NHS Patient Safety – Medication

How can Pharmaceutical Companies contribute to improving NHS Patient Safety?

They can demonstrate ‘added value’ , for example, by either offering products which contribute directly to making the administration of medicines safer by helping to reduce:-

• Making the drug up to the wrong strength
• Using the wrong diluent
• Microbial or other forms of contamination
• Labelling errors
• Administration by the incorrect route by clearer design/packaging of the product

The products which are commonly offered as part of a compounding service include:-

• Cytotoxics
• Antibiotics
• Inotropes
• Potassium solutions
• TPN
• Unlicensed medicines

In addition, the provision of non-promotional training/educational services to healthcare professionals in the form of Continuing Professional Development events and nurse advisor teams helps to educate NHS staff on how to administer medicines more

• Confidently
• Accurately
• Competently

The Department of Health (DH) has issued the following list of ‘Never Events’ for 2012-13. The list is circulated to a wide range of NHS managers, clinicians and healthcare professional allied to medicine.

The document authors are the DH’s Patient Safety and Investigations unit. The purpose of the document is to highlight certain events which are deemed to be very serious risks to the standard of care to patients, but most importantly avoidable.

The document forms part of the wider DH’s Patient Safety Agenda policy and should be read in conjunction with the NHS Standards Contract for organisations providing services to the NHS

1. Wrong site surgery
2. Wrong implant/prosthesis
3. Retained foreign object post-operation
4. Wrongly prepared high-risk injectable medication
5. Maladministration of potassium-containing solutions
6. Wrong route administration of chemotherapy
7. Wrong route administration of oral/enteral treatment
8. Intravenous administration of epidural medication
9. Maladministration of Insulin
10. Overdose of midazolam during conscious sedation
11. Opioid overdose of an opioid-naïve patient
12. Inappropriate administration of daily oral methotrexate
13. Suicide using non-collapsible rails
14. Escape of a transferred prisoner
15. Falls from unrestricted windows
16. Entrapment in bedrails
17. Transfusion of ABO-incompatible blood components
18. Transplantation of ABO incompatible organs as a result of error
19. Misplaced naso- or oro-gastric tubes
20. Wrong gas administered
21. Failure to monitor and respond to oxygen saturation
22. Air embolism
23. Misidentification of patients
24. Severe scalding of patients
25. Maternal death due to post partum haemorrhage after elective Caesarean  section

Source: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_132352.pdf

You can read the whole document if you wish, but the indicators within the specific areas where the Pharmaceutical Industry has opportunities to work in conjunction with the NHS includes:-

1. Wrongly prepared high-risk injectable medication

• Death or severe harm as a result of a wrongly prepared high-risk injectable       medication.
• High-risk injectable medicines are identified using the NPSA’s risk assessment tool1. A list of high-risk medicines has been prepared by the NHS Aseptic Pharmacy Services Group using this tool2. Organisations should have their own list of high-risk medications for the purposes of the “never event” policy, which may vary from the NHS Aseptic Pharmacy Services Group list, depending on local circumstances.
• A high risk injectable medicine is considered wrongly prepared if it was not; o prepared in accordance with the manufacturer’s Specification of Product Characteristics;

1 NPSA High Risk Medication Risk Assessment Tool, 2007, available at

http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=60097&type=full&servicet ype=Attachment

2 Pharmaceutical Aseptic Services Group. Example risk assessment of injectable medicines. 2007. Available at http://www.civas.co.uk/

• This event excludes any incidents that are covered by other “never events”.
• Where death or severe harm cannot be attributed to incorrect preparation, treat as a Serious Untoward Incident.

5. Maladministration of potassium-containing solutions

• Death or severe harm as a result of maladministration of a potassium-containing solution.

Maladministration refers to;

• selection of strong potassium solution instead of intended other medication,
• wrong route administration, for example a solution intended for central venous catheter administration given peripherally,
• infusion at a rate greater than intended.

Setting: All healthcare settings.

Guidance: – Patient safety alert – Potassium chloride concentrate solutions, 2002 (updated 2003), available at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59882

6. Wrong route administration of chemotherapy

Intravenous or other chemotherapy (for example, vincristine) that is correctly prescribed but administered via the wrong route (usually into the intrathecal space).

 

Setting: All healthcare premises.

Guidance: – HSC2008/001: Updated national guidance on the safe administration of intrathecal chemotherapy, available at http://www.dh.gov.uk/en/publicationsandstatistics/lettersandcirculars/healthservicecirculars/dh_ 086870 – Rapid Response Report NPSA/2008/RRR004 using vinca alkaloid minibags (adult/adolescent units), available at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59890

7. Wrong route administration of oral/enteral treatment

Death or severe harm as a result of oral/enteral medication, feed or flush administered by any parenteral route.

