McColgan (General Manager) and Dr Azmat Sadozye (Clinical Director). The wider project team are Gillian Barmark (Clinical Pharmacist) and Catriona Graham (Sarcoma CNS).

WHAT HAPPENED NEXT

Since the roll out of the nurseled service, patients reported being extremely satisfied with their care under the new model.

The average score from a patient satisfaction questionnaire was 4.6 out of 5, meaning patients were satisfied with all aspects from booking appointments to provision of care and follow-up post treatment. The CNS only required clinical support in line with the SOP, for example when discussing scan results. This demonstrates the success of the nurse-led service and also the need for the service to be run by a CNS no less than a band 7. This information was used to compile a business case to successfully secure future funding for the position. Patients also stated that they preferred seeing the same caregiver on each visit, and that they had no objections to this being a nurse, though would like a doctor to explain results to them and review their scans, something which has been factored into the new care model.

This work has gained more importance in the light of the Covid pandemic, as important priority for all organisations particularly those in healthcare is to minimise waits, delays and contact with other individuals to reduce the potential risk of in hospital transmission of coronavirus

Dr Jeff White, Medical Oncologist, The Beatson West of Scotland Cancer Centre

M AG A ZI N E S P EC I A L ED I T I O N | D EC EM B ER 2020 | 13

VIRTUAL

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INSIGHT

THE IMPORTANCE OF ADHERENCE What makes the difference between a patient with a chronic condition adhering or not adhering to treatment?

WORDS BY

Amy Schofield

P

oor adherence to treatment of chronic disease has been described by the World Health Organization (WHO) as ‘A worldwide problem of striking magnitude’. A number of rigorous reviews have found that, in developed countries, adherence among patients suffering chronic diseases averages only 50%. In developing countries, the rates are even lower 1.

According to The National Institute for Clinical Excellence (NICE), between a third and a half of all medicines prescribed for long‑term conditions are not taken as recommended 2 by UK patients. Adherence is distinct to compliance. Whereas ‘compliance’ implies a passive following of instructions, adherence is active. Although adherence has many factors3 , it is dependent on an active 2-way dialogue between healthcare professional (HCP) and patient.

In response to the issue of non-adherence, the Bowel Interest Group, a multidisciplinary group dedicated to raising the profile of bowel management and supporting healthcare professionals treating patients with bowel conditions, has compiled a report, ‘The Importance of Adherence’.

Adherence is a ‘multifactorial phenomenon that can be influenced by various factors’3: • social and economic • therapy-related • disease-related • patient-related factors • healthcare system-related 4 .

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In the report, Professor Anton Emmanuel, Professor in Neuro-Gastroenterology at University College London & Consultant Gastroenterologist at University College Hospital and the National Hospital for Neurology and Neurosurgery, says: “A multitude of data covering a range of therapies and a range of clinical contexts have shown that it is easier to give advice than it is to monitor that the advice is being followed. This is especially true for chronic conditions, and possibly for bowel conditions where the symptoms are often intermittent.

Bowel symptoms are also somewhat taboo, so it is easy to imagine that once symptoms temporarily abate there is a temptation to ignore their existence and ‘return to normal’ without adhering to the initial treatment.”

Professor Emmanuel adds that there may not be any follow-up once a patient has been prescribed their treatment, due to a lack of confidence: “Checking that patients adhere with therapy is not something that many HCPs are confident with. It can be regarded as questioning the professionalpatient relationship which is at the heart of the clinical process.”

It all starts with excellent detailing from the pharmaceutical sales professional on the medication, along with an understanding of the factors related to non-adherence, including ‘social and economic factors, the health care team/system, the characteristics of the disease, disease therapies and patient-related factors’5.

Checking that patients adhere with therapy is not something that many HCPs are confident with

This enables the healthcare professional to in turn educate the patient and therefore improve the chances of them adhering to the treatment.

