How changes in the NHS are creating new roles within the medical device sector

In May 2010 the new coalition government came into power and in July they issued their White Paper – Equity and Excellence: Liberating the NHS. As we move away from 150 or so PCTs in England to around 400 GP consortia what new roles are being created in the medical device industry to allow it to get closer to what the NHS is doing?

Over the past few years we have seen the emergence of a number of roles and functions within Medical Device Companies that were traditionally the preserve of Pharmaceutical companies. These include, Re-imbursement, Public Policy Research, Health Economists, Ethics and Compliance and Outcomes Research. Going back 20 years ago when I joined Becton Dickinson and during my 12 years there and at Smiths Medical these functions either did not exist or they sat within marketing or regulatory. We are now seeing the establishment of whole new departments dedicated to these functions within large Medtech companies, Let’s explore some of the reasons for this.

The New Outcomes framework sets the new outcomes that the NHS Commissioning Board will be expected to deliver. Supporting this, the new GP commissioning consortia will be responsible for delivering improvements in health outcomes through the services that they commission.

The NHS needs to assess the benefits of new products and treatments in a more consistent manner, to date this has not been done well enough and the consequence is that many new products are still introduced simply on the basis of price and not on the basis of how they improve patient care, increase productivity and efficiency and most importantly either keep the patient out of secondary care, the most expensive place to treat them, or move them through to discharge from secondary care as quickly as possible.

In December 2010 Health Secretary Andrew Lansley told a commons select committee that the NHS will have until March 2015, an extra year compared to initial plans, to achieve £20bn in savings from quality, innovation, productivity and prevention measures. He then outlined where he saw some of these savings coming from and up to 40% some £8bn will come from tariff savings.

In an open letter to the NHS in September 2010 David Flory CBE Deputy Chief Executive of the NHS laid out plans for tariff efficiency savings in 2011-2012.

Two of his key themes were:

Incentivising quality and better patient outcomes, for example through expanding the coverage of best practice tariffs
Embedding efficiency within the tariff, for example by setting prices for a number of high volume procedures at a level below the average cost.

Both of these suggest there will be significant downward pressure on the price of medical technology products used in all procedures, this is a concern since many product innovations cost more at the product level but offer an increased outcome in terms of quality, efficiency productivity and prevention.

These marketplace pressures mean that Medtech companies can no longer sell their products simply on an old fashioned feature Vs benefit model.

The more enlightened companies have foreseen this market demand for better information about how a product will achieve the set metrics as set out above and they have moved to bring in this new expertise. This allows them to get closer to the market focussing their R&D on products that not only meet a clinical need but also an economic one.

Some of the responsibilities of these new roles include:

Knowledge of the factors which influence local, national, regional and global legislative and health and social polices. People with experience of working with politicians, civil servants and a wide range of policy influencers at national and regional level are the ideal candidates
The ability to assess and demonstrate the value of medical devices, capital equipment, software systems, drug delivery systems and diagnostics developed, manufactured and sold by the company
Developing sophisticated economic models demonstrating that the economic benefits of a device do not simply stop after it has been used, nor in the department of its use, but that the right device used in the right manner can contribute significantly to patient care, increased productivity, efficiency and quality.

As the NHS continues to evolve and change it will be interesting to see how industry functions adapt and change to keep abreast of this.