Setting: All healthcare settings.

Guidance: – Patient Safety Alert NPSA/2007/19 – Promoting safer measurement and administration of liquid medicines via oral and other enteral routes, 2007, available at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59808

8. Death or severe harm as a result of intravenous administration of epidural medication.

• A broader “never event” covering intravenous administration of intrathecal medication or The “never events” list 2012/13 9 intrathecal administration of intravenous medication is intended once the deadlines for Patient Safety Alert 004A and B actions have passed.

 Setting: All healthcare premises.

Guidance: – Patient Safety Alert NPSA/2007/21, Safer practice with epidural injections and infusions, available at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59807 – Safer spinal (intrathecal), epidural and regional devices – Parts A and B, available at http://www.nrls.npsa.nhs.uk/resources/?EntryId45=65259

9. Maladministration of Insulin

Death or severe harm as a result of maladministration of insulin by a health professional. Maladministration in this instance refers to when a health professional

• uses any abbreviation for the words ‘unit’ or ‘units’ when prescribing insulin in writing,
• issues an unclear or misinterpreted verbal instruction to a colleague,
• fails to use a specific insulin administration device e.g. an insulin syringe or insulin pen to draw up or administer insulin, or
• fails to give insulin when correctly prescribed.

Setting: All healthcare settings.

Guidance: – Rapid response report – Safer administration of insulin, 2010, available at http://www.nrls.npsa.nhs.uk/alerts/?entryid45=74287 – NHS Diabetes – Safe use of insulin, 2010, available at http://www.diabetes.nhs.uk/safe_use_of_insulin/ – NHSIII Toolkit – Think Glucose, 2008, available at http://www.institute.nhs.uk/thinkglucose – NHS Diabetes guidance – The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus, 2010, available at http://www.diabetes.nhs.uk/document.php?o=1037

19. Misplaced naso- or oro-gastric tubes

Death or severe harm as a result of a naso- or oro-gastric tube being misplaced in the respiratory tract.

Setting: All healthcare premises.

Guidance: – Patient safety alert – Reducing harm caused by misplaced nasogastric feeding tubes, 2005, available at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59794 – Patient safety alert – Reducing harm caused by misplaced naso and orogastric feeding tubes in babies under the care of neonatal units, 2005, available at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59798&q=0%c2%acnasogastric%c2%ac

Please visit the20:20Selection website if you have found this article helpful, as we regularly update the articles in our Factsheet section

http://www.2020selection.co.uk

Primary Care Medical Sales Representative

Primary Care Representative

A Primary Care Representative is an ABPI qualified Medical Sales Representative who concentrates their efforts in the primary care setting, with customers who work in the primary care arena.

The Primary Care setting consists of local GP surgeries/ Health Centres/ Medical Centres/  Walk-in-Centres/ Community Pharmacies/ Primary Care Trusts(PCTs) and Clinical Commissioning Groups(CCGs). These locations will house the customer base for the Primary Care Representative – for instance: GPs, practice nurses, practice managers, dieticians, practice pharmacists, non-medical prescribers, community pharmacists, PCT personnel ( medicines management team, medical director, prescribing lead).

A Primary Care Representative is responsible for business planning, budgetary planning and targeting, to make sure that they sell to the ‘right people and see them the right number of times’. It is the role of the Primary Care Representative to build trusted working relationships  with their customers  and to implement the marketing plan in their area. They work closely with colleagues in their team, such as Hospital Specialists and NHS Liaison Managers, sharing relevant information so that customers receive excellent service from the company, and so that product sales grow optimally.

Typically, a Primary Care Representative will be a graduate with a science based background, although graduates in the Humanities, Commerce or Law fields are also employed.  Occasionally, non-graduates with a good academic background and relevant background in sales may also be employed as Primary Care Representatives.  Nurses, pharmacists and other health care professionals can also make excellent sales representatiives if they have good commercial acumen and selling skills also. The most important qualities that an employer will be seeking in any potential Primary Care Representative are positive attitude, resourcefulness, commercial focus, good work ethic, ability to work autonomously, excellent planning and organisational skills, good time management skills and above all exceptional communication skills.