Although adherence is complex, it essentially comes down to three simple things. “What this report summarises are the essential healthcare values: communication, time and empathy,” says Professor Emmanuel.

To get a copy of the report on publication, email enquiries@bowelinterestgroup.co.uk References 1 https://tinyurl.com/y8ojkxvr | 2 https://tinyurl.com/ yyxtlf4z | 3 https://tinyurl.com/y4y8wlk2 | 4 https:// tinyurl.com/y4y8wlk2 | 5 https://tinyurl.com/y8ojkxvr

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Perhaps the most surprising development... has been the way in which so many services have, out of necessity, been transformed – sometimes in ways previously unimagined. Changes that would have taken years have been delivered in weeks

NHS RESET REPORT Give the NHS what it needs to build back stronger from 2020, says report.

WORDS BY

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Amanda Barrell

INSIGHT

C

ovid-19 has exacerbated many of the health and care services’ pre-existing challenges. But it has also shown what teams can achieve when they have the tools and resources they need. The NHS’ response to Covid-19 has been nothing short of heroic.

Now, as the acute crisis transitions into a long-term challenge, it is time to take stock, learn lessons, and build back stronger.

But the health service cannot achieve this alone. It needs new frameworks, new ways of working, and new funding models.

That’s according to a new report from NHS Reset, an NHS Confederation campaign to help shape what the health and care system should look like in the aftermath of the pandemic.

‘Covid-19 is the greatest challenge we have faced as a country for more than two generations. As we head towards what could be one the deepest recessions, its impact will be felt for years to come,’ said the authors.

THE TRIPLE WHAMMY

Before anyone had even heard of Covid-19, the NHS was already under significant pressure. But despite dire predictions of the pandemic overwhelming services, teams up and down the country coped by working tirelessly and adapting rapidly.

‘Perhaps the most surprising development...has been the way in which so many services have, out of necessity, been transformed – sometimes in ways previously unimagined. Changes that would have taken years have been delivered in weeks.’

As we emerge from the initial crisis, the service is now facing a ‘triple whammy,’ the publication, NHS Reset: A New Direction for Health and Care, continued.

‘It must deal with local outbreaks and a second surge. It has to manage a huge backlog of treatment that has built up during the pandemic. And it must do this and restore services with reduced capacity

as a result of infection control measures.

On top of this… staff are exhausted.’

The time is ripe, then, for a reassessment of what the NHS can realistically be expected to deliver.

‘What capacity and resources does it need to meet the challenges ahead, and what steps are needed to liberate and empower local leaders to work with and find the right solutions for their communities?’

In a bid to answer these questions, the federation has surveyed 250 NHS leaders and held more than 50 webinars, roundtables, and private meetings over six months. Of the issues the resulting report highlights, all are pre-existing challenges that have been brought into sharp focus by the pandemic.

HEALTH INEQUALITIES

The second Marmot report, published just weeks before the virus arrived in the UK, found that health inequalities had widened between 2010 and 2020, and that improvements in life expectancy had ground to a halt. As Covid-19 swept the nation, the implications of this were laid bare.

Overall, 90% of survey respondents believed that addressing health inequalities must be at the forefront of the reset process, and 80% said tackling the issue should be a key performance measure.

A national framework that gives local leaders the autonomy to develop community engagement and co-design services that meet local needs, backed up by appropriate, ring-fenced funding, is key, they said.

Dr Mark Spencer, GP and Co-Chair of the NHS Confederation’s Primary Care Network (PCN), said: “We are always telling communities what they need, rather than genuinely listening and co-producing.

PCNs have an opportunity to re-frame the narrative, to listen and build bridges and to work with communities in a meaningful way over the longer term.”

HEALTH AND CARE WORKFORCE

At the start of 2020, there were 90,000 NHS and 120,000 social care vacancies.

The consequences are now starting to bite,

said the report, which found that 85% of NHS leaders believed understaffing was putting patient safety and care at risk.

