In theory, healthcare providers (HCPs) and the pharma industry ought to be on the same page. Both must operate within an overburdened healthcare system, faced with ever tighter budgets and ever increasing demand. Both exist to add value to the patient pathway, and neither can achieve their aims without input from the other.

Unfortunately, among British HCPs, the pharma industry has a less than stellar reputation. A recent industry survey, conducted by healthcare intelligence provider Binley’s in October, revealed that more than 40% of respondents viewed the industry in an unforgiving light.

"Despite clear similarities in their working environments and objectives, joint working still hasn’t delivered what they are looking for," says Sarah Eglington, healthcare intelligence director at Binley’s / Wilmington Healthcare.

The Perceptions of Pharma survey, which involved 551 general practitioners (GPs) working in England, found that negative attitudes held sway. Among those who viewed the industry unfavourably, 43% believed pharma had a different agenda to their own – namely that while GPs are patient-focused, pharma is focused predominantly on making profits.

On top of this, 20% felt that pharma companies don’t appreciate doctors’ needs, and 17% claimed that pharma doesn’t understand doctors’ prescribing budget pressures.

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Illuminating the issues

Binley’s conducted its survey not just to understand the prevalence of such perceptions, but also to get to the root of them and think up ways that faith in the industry could be restored.

As Eglington explains: "We wanted to try and shed some light on why, and give both parties some insight into how joint working could be achieved in future."

"A clear divide became apparent between HCPs who had regular contact with industry reps, and those who did not."

The survey’s questions focused on three main areas. First, the challenges faced by HCPs and the pharma industry’s understanding of those challenges, as well as what pharma can do to help. Second, whether or not HCPs are being visited by pharma reps and the nature of that working relationship. Third, to understand their preferred mode of communication with pharma companies – do HCPs appreciate this communication, and if so, which channel is best?

Engaging with pharma

From the respondents’ answers, a clear divide became apparent between HCPs who had regular contact with industry reps, and those who did not. As many as two thirds had no contact with industry at all, with the majority (63%) attributing their disengagement to lack of time. A further 19% cited restrictive practice policies.

Compared to those who regularly met with sales reps, this contingent was far more likely to hold negative opinions of the industry (56%). Among the GPs who did meet with pharma reps, 68% of them were satisfied, giving particularly high ratings to reps from AstaZeneca, Boehringer Ingelheim, GSK, Merck and Eli Lilly.

The implication here is surely that pharma reps can be instrumental in changing GPs’ attitudes, particularly when meeting face to face – productive communications are naturally easier to achieve in a setting that enables the free flow of ideas. However, with time pressures impossible to escape from, traditional meetings of this nature may not always be the most feasible approach.

"Face-to-face is only one channel that can be used to communicate and engage with HCPs – educational meetings were the most popular and telephone calls were the least popular. A multichannel approach with a mixture of educational and promotional touch points was deemed the most favourable," says Eglington.

Ways to help

The GPs were also quizzed on the ways they felt pharma could help them, foregrounding the ways that a more positive side to the relationship might emerge. Their responses included funding education (18%), educating patients on the best ways to self-manage their conditions (12%) and setting more reasonable drug costs (12%).

These findings can be best understood in conjunction with a different part of the survey, in which 169 GP practice nurses were asked how pharma might best support them. Their responses suggested ways the industry might step up its game, such as by providing additional prescribing information specifically targeted at nurses, alongside funding for training.

When asked about the challenges they faced on a day-to-day basis, the nurses listed their biggest bugbears as rising patient expectations (76%), and increased administrative duties and bureaucracy (70%).

Knowing your audience

Evidently, HCPs feel strapped for money and time, and any engagement with the pharmaceutical industry will take place against this backdrop. Knowing your audience is therefore key for a pharma rep – it’s important to empathise with the difficulties the HCP is facing and target your recommendations accordingly.

"Quotes regarding good relationships with pharma companies highlighted support with patient education materials and services, good education meetings for GPs, complete honesty and reliable information," says Eglington. "One comment that sums this up was ‘Mutual respect and understanding of each other’s aims and objectives in the transaction’."

"HCPs feel strapped for money and time, and any engagement with the pharmaceutical industry will take place against this backdrop."

It’s also important to work on alleviating mistrust, and assuring GPs that drugs fit existing guidelines. After all, if the pharma company is more invested in promoting their brand than in the patient’s health, there is a danger that this may lead to less-than-rational prescribing.

In the UK, drug promotion is largely policed by voluntary guidelines, enforced by the pharmaceutical industry and medical bodies. For instance, the Association of the British Pharmaceutical Industry (ABPI) has set a code of best practice, designed to deter anti-competitive practices, with the Medicine and Healthcare Products Regulatory Agency (MHRA) acting in extreme cases, where self-regulation fails.

Pharma companies are also advised to discuss their product at Clinical Commissioning Group and NHS England level first, before attempting to approach GPs. This provides a clear indication the visit has a purpose beyond furthering their commercial interests.
It seems clear that, while pharma companies do invest significant amounts of time and money in their engagement with HCPs, a lot of their efforts are falling on deaf ears. On the basis of this survey, the solution is to focus on partnerships, not products. And because this area is so weakly regulated, relationship building is particularly important.

"Our report showed that GPs want to feel that pharma understands the pressures that they are under and the challenges they face," says Eglington. "They know that pharma can only exist if it makes money but they don’t always want to be sold to. They want to talk about improving patient outcomes rather than products and pricing."