What is the typical working day of  a Primary Care Representative ? Having already planned the day several days or more in advance, they tend to see GP’s either during or after surgery in the morning, and see retail pharmacists and practice nurses in the afternoons.Their role is to build relationships with practice staff, doctors, nurses and retail pharmacists, to ensure that they create an environment where their products are most likely to be prescribed more frequently. These meetings will take the form of one-to-one discussions during which the Primary Care Representative will seek to understand the health care professional’s needs through appropriate questioning and enagement in a two way communication to sell the benefits of their product portfolio for the customer and for the patients. Promotional materials may be used to remind a reinforce product benefits of the Primary Care Representative’s visit but the nature of it’s content and the format is tightly controlled by the ABPI.

Alternatively, the Primary Care Representative could hold a structered meeting witht a wider audience which usually involves delivering a presentation during a luch time break at a GP surgery or to a larger audience perhaps at an after hours educational meeting led by Key Opinion Leaders. A meeting or appointment may be subject to change at short notice as the healthcare professional who the Primary Care Representative is going to visit may have to attend to the clinical needs of their patients, so it is always prudent to have several back-up plans and contingencies for each days work.

The success of a Primary Care Representative is largely measured by the sales of the products that they have in their portfolio. Sales data is usually collected by the amount of product that is sold into the pharmaceutical wholesalers and by the number of prescriptions that are processed by the NHS Business Services Authority who are the government agency responsible for reimbursing pharmacies for the NHS prescriptions that they have dispensed.

The Primary Care Representative may find themselves either employed directly by a manufacturer of a pharmaceutical product i.e. in what is known as a ‘headcount’ role or possibly as a part of a team of contract sales representatives, as either a dedicated or syndicated sales team.

Contract teams are run by organisations which specialise in putting sales teams into pharmaceutical companies who maybe wish to run a sales campaign for a limited period of time or want to assess the uptake of their product before they employ a large ‘headcount’ sales team. The pharmaceutical industry is held in very high regard for the excellent level of training that it gives it’s employees and for the ethical manner in which they work.

Are you eligible? Having your documents ready for your job search.

Embarking on a search for a new job can be daunting however like all things in life it can go more smoothly with forward planning. This short article is aimed at ensuring you have the relevant factual information at hand. This is important as agencies (like20:20 Selection Ltd) and importantly employers do need to check your legal, employment and academic documentation. Hence if you have all this in order, then when it comes to you being made that perfect job offer the contract/job offer letter is likely to be with you more quickly.

 

The following checklist should help you with your preparation:

• Passport & Visa (if applicable) – an employer can be fined for employing individuals who are not eligible to work in theUK

• Driving Licence – you will need the paper and photo card parts. For field based positions you will need a validUKdriving licence with no more than 6 penalty points. It is important you make clear declarations about your driving history when asked as employers will check this with the DVLA.

If you have a nonUKlicence holder and need to convert your licence the following link will give you some guidance:

http://www.direct.gov.uk/en/Motoring/DriverLicensing/DrivingInGbOnAForeignLicence/DG_4022562

• A recent payslip. This will validated your current basic salary and your National Insurance number. If you are in receipt of other monthly benefits such as a car allowance this will also be verified on the payslip.
• ABPI certificate – if you have sat and passed the examination you will need to produce your certificate if you are offered employment with a pharmaceutical company. If you have misplaced this, the following link may help

https://extranet.abpi.org.uk/web/abpi/exams.nsf/pages/duplicate_certificate_request

• Highest education certificates (degree, nursing, A levels etc)
• For nursing roles you will need your current NMC PIN number and date of expiry. Plus you will also be asked about the date of your last CRB check however your new employer will need to undertake a fresh check.
• For sales positions you should also put together your ‘Brag File’ or portfolio of successes which should include Sales Data, other performance against KPIs, recent appraisal documents; in fact anything that you can use to sell you and differentiate you in the marketplace.

 

If you are not facing redundancy, timing your job search is also something to consider. For example,

• We do come across people who may be tied in to car schemes. You are advised to carefully calculate the costs involved to you in walking away from your current agreement, as not all employers offer car opt-out schemes.
• If you are going to jeopardise any bonus/incentive payments pay by leaving before a certain date.
• If you have significant holiday commitments it is important you flag these. A job offer may be subject to you attending a training course on a specific date for a fixed time, however discussing these with your Recruitment Consultant early in the process may mean this can be negotiated. Also remember that holiday entitlement will be prorated depending at what stage of the leave year you commence work.

 

At 20:20Selection, we are here to help and guide our candidate along the process. Our specialist team can be contacted on 0845 026 2020 from08:30 – 18:00weekdays.

MABS / CYTOKINE MODULATORS / ANIT- TNF AGENTS AND MORE

A medication ending with the stem ‘mab’ indicates that it is a monoclonal antibody. This is the internationally recognised nomenclature for the naming of monoclonal antibodies. 