‘Colleagues across all parts of the system have mobilised their resources, including volunteers and students. Current staff stepped up and into other roles; leavers offered to return; and corporate and administrative team colleagues adapted quickly to new ways of working,’ said the authors.

‘But as services are restored, pre-existing workforce shortages are starting to show. At the same time, members are keen to ensure that staff who have worked tirelessly for the last few months are able to take a proper break.’

NHS leaders need investment to support staff wellbeing, and clarity on future recruitment, they told the federation.

‘In particular, they need commitment to increased support for undergraduate study, support for workforce placements of additional healthcare professionals, and continued support for national recruitment campaigns for health and social care.’

FUNDING AND CAPACITY

The NHS was already struggling to meet demand long before Covid-19 threatened to overwhelm the system. Now it is faced with the challenge of bringing services back online, dealing with the backlog of the last few months and surges in demand for mental health and community services, all while managing Covid patients and adhering to infection control measures.

Since the start of the year, there has been a step change in how health services use technology, such as telemedicine and AI diagnostics, to expand capacity – but tech alone is not the answer.

According to the report, NHS leaders need more financial support, a simplified bidding process, and realistic expectations. ‘The commitment of NHS staff to do their best for the public has been demonstrated many times over during the pandemic. Politicians and national bodies need to support the NHS to manage the realities of recovering services, not set unrealistic targets and impose financial penalties,’ said the authors.

M AG A ZI N E S P EC I A L ED I T I O N | D EC EM B ER 2020 | 19

INSIGHT

INTEGRATION & SYSTEM WORKING

From working together to acquire personal protective equipment (PPE), to coordinating patient discharge and community outreach, Covid-19 has demonstrated the importance – and strength – of joint working.

Alison Lathwell, Strategic Workforce Transformation Lead at Bedfordshire, Luton and Milton Keynes ICS, said: “The Covid-19 response has propelled joint working across the NHS, social care and wider public sector teams.

We have seen rapid decision making and (safe) bypassing of the rule book, which has resulted in more effective up-skilling, such as forward-based staff developing critical care skills or mental health nurses delivering end-of-life care.”

But while the NHS Long Term Plan is clear about a shift to integrated care systems (ICSs), there remain several uncertainties about how they will operate, and the extent to which they will be underpinned by new legislation.

Architecture that supports integration and partnership working, as well as a ‘fit-for-purpose financial framework’ that moves away from the transactional relationships created by payment by results, are vital, the report found.

SOCIAL CARE

The pandemic has highlighted the critical role of social care, while simultaneously exacerbating its underlying weaknesses. Staff shortages, a severe lack of funding, the absence of robust data and access to PPE and testing have all exposed the need for ‘urgent government action to fix social care.’

Michael Williams, Chair of the Nottingham City Care Partnership, told the report’s authors: “It has taken the combined efforts of many agencies to tackle Covid-19. It has forced a new level of cooperation and trust.

“It has also exposed, both nationally and locally, the key importance of a more integrated approach to health and social care.”

Professor Donna Hall CBE, Chair of the Bolton NHS Foundation Trust, agreed, adding that the crisis had, more than ever, demonstrated how intrinsically linked health and social care are.

“But it has also exposed the stark divide between the two in our failure to treat them as a single system and offer parity in the value we apply to social care and the NHS,” she said.

If the NHS is to survive, the government needs to immediately provide social care with the funding it needs to respond to Covid-19 and its aftermath, whilst addressing the longer-term need for a multiyear funding settlement. The sector also needs a ‘clear road map’ that supports and runs in parallel to the Long Term Plan, said the report.

NEXT STEPS

NHS leaders need more financial support, a simplified bidding process, and realistic expectations

2 0 | P H A R M A FI EL D.CO.U K

The Covid-19 pandemic will change the way health and care services are planned, commissioned, and delivered for years to come.

