From this week, the way the NHS operates is changing: Primary Care Trusts (PCTs) and Strategic Health Authorities will disappear, to be replaced by around 200 Clinical Commissioning Groups (CCGs).
As one of the centrepieces of the Health and Social Care Act 2012, the aim of the changes is to give doctors more power to make local health decisions. CCGs - comprising GP practices - will, between them, commission most of England's public health services, deciding how much money to spend on procedures and medicines.
'The reforms are quite radical,' says Chris Naylor, fellow in health policy at The King's Fund think-tank. 'All of the power and most of the money will go to these GP-led groups. In theory, this will take us to a new world where CCGs will be looking out to their communities, not up to the Department of Health.'
For pharmaceutical companies, used to dealing with relatively monolithic PCTs, this represents a significant change. 'What's going to be interesting is that CCGs won't have the same uniformity as PCTs,' says Duncan Cantor, director of comms at drug manufacturer Boehringer Ingelheim. 'On the ground, when you're trying to do business, you'll need local insight. You can't communicate in a one-size-fits-all way.'
Some CCGs will be made up of ten GP practices, others will comprise up to 100 or so. But, whatever their size, opportunities are there. Nascent CCGs have already turned to the private sector over the past couple of years as they readied themselves for authorisation.
An investigation by GP magazine Pulse found they had paid millions of pounds to consultants - including PricewaterhouseCoopers and Capita - for projects such as 'mock authorisation panels' and training programmes.
Pharma is in a prime position to help further: if diabetes care is the priority in one CCG's area, then drugs companies have an opportunity to put anti-obesity programmes in place, for example.
As well as the whole issue of diagnosis, CCGs are going to be interested in patients' care pathways - that is, the routes by which people get in and out of the health and social care system, including what treatments or support they should receive on the way.
CCGs will also have their eye on the increasing stratification of drugs: the attempt to 'personalise' medicines by identifying who might best be able to benefit from them.
'Our job as pharma companies is to work out what the value chain looks like for any given medicine,' says Cantor. 'For example, getting the care pathway right is the difference between the drug being effective or not. Medicines have to be seen as an investment.'
Dr Joe McGilligan, a GP and chair of East Surrey CCG, agrees. 'Pharma is still seen as the big bad wolf, trying to take money out of the NHS,' he laughs. 'But all we want is improved outcomes.' If pharma companies can deliver healthier patients by putting together new services, then CCGs will be receptive.
'We've had a very different relationship with pharma over the past few years in terms of partnership working - using their project management exp-ertise, for example,' McGilligan adds.
Drug companies such as Roche and Pfizer are beginning to offer nursing support with some treatments, he says. 'We're interested in the added value that manufacturers are going to offer,' McGilligan concludes.
'Pharma marketers are aids to commissioning,' Cantor suggests, with a key role in educating GPs and hospital doctors about the best and most appropriate use of a manufacturer's products.
The Association of the British Pharmaceutical Industry (ABPI), the trade body for pharma companies operating in the UK, is certainly banging the drum for its members to be alive to the prospect of such collaborations.
ABPI NHS partnership manager Kevin Blakemore, who has spent his career working for pharma companies such as GlaxoSmithKline and UCB, expects things to change for pharma marketers. 'Going in (to a CCG) and talking about a product and three key messages isn't going to work anymore,' he says. Instead, companies need to present themselves as 'a valued and important partner, focused on outcomes, quality and productivity'.
Due to cost pressures in the NHS (and therefore on CCGs), there is a willingness to embrace ideas that pharma companies have to offer. 'The current environment is more conducive to joint working than it has been for years, perhaps decades,' Blakemore insists.
He cites the case of drug company Baxter Healthcare, whose Floseal product stops nosebleeds, being asked by Liverpool's University Hospital Aintree to redesign its patient pathway. The hospital found nosebleeds caused hospitalisations and wanted to see them reduced. Baxter put in place staff training to assess whether Floseal should be used when patients presented.
This seems minor stuff, but hospital bed use by nosebleed sufferers fell by 27 per cent as a result, and £100,000 was saved. 'If we start spreading that across other things that are causing the NHS problems, and demonstrate the value of the medicines we make, that is how we get buy-in,' Blakemore concludes.
It is worth bearing in mind that CCGs will start life under pressure - an ageing population, the cost of new technology and rising patient expectations mean there are opportunities for private companies to make their mark with the right idea. 'Maybe ten years ago it was more of an "us and them" situation - big pharma versus the good-old NHS,' Cantor says. 'But we see ourselves much more as a partner to CCGs.'
Crucially, pharma has to look at how it delivers services, McGilligan adds. 'It is difficult for them to get in front of a GP,' he explains. 'We don't really see drug reps anymore, so they have to find another way of accessing CCGs. They would now usually approach the chair of a CCG to say, "This is what we can offer." We want projects with a good legacy. What they get out of it is that if it's a good outcome, we'll publish it.'
Successful projects may well lead to an uptake in prescriptions of a given drug too. Above all, pharma must look carefully to see what it can do for individual CCGs. 'We've all got different priorities,' says McGilligan. 'If their drugs are great, we'll buy them anyway.'
REDUCING ADMISSIONS: Attention on prevention
'The important thing is how you prevent people getting ill,' says Dr Joe McGilligan, chair of East Surrey CCG. 'We should be screening more patients and doing health checks - we have the data to search for a family history. For instance, put people on statins early on and they don't have heart attacks. We should be working with pharma to identify the right patients.'
Pharma can provide 'an extra pair of hands' for busy GPs, he says. For example, patients with an atrial fibrillation heart condition could be identified by GPs as candidates for intervention but a pharma company could put together a project in which these patients are contacted and seen.
Since CCGs will receive bonuses based on outcomes, they will be open to anything that can help them get better results for patients and reduce demand on their services.
Indeed, pharma's experience of project management could prove useful when it comes to integrating the various care pathways - often prepared in silos at present - that a CCG has to have in place.
A&E may be a crucial battleground with chronic obstructive pulmonary disease (COPD) patients, for example. A catch-all term encompassing chronic bronchitis and emphysema, COPD is usually caused by smoking and is a major cause of death. Therefore, many CCGs will seek to manage their COPD sufferers and view an emergency admission as a system failure which sucks money out of their budgets somewhere else.
In a similar way, use of a drug company's long-acting insulin products, where appropriate, could allow CCGs to save on hypoglycaemic admissions by diabetic patients - far better for their condition to be managed effectively rather than reach the point where high blood sugar causes a crisis.
If pharma firms can help reduce non-elective admissions by designing patient pathways or creating a new training programme in a given therapy area, they will have the attention of doctors and financiers alike.