Joint Working between Pharmaceutical Companies and the NHS and Others for the Benefit of Patients
An introduction to the ABPI guidance notes

This presentation is a brief summary of key issues in the ABPI Guidance Notes on Joint Working.
Joint Working between the NHS and the pharmaceutical industry is a relatively new concept and companies are likely to have little or no historic experience. The purpose of the ABPI Guidance is to support appropriate
Joint Working including how potential pitfalls might be identified and avoided.
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Chapter Key content
Purpose of this Guidance
Background to Joint Working
Outlines the need for a framework for joint working.
Describes how NHS and pharmaceutical company relationships are evolving.
Definition and Scope of Joint Working Patient benefit and pooled resources are core.
Describes what is not Joint Working.
Principles of Joint Working Need for patient benefit, mutual benefit, transparency and organisational level sign off.
Examples of Joint Working Suggested types of activity that can be included in Joint Working projects.
Joint Working Governance Transparency and the need to avoid inappropriate influencing of prescribers.
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Chapter
The Mutual Benefits of Joint Working
Measuring Joint Working
Deciding to Take Part in Joint Working
Joint Working Agreements
Disengagement/Exit Criteria
Key content
Describing patient, NHS and company benefits. Being clear about expected outcomes.
Affirms that measurement is required and suggests criteria that can be assessed.
Being transparent, how to calculate return on investment for all and the importance of patient benefit.
Need for a formal agreement and specific areas that should be included.
Need to define a clear end point at the outset.
Reasons to exit an agreement early.
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Chapter
Joint Working Projects and Clinical
Guidelines
Key content
No inappropriate influencing of prescribers. Supported guidelines must be independent.
Communicating Joint Working Projects within the Company
Using Data Obtained from Joint Working
Projects
Consistency of message. Ensuring JW is not used as inducement by representatives.
Outlines the various legislation that applies.
Competition and Commercial-In-Conference Applies when more than one company is
Issues involved. Legal counsel may be required.
Other Considerations Personal benefit must not come from joint working. Anti corruption rules.
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Moving beyond sponsorship: Interactive toolkit for joint working between the NHS and the pharmaceutical industry, Department of
Health/ABPI (March 2008)
Best practice guidance for joint working between the NHS and the pharmaceutical industry, Department of Health (February 2008)
A Common Understanding: Guidance on Joint Working between
NHS Scotland and the Pharmaceutical Industry (2003)
Guidance for Partnership Working between NHS Organisations,
Primary Care Contractors, the Pharmaceutical Industry and the
Allied Commercial Sector in Wales (2004)
ABPI Code of Practice for the Pharmaceutical Industry (2008) www.abpi.org.uk

Most relevant clauses – Clause 18.
Joint working must not be an inducement to a health professional to prescribe, supply, administer, recommend, buy or sell any medicine.
Only informal guidance about the Code can be provided by the PMCPA.
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 Overview of content
 Definition of Joint Working
 Suggested audiences
 How to articulate benefits and return on investment
 Summary of mutual benefits
 Placing of initiatives (Targeting)
 Measurement
 Communication to sales forces and others
 Key differences between medical and educational goods and services and joint working
 Potential pitfalls www.abpi.org.uk

This presentation is for those most likely to have a key role in the development and implementation of joint working projects such as:
– Medical signatories
– NHS liaison team management
– NHS liaison teams
– Brand marketing teams
– Compliance officers
– Legal www.abpi.org.uk

Joint Working is defined in the DH/ABPI Joint Working
Toolkit ‘Moving Beyond Sponsorship’ as:
Situations where, for the benefit of patients, one or more pharmaceutical companies and the NHS
pool skills, experience and/or resources for the
joint development and implementation of patient centred projects and share a commitment to successful delivery. www.abpi.org.uk

the Joint Working project must be focused on benefits to patients; and there must be a ‘pooling’ of resources between the pharmaceutical company/ies and the NHS organisation(s) involved.
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Each party must, therefore, make a significant contribution to the Joint Working project to avoid the arrangement being construed as merely a gift, benefit in kind, donation or some other non-promotional/commercial practice.
Resources may come in various forms, including people, expertise, equipment, communication channels, information technology and finance.
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benefit patients (expected to also mutually benefit the parties).
be conducted in an ethical, open and transparent manner – overall arrangements made public.
take place at a corporate organisational level and not with individual health professionals.
be in accordance with the ABPI Code, government guidance, NHS rules and relevant professional codes, etc.
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Joint Working projects are likely to be of significant scope and size, involving resources in the region of £15
£20k or more and lasting six months or longer. Lower figures may be applicable depending on circumstances.
The key determinant is whether a project follows the principles of joint working.
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 When describing the benefits of a specific joint working project one must be able to:
– Clearly define patient benefits
– Show how the NHS will benefit
– Describe how the company will benefit
– Ensure that both parties are comfortable with the arrangements
 As these are ‘business to business’ arrangements it is both reasonable and appropriate for both parties to consider return on investment (ROI) before committing to any project.
Commercial benefit to either party must not be the sole benefit.
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 Pharmaceutical companies can calculate ROI provided governance arrangements are in place
– ROI calculations should be set out in the context of patient care and shared with the parties
– The aim of conducting ROI analysis should be made clear eg to make decisions on resource utilisation
– Companies should not terminate a project solely on the basis of a negative ROI for its medicines
 Both parties, the NHS and company, should be able to articulate their ROI in clear and measurable terms www.abpi.org.uk