It may have intensified many of the health and care sector’s pre-existing challenges, but it has also shown how much teams on the ground can achieve when given the tools and resources to do so. The challenge now is to ensure the beneficial changes are sustained, according to the report.

‘Some of our NHS Reset work asks for structural change in the NHS and social care, a changing of priorities, and a change in the way that we think about health and care. But much of what NHS leaders talk about is practical – about supporting the lean, light, agile, and patient-focused culture that developed in the spring,’ the authors explained.

The NHS is not out of the woods yet, and right now, quite rightly, it is focused on managing the extra demand on services this winter.

‘However, with an eye on the longer-term outlook, there has been one enduring message that we have heard from NHS leaders: the health and care system must build on the remarkable progress of recent months to chart a new course,’ they concluded.

Amanda Barrell is a freelance health and medical education journalist, editor and copywriter.

COMMUNIT Y PHARMACY

Community pharmacy & collaboration How community pharmacy can create capacity in Secondary Care

I

t is a widely held belief that the pharmaceutical sector needs to understand the challenges faced by its colleagues in Acute Trusts. Secondary Care managers will know very little about community pharmacy and the opportunity it represents. The key is to whet their appetite by creating discourse on the very issues that keep them awake at night. For example, what capabilities does community pharmacy hold for helping to reduce patient attendance at hospitals, support early discharge and monitor patients post discharge? Community pharmacy needs to lead the conversation, opening up the opportunities and scoping the means by which co-designed, shared solutions will improve Trust performance, enhance patient experience and deliver better outcomes.

Community pharmacy is under-commissioned and forms a highstreet healthcare asset. The sector’s dependency on primary care commissioners has limited its opportunity to play a larger partnership role in addressing the wider challenges across health systems. As Local Pharmaceutical Committees (LPCs) articulate their ‘other partnerships are available’ offer, new relationships could flourish between community pharmacy, NHS Trusts and community providers.

Integrated care systems create a fertile loam for this future-scape planting and present community pharmacy with an opportunity to play a leadership role in health systems.

However, dialogue between NHS Trusts and community pharmacy needs to be purposive. Community pharmacy is a strategic player in any integrated care system, with the capacity and capability to occupy a central position within NHS transformation.

STRIKING A BALANCE

While there is agreement around shifting care out of hospital, if community pharmacy is to strike a new note with Trusts on how jointly designed approaches can secure this, it needs a firm appreciation of the key dynamics in hand at Trusts, including: • Payment by results – the disincentivising of Trusts to part company with the patient.

• Confidence – securing parity of esteem between hospital and community clinical care.

• ‘ Too difficult’ – changing services delivered by hospitals can be a challenging experience.

• P ublic perception – the idea that hospital is best for ongoing care.

• Care silos – creating a seamless and co-ordinated experience for patients.

• Restrictive practices – the effects of rigid practice boundaries between different health professional groups.

WORDS BY

Mike Proctor & Johnny Skillicorn-Aston

CLOSING THE GAP

Integrated Care Systems are speeding the pace of collaboration and associate working, and performance management is measured from the centre across the sum total of system outputs and outcomes. Where a shortage of professionals in clinical specialisms bites, a more panoramic focus has revealed opportunities to increase the licence of other allied professionals and clinicians to close the gap and increase capacity.

New partnerships between Trusts and community pharmacy involve creating a continuum of developing new service offers to local hospitals in London. Ones that flex with the changes and where the unifying mantra is: “Your patient is my patient, your challenge is my challenge.”

To crack the case of partnership working, consider the solution framework common in investigative processes and TV crime dramas: • Motive: structural and financial changes are removing barriers and creating fresh motivation to join up around better patient outcomes.

• Means: The Covid-19 pandemic is driving new approaches in healthcare, spurring on innovation and fashioning new tools and methodologies.

• Opportunity: Is everyone’s. All three are within the grasp of both Trusts and community pharmacy. To miss out may be considered a crime.

