Speaking outside Downing Street in December, following his general election triumph, Prime Minster Boris Johnson declared that the NHS would be “his top priority in government”.
Additional NHS funding and staff, and new hospitals, were key commitments in the Tory manifesto, which also promised to legislate to support the implementation of the NHS Long Term Plan.
These ambitions sit alongside the Tories’ key election commitment – “to get Brexit done”. In line with this, Britain is expected to leave the EU by January 31, before beginning negotiations with it on trade deals.
In this article, we explore what the Tories’ win means for healthcare and how these changes will impact on the pharma industry in 2020 and beyond.
Integrated care
A third of the country is already covered by an Integrated Care System (ICS) and the Tories’ win has provided assurance that there will be 100% ICS coverage across England by April 2021, as promised in the Long Term Plan. We also expect to see Clinical Commissioning Group (CCG) mergers continue apace in line with the Plan’s ambition to have ‘typically’ one CCG per ICS area.
Integrated Care Providers and Partnerships (ICPs) have been springing up across the country to aid collaborative working, and we expect the ICP standard contract launched in 2019 by NHS England to be widely used between CCGs and ICPs in 2020.
Primary Care Networks (PCNs) will also have a key role. In addition to providing core GP services, they have been tasked with delivering a number of new services that are all linked to Long Term Plan priorities.
Five of the new services will start by April 2020, namely: structured medication reviews, enhanced health in care homes, anticipatory care (with community services), personalised care and supporting early cancer diagnosis. These services follow the appointment of new staff in June 2019 – namely practice pharmacists and social prescribing link workers – who are now funded in every PCN across England.
Funding
Base funding for the NHS will increase by 29% – £650 million extra a week – by the end of the Parliament. But is this enough to get the NHS out of trouble? Bodies such as the Nuffield Trust think it might be – and speak positively about the Tory spend in relation to the other parties. However, it is less clear how social care will be paid for and this will have a huge impact on demand.
The manifesto suggests that there will be investment in prevention. However, it is difficult to determine if it will be enough to effect real change, especially since no figure has been put on it. We wait to see if it will mean a growth in CCG and ICS budgets.
Brexit
While the Government planned to start the EU withdrawal process ahead of Christmas, the final outcome remains uncertain. Continuity of supply of drugs and other medical equipment is the chief concern for the NHS, and it has already been contingency planning for the possibility of a no-deal Brexit.
If Brexit does hit the supply chain, UK pharma companies with branded drugs could leverage an advantage over companies selling generics sourced from abroad. This is because UK branded drugs manufacturers tend to have greater warehousing capacity in the UK, so they are not as reliant on ‘just in time’ delivery and getting stock through ports to wholesalers.
The greater availability and stable cost of these branded drugs could increase their attractiveness for two reasons. Firstly, if generic drugs shortages occur, this may drive up tariff prices for these products and secondly the NHS might come under pressure to maintain continuity of care for certain critical medical conditions where it is not possible to get generic medicines through border controls quickly enough to meet demand.
Workforce
In their manifesto, the Tories pledged to provide 50,000 new nurses. However, Boris Johnson later publicly admitted that only 31,000 of that number would be new recruits and the rest would be existing nurses who would be encouraged to remain within the NHS or attracted back after leaving.
The plan to recruit thousands more nurses, in addition to the 6,000 extra GPs also promised by the Tories, relies heavily on recruiting talent from abroad. However, this is likely to be problematic in light of Brexit.
Boris Johnson has promised a new ‘NHS visa’ to make it easier for doctors and nurses from around the world to work in the UK. However, at the moment, it is an unknown quantity.
Buildings
According to the Tory manifesto 40 new hospitals will be built over the next 10 years – a promise that, at first glance, seems to be at odds with the Long Term Plan’s ambition to take more care out of hospitals.
However, given funding constraints and Plan ambitions, it is likely that building work will involve reconfiguring existing sites to make them more efficient and cost-effective, rather than constructing new hospitals from scratch.
So, for example, where hospitals have been merged, redundant buildings will be demolished, and new ones erected to make these sites more efficient. We also expect to see additions such as new scanner rooms, theatre suites and wards as well as investment in diagnostic equipment. There is likely to be a continued separation of emergency and planned care – also known respectively as ‘hot’ and ‘cold’ sites.
Digital
Digital technology is central to the NHS Long Term Plan, which promises that all patients in England will have access to online consultations by 2022/23 and the ‘right’ to switch to ‘digital first’ GP practices. The Plan envisages a similar expansion of online consultations in secondary care in a bid to avoid a third of all hospital outpatient appointments within five years.
Given workforce challenges, the ability for healthcare professionals to provide online consultations, diagnose many ailments digitally and monitor conditions remotely, has huge potential for the NHS. For example, with long-term conditions such as asthma and diabetes, remote monitoring enables better self-management, which, in turn, should lead to fewer hospital admissions, less face-to-face contact with GPs and practice nurses and better patient outcomes.
Market access
A key question facing pharma in 2020 is not just who is the customer in the new integrated care organisations – but where are they based? As online consultations make it easier for HCPs to work remotely, arranging face-to-face visits in the surgery could become increasingly challenging for sales representatives.
Digital communication and education around disease areas will, therefore, become ever more important. However, as HCPs work across integrated care organisations, communications campaigns should not simply be targeted at single HCP groups. Pharma needs to think more widely about other HCPs involved in delivering multidisciplinary team-based care, such as specialist nurses, physiotherapists and practice-based pharmacists.
All health economies are due to produce ‘place based’ plans for their localities in response to the Long Term Plan. These plans could be highly significant since they may impact on which drugs are used and how care pathways evolve and integrate.
It will, therefore, be essential for pharma to take a locality by locality approach to customer engagement in 2020, as well as ensure that its messages are tailored to the increasingly diverse range of stakeholders who are getting involved in integrated care from Social Services to Housing Associations, police and charities.
By gathering and interpreting data on wider population health management issues, such as the causes of A&E admissions or the burden of specific diseases on healthcare resources, pharma can begin to build a detailed picture of what is happening in very localised parts of the NHS and why.
This can help pharma to better understand the wider cost implications of problems such as preventable A&E admissions and how they ripple out from hospitals into wider health and social care settings. This, in turn, can enable pharma to partner up with integrated care providers to help become part of the solution.
This type of insight can be invaluable in helping pharma to define how a drug fits into an integrated care pathway and how it can deliver wider benefits across health and social care systems. This is a critical message for integrated care organisations in general and particularly for clinicians who tend to be more concerned with the direct impact of a drug on a patient.
Developing clinical champions who understand whole system and whole pathway impacts of different treatment options is a big opportunity.
Conclusion
As a new year and a new decade dawn, questions still remain unanswered on many key issues, particularly around Brexit and the interrelated challenge of increasing an NHS workforce that will be heavily dependent on recruiting workers from overseas.
However, the Tories’ decisive general election win has delivered certainty on key NHS Long Term Plan ambitions, particularly with regards to integrated care, which will continue apace as the April 2021 deadline looms.
There is much that pharma can do to support the NHS in 2020 and beyond, provided it seeks to understand the needs and challenges of individual health economies, and thinks more broadly about how it can help the NHS to deliver whole system benefits within the integrated care environment.
Paul Midgley is director of NHS Insight and Oli Hudson content director at Wilmington Healthcare. For information on Wilmington Healthcare and to find out more about the latest developments in the NHS, visit www.wilmingtonhealthcare.com