 Care closer to home
 Fewer hospital admissions
 More equitable and consistent care and access to care
 Better information about conditions and treatment options
 Clearer and improved care pathways
 Better experience of the healthcare system www.abpi.org.uk

 Higher quality, more consistent care achieved more rapidly
 Services configured around patients’ needs
 Better health outcomes
 Better use of resources, more value for money, lower costs
 More people treated appropriately (eg in line with national guidelines)
 Lower costs of hospital admissions
 Support towards achievement of performance targets
 More creative approaches to problems
 Better cross-sectoral working
 Better skilled personnel www.abpi.org.uk

 Market expansion and/or more appropriate use of medicines, including the company’s medicine(s)
 Better understanding of customers’ and patients’ needs
 Improved reputation
 Faster NHS implementation of policy which may be relevant to the company’s business www.abpi.org.uk

 It is acceptable to target Joint Working geographically according to:
– Identified patient need
– Availability, experience and commitment of relevant personnel to deliver the project
– Areas where the NHS has expressed a need or desire to improve benefits to patients by working together with the pharmaceutical company/ies
 When targeting a project to a location ROI for the company must not be the sole or primary criterion www.abpi.org.uk

The outcome of every project should be measured and baseline measurements might be helpful to track success, particularly patient outcomes.
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Must be agreed and included in the Joint Working agreement.
Either party should be able to exit an agreement if patients are not benefiting and must do so if the project is detrimental to patients.
A pharmaceutical company may not terminate a Joint
Working project solely on the grounds that prospective
ROI is not met.
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Name, parties, date and term.
Expected benefits for patients, the NHS and pharmaceutical company.
Outline of the financial arrangements.
Roles of the parties, how success will be measured.
Contingency arrangements.
Summary of Joint Working agreements to be made public by the pharmaceutical company.
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 Companies should consider how sales representatives and other personnel are briefed to ensure that the Joint Working agreement is not infringed and that the project is not used inappropriately by sales representatives to gain access to customers or to influence prescribing
 The importance of consistent communication within a company regarding Joint Working initiatives should not be underestimated www.abpi.org.uk

 Joint Working is different to the provision of Medical and Educational Goods and Services (MEGS) that enhance patient care or benefit the NHS and maintain patient care.
 It is very unlikely that the provision of MEGS would ever meet the definition of Joint Working as they are mainly provided by a pharmaceutical company in circumstances where there is no ‘pooling of resources’.
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NHS/Pharma company pool resources
Detailed JW agreement
Details of arrangement made public
MEGS x x
O
JW
P
P
Outcomes must be measured O P
Shared commitment to successful delivery P P
P
O = Optional www.abpi.org.uk

Chapter
Definition and Scope of Joint Working
Principles of Joint Working
Joint Working Governance
Features of proposal
Able to describe how patients, the NHS and the company are likely to benefit. There is a clear and significant pooling of resources between the company and the NHS. Certainty that this is not just a traditional MEGS activity.
Patients are the principal beneficiary. A written agreement will be in place.
The project is transparent. Have ensured that the project has been agreed at an organisational level so that inappropriate influencing of prescribers has not occurred.
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Chapter
Measuring Joint Working
Deciding to Take Part in
Joint Working
Features of proposal
Have a range of measures that are specific to the patient, NHS and company. Have expected outcomes for this project and an agreed schedule for measurement to ensure these take place.
Have considered a balance of benefits for all parties and can clearly show that decisions have been made at an appropriate level in the company. Any ROI calculations have been made to support resource allocation decisions.
Joint Working Agreements Have a formal agreement in place that is very clear about what all parties have agreed. Have not started the project prior to having this agreement.
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Chapter
Disengagement/Exit Criteria
Joint Working Projects and
Guidelines
Communicating Joint Working
Projects within the Company
Features of proposal
Both parties know exactly when and why the project will end. All know what interim steps must be achieved in order to reach the project end and can describe the circumstances that will end the project earlier than planned.
Any clinical guidelines being followed are independently approved. If the company previously supported their development can independence from the project be demonstrated? Guidelines are not a disguised switch programme.
Everyone in the company who has contact with any customer affected by this project understands their role. All have clarity about the expected outcomes and know that the project must not be used to influence prescribing.
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 ABPI - Martin Anderson (Director, NHS Policy and
Partnerships) on 020 7747 1401 or manderson@abpi.org.uk
 ABPI Extranet
 PMCPA – Heather Simmonds, Director on 020 7747
1438 or info@pmcpa.org.uk
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