Mike Proctor is Non-Executive Chair & Johnny Skillicorn-Aston is Communication and Engagement Consultant at Conclusio. Go to www.conclusio.org.uk

M AG A ZI N E S P EC I A L ED I T I O N | D EC EM B ER 2020 | 21

AF TOOLKIT TO TACKLE AVOIDABLE STROKES The AF Toolkit aims to save lives & strain on the NHS.

W

ith approximately 15,000 people a year being admitted to hospital following an atrial fibrillation (AF) related stroke, the AHSN Network launched the AF Toolkit to bring together data and resources to address avoidable strokes to save lives and strain on the NHS. The AHSN Network of 15 Academic Health Science Networks in England launched the national ‘Atrial Fibrillation Toolkit’ to also address barriers to stroke prevention in atrial fibrillation with a unique AF Data Tool to highlight improvement opportunities across the AF pathway.

22 | P H A R M A FI EL D.CO.U K

IMPACT OF ATRIAL FIBRILLATION

Across England, atrial fibrillation is sub-optimally detected and managed resulting in avoidable strokes which can lead to death or significant disability. Early detection of AF to enable the initiation of protective anticoagulant therapy is vital to save lives and strain on the NHS. • Public Health England modelling suggests there are around 300,000 people in England with undiagnosed AF1,2 .

• Each year, about 15,000 people in England, Wales and Northern Ireland are admitted to hospital for an AF-related stroke 3 .

• The average cost of an AF-related stroke to both health and social care is £46,039 over the first five years1.

ATRIAL FIBRILLATION TOOLKIT

The Atrial Fibrillation Toolkit provides methodologies, resources and support for commissioners and clinicians working to reduce AF-related strokes, saving lives and NHS resources nationally.

Following the AF Improvement Cycle of Detect, Protect, Perfect, it brings together the core elements that make up the foundations of an AF improvement project.

With service change high on the NHS agenda due to the coronavirus pandemic, the Toolkit gives commissioners and clinicians all the tools they need to address atrial fibrillation in their region. It offers examples of pathway redesign, skilling frontline staff, spread and adoption of innovation and aligning system incentives.

C A S E S T U DY

This Atrial Fibrillation Toolkit is an excellent resource. It will help us to do things differently providing methodologies, resources and support for commissioners and clinicians to reduce AF-related strokes in their local communities

WORDS BY

Emma Morriss

AF DATA TOOL

Unique to the Atrial Fibrillation Toolkit is the interactive AF Data Tool which supports clinical commissioning groups (CCGs) to develop their local AF service to meet the needs of the population.

Utilising data from the Quality and Outcomes Framework Data 2 (QOF), Sentinel Stroke National Audit Programme 3 (SSNAP) and the National Cardiovascular Intelligence Network 1 (NCVIN), the AF Data Tool can be used to highlight improvement opportunities nationally across the AF pathway, including: • a comparison of actual local AF prevalence to the NCVIN expected prevalence • the number of people in a CCG with AF and at risk of stroke, who are not receiving anticoagulation therapy • the number of people with an AF diagnosis who experienced an AF-related stroke, and how many were receiving anticoagulation therapy at the time of their stroke • comparisons of local data with the NHS England Cardiovascular ambitions for Atrial Fibrillation 4 (2019-2029).

The Atrial Fibrillation Toolkit provides methodologies, resources and support for commissioners and clinicians working to reduce AF-related strokes, saving lives and NHS resources nationally

Commissioners and clinicians can use the data for service design or improvement. Data is presented in an informative infographic which can be filtered by CCG and year for comparative analysis. Infographics can be downloaded for use in presentations and business case development.

Dr Matt Kearney, GP and Programme Director, UCLPartners AHSN said: “This Atrial Fibrillation Toolkit is an excellent resource. It will help us to do things differently providing methodologies, resources and support for commissioners and clinicians to reduce AF-related strokes in their local communities.”

The Atrial Fibrillation Toolkit can be found at www.aftoolkit.co.uk and also includes comprehensive resources, clinical guidance, myth busters, and additional reading to support commissioners and clinicians working to reduce AF-related strokes. The AHSN Network would like to thank Bayer, Daiichi-Sankyo, and Pfizer Limited on behalf of the BMS-Pfizer Alliance for sponsoring the development of the AF Toolkit; these companies have had no input into the toolkits content, data tool or the online resources.The AF Toolkit is powered by E4H. Go to www.e4h.co.uk References 1 NCVIN https://tinyurl.com/y9xf hg fj | 2 QOF https://tinyurl.com/y2rcf k39 & https://tinyurl.com/yxgynd8r | 3 SSNAP www.strokeaudit.org/results | 4 Health matters: preventing cardiovascular disease https://tinyurl.com/yybwl8gx

M AG A ZI N E S P EC I A L ED I T I O N | D EC EM B ER 2020 | 2 3

T

here is no doubt that Covid-19 has changed the world, forever.

This is particularly true of the NHS and patient care. Going forward, care providers will need to blend traditional techniques with new technology and training to help ensure patients continue to receive the support they need in a way that is sensitive to their concerns around Covid-19 and meets a newly adopted preference for remote engagements, all while offering the same standards of care.

PUTTING THE NHS UNDER PRESSURE

Covid-19 has put the NHS and its partners under intense pressure, like never before.

Analysis of August/September monthly data by NHS England highlights the huge pressures being placed on an over-burdened healthcare sector 1. The data highlights longer waiting times for specialist treatment and notably a significant slowing of cancer treatments – just over 20,000 patients started their cancer treatment in August, which is a 20% reduction in a year.

The volume of patients experiencing long delays for treatment at the end of August has again raised important questions about preparedness as the country enters the winter months, with the expected increase in seasonal flu infections, exacerbating the ongoing pressure from Covid-19.

Catalysing pharma How new approaches to patient care will help the NHS manage the Covid-19 burden.

2 4 | P H A R M A FI EL D.CO.U K

THOUGHT LEADERSHIP

ADDRESSING THE CHALLENGES

A NEW WAY OF WORKING

The need to care for patients outside the hospital environment, wherever possible, has been a recognised solution to alleviate pressure from national healthcare systems for many years. Since the Covid-19 pandemic began, the need to support patients somewhere other than their normal care setting became paramount almost overnight.

Throughout the pandemic there has been an unprecedented increase in requests for patient support. These include patients receiving treatment for a pre-existing condition, participants in clinical trials or those who have self-supported prior to the pandemic using NHS facilities. This has often meant a shift in the care provided. For example, patients with chronic conditions invariably get a regular face-to-face review with their GP or specialist nurse to monitor their condition, but due to restrictions in movement, many GPs and specialists have resorted to telemedicine to maintain regular follow ups with their patients. This shift from face-to-face contact has been widely welcomed by many patients and will likely become a permanent feature in some form with consultations taking place over the phone or via Zoom. While many patients feel empowered by home consultations, they merely address the ‘now’ and do little to ease the backlogs the NHS currently faces.

Healthcare professionals require extra support to help address this. There is also a significant need for specialised training given that phone and online contact is entirely different to face-to-face. Thankfully, there are a number of organisations experienced in delivering both patient solutions and training for HCPs. There is also a realisation from pharma companies that participating, supporting and even funding such programmes will have a huge impact on patient outcomes, both now and in the future.

The industry must recognise that while patients were ‘forced’ to adopt new models of engagement, they have welcomed and embraced them. This new dynamic has created an opportunity for pharma to deliver change that will greatly benefit patients.

In a small study conducted by the Royal Marsden Hospital (RMH) Sarcoma Unit analysing care during the pandemic, patients identified a preference for telephone consultations. The results showed mean satisfaction with telephone consultation was higher than face-to-face consultation (rating 8.99/10 v 8.35/10, respectively) and the majority of patients (80%) indicated they would like some future appointments to be performed using telemedicine. Common reasons for telemedicine preference were reduced travel time (42%), reduced travel expenses (20%) and convenience (30%).2 The flexibility of the virtual approach has also been bolstered by the increased availability of community nurses as they progressively work from home, spending less time travelling between patients. Populations that fall within the ‘vulnerable’ criteria are invariably not geographically-clustered, which resulted in nurses spending a substantial amount of time travelling pre-pandemic.

When working virtually, they have been able to spend more time on patient support activities.

This shift from face-to-face contact has been widely welcomed by many patients and will likely become a permanent feature in some form with consultations taking place over the phone or via Zoom

WORDS BY

Stephanie Hill

SHORT-TERM PAIN VS LONG-TERM GAIN

While Covid-19 may have blindsided the NHS at the beginning of 2020, it is now, with the support of its partners and a better understanding of how patients have embraced telehealth, in a stronger position.

Healthcare providers are under no illusion about the challenging time that lies ahead, but investments made in technology and new ways of working will soon pay dividends for the NHS, their partners, and ultimately, the patients. Stephanie Hill is Head of Patient Solutions for Ashfield UK. Go to www.ashfieldhealthcare.com

References 1 https://www.bma.org.uk/advice-and-support/nhsdelivery-and-workforce/pressures/pressure-points-in-thenhs | 2 https://ascopubs.org/doi/full/10.1200/GO.20.00220

M AG A ZI N E S P EC I A L ED I T I O N | D EC EM B ER 2020 | 2 5

TOP TIPS

FOR VIRTUAL MEDICAL EDUCATION WORDS BY

Emma Morriss

Try these top tips to make your virtual medical education a success.

V

irtual solutions are one of the most effective communication channels to extend reach and frequency of engagement with customers. And following Covid-19 restrictions they are now the norm.

But it takes more than just loading up Zoom to achieve your objectives in a way that will benefit your customers and, ultimately, patients.

Virtual medical education covers a broad range of solutions including webinars, eConferencing, advisory boards, briefings, round tables and training. Here’s how you can get the most out it from planning to delivery.

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M E D I C A L E D U C AT I O N

The right KOLs and speakers are essential as they can make or break your event

PLANNING When planning your virtual medical education, define the what, the who, the how and the when.

WHAT?

Start with clear objectives, data and messaging.

• What are your objectives?

• What is your purpose, goal, and target audience?

• What customer insights do you have?

• What is your message?

• Make sure it’s clear.

• Is it topical or relevant to current policy/ developments?

WHO?

The right KOLs and speakers are essential as they can make or break your event, but you must also make sure they’re fully briefed.

• Who is best placed to represent you and your brand?

• W ill a Chair add value to discussions?

• Do they understand your proposition?

• Do they know the data?

• Do they understand compliance?

• Engage internal compliance early and throughout.

HOW?

It’s important that you deliver what your customers need to know.

• How will you get maximum learning and engagement?

• How can you enhance the benefit to the audience?

• W ill CPD/CME certification help?

• How long do you need to do the subject justice?

• A llow time for introductions, presentations, polls and Q&A. WHEN?

Timing is crucial to ensure maximum attendance.

• When can your audience attend?

• M id-week is ideal.

• D uring lunch or outside clinic hours?

• Is your audience global?

Think about time zones.

MAKING IT HAPPEN Once you have defined these steps in your planning, consider the specifics to make your virtual medical education a reality.

This involves marketing to reach your audience, technical elements to make sure it runs smoothly and represents your brand, and the all-important follow-up to add value, build on the work and keep momentum.

MARKETING

• Set your KPIs. • Plan your multichannel marketing.

• What’s the best route to your audience?

Use any data you have on individual preferences.

• P romote through third party lists, sales force, digital advertising, journals, emailers and, where compliant, social media.

• Have you got permission to contact existing customers?

• Define your call to action. Does it match your learning objectives?

• Be clear, catchy and compliant with your messaging.

• P rofile speakers and learning objectives.

• Link all marketing to the registration portal.

• Include ‘add to calendar’ and ‘submit advance questions’ links.

• Is it a promotional webinar?

Remind attendees to watch in private.

• Start marketing at least two weeks in advance.

• M idweek is the best time to email.

• Monitor response rates and resend weekly, also target non-registrants.

• Send out reminders: one week, one day, one hour.

TECHNICAL

• Not all platforms are the same; select one with the functionality you need.

• A n external agency can take on the technical elements.

• A fully trained, competent technician ensures seamless delivery.

• Run a technical briefing to check speaker and Chair connectivity and broadcast quality.

• Get online early to avoid last minute hitches; 30 minutes in advance is ideal.

• Speakers need a private space, free from noise and distraction.

• I f on camera, ensure speakers are well-lit with clear backgrounds.

FOLLOW UP

• Get feedback; use a post-event survey.

• A nalyse the data including attendee numbers, attentiveness, engagement with Q&A, polls and surveys.

• Benchmark the data against your KPIs. • I f you’re hosting on-demand, get the webinar recording approved.

• Send post-event communications including a link to on-demand, certificate, future webinar details and the survey.

• P romote the on-demand for wider reach.

• Review the ongoing performance of the on-demand.

Follow these tips to make your virtual medical education a success, and if you need further assistance, E4H is a trusted partner for national and global pharmaceutical companies. For more information, contact our experienced team on 01462 226126 or email enquiries@e4h.co.uk.

Go to: www.e4h.co.uk #WeAreE4H

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DIRECTORY

D I R ECTO RY

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ASHFIELD Ashfield, part of UDG Healthcare plc, is a global leader in commercialisation services for the healthcare industry. We partner with our clients to build creative, scalable and tailored health solutions, to deliver positive outcomes for patients and add value to your business. www.ashfieldhealthcare.com web@ashfieldhealthcare.com 0870 850 1234 CONCLUSIO Conclusio is in the vanguard of the transformation that is sweeping the health and social care sector.

Well placed to drive innovation and transformation. Conclusio works in the UK and internationally, across the whole health and care supply chain within the health, social care, pharmaceutical, civil society, digital and academic landscape. www.conclusio.org.uk @conclusioglobal

DRUGSDISCLOSED.COM DrugsDisclosed.com is a new service designed to empower patients all over the world through real-life experiences with medication.

The platform also seeks to remove the red tape to allow the pharma industry to take action on these anonymously aggregated insights. www.DrugsDisclosed.com

E4H E4H is an industry leader in medical education and partnership working. We work closely with our clients, healthcare professionals and patients to understand needs and provide the right solutions. #WeAreE4H www.e4h.co.uk enquiries@e4h.co.uk 01462 226126

ELI LILLY AND COMPANY Lilly is a global healthcare leader that unites caring with discovery to make life better for people around the world. Across the globe, Lilly employees work to discover and bring life-changing medicines to those who need them, improve the understanding and management of disease, and give back to communities through philanthropy and volunteerism. Lilly has been operating in the UK since 1934 working in sales and marketing, research and development and bio-tech manufacturing. Lilly’s research priorities are aligned with significant UK health needs including diabetes, immunology, mental health, and cancer. www.lilly.co.uk WILMINGTON Wilmington Healthcare has unrivalled healthcare knowledge intelligence and access across the NHS, and incorporates HSJ, Interactive Medica and OnMedica.

The company focuses on working with its customers to turn its high-quality healthcare data into meaningful intelligence to support their business objectives and the improvement of healthcare. www.wilmingtonhealthcare.com

PHARMAJOBS.CO.UK

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We work from bench to bedside - researching new medicines, running global clinical trials, and collaborating with the NHS to try to ensure rapid uptake and delivery of our products and services.

Our drive, every day, is to ensure our medicines reach those who need them as soon as possible.

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