Nomenclature has become somewhat confusing though as the BNF includes ‘mabs’ under the heading of cytokine modulators and anti-lymphocyte monoclonal antibodies in several chapters.

 Monoclonal antibody production for medical use was first discovered by Milstein and Kohler in 1975, but it was confined mainly to diagnostics until Vilcek and Li approached Centacor (now part of Johnson & Johnson) to help them produce ‘mabs’ against TNFα.

Tumour necrosis factor-alpha (TNFα) is a cytokine (an immunomodulating agent) produced by monocytes and macrophages, two types of white blood cells. It mediates the immune response by increasing the transport of white blood cells to sites of inflammation, and through additional molecular mechanisms which initiate and amplify inflammation. Inhibition of its action by ‘mabs’ reduces the inflammatory response which is especially useful for treating autoimmune diseases.

The ‘mab’ that Vilcek and Li discovered become known as Infliximab (Remicade) and it became an important treatment for severe Crohn’s disease, including the fistulating variety. It has subsequently been used to treat other auto-immune system  diseases such as psoriasis and rheumatoid arthritis. Infliximab became known as ‘Kwik Fiximab’ in medical circles due to it’s clinical success in treating otherwise unresposive patients.

There are two types of TNF receptors: those found embedded in white blood cells that respond to TNF by releasing other cytokines, and soluble TNF receptors which are used to deactivate TNF and blunt the immune response. In addition, TNF receptors are found on the surface of virtually all nucleated cells. Red blood cells, which are not nucleated, do not contain TNF receptors on their surface.

A ‘mab’ neutralises the biological activity of TNFα by binding with high affinity to the soluble (free floating in the blood) and transmembrane (located on the outer membranes of T cells and similar immune cells) forms of TNFα and inhibits or prevents the effective binding of TNFα with its receptors. Infliximab and adalimumab (another TNF antagonist) are in the subclass of “anti-TNF antibodies” (they are in the form of naturally occurring antibodies), and are capable of neutralising all forms (extracellular, transmembrane, and receptor-bound) of TNFα. Etanercept, a third TNF antagonist, is not a ’mab’ and it is in a different subclass (receptor-construct fusion protein), and, because of its modified form, cannot neutralize receptor-bound TNFα. Etanercept is sometimes referred to as a ‘non-biologial’ agent to distinguish it further from the ‘mabs’ Additionally, the anti-TNF antibodies adalimumab and infliximab have the capability of lysing cells involved in the inflammatory process, whereas the receptor fusion protein apparently lacks this capability. Although the clinical significance of these differences have not been absolutely proven, they may account for the differential actions of these drugs in both efficacy and side effects.

Infliximab has high specificity for TNFα, and does not neutralise TNF beta (TNFβ, also called lymphotoxin α), an unrelated cytokine that uses different receptors from TNFα. Biological activities that are attributed to TNFα include: induction of proinflammatory cytokines such as interleukin (IL) 1 and IL 6, enhancement of leukocyte movement or migration from the blood vessels into the tissues by increasing the permeability of endothelial layer of blood vessels; and increasing the release of adhesion molecules.

A range of newer agents which act against these other cytokines have subsequently been developed.

Tha table below summarises the anti- TNF mabs available in the UK currently. None-mab anti-TNF agents are also included for comparison

MOLECULE	BRAND	CLASS	DERIVATION	INDICATION	NICEAPPROVED
Adalimumab	Humira (Abbott)	Anti-TNFα	Recombinant human ‘mab’ From hamster ovary	RA PJIA PA AS CD P	Yes No Yes Yes Yes Yes
Alemtuzumab	MabCampath (Genzyme)	Anti-lymphocyte	Recombinant human ‘mab’ from hamster ovary	CLL	Yes
Certolizumab Pegol	Cimzia (UCB Pharma)	Anti-TNFα	Recombinant human ‘mab’ From E Coli	RA	Yes
Golimumab	Simponi (Schering-Plough)	Anti-TNFα	Recombinant human ‘mab’ from murine cell line	RA PA AS	No No No
Infliximab	Remicade (Schering-Plough)	Anti-TNFα	Recombinant human ‘mab’	RA CD UC AS PA P	Yes Yes Yes Yes Yes Yes
Ofatumumab	Arzerra (GSK)	Anti-lymphocyte	Recombinant human ‘mab’ from murine cell line	CLL	No
Rituximab	MabThera (Roche)	Anti-TNFα	Recombinant human ‘mab’ from hamster ovary	RA CLL NHL	Yes Yes Yes
Tocilizumab	RoActemra (Roche)	Anti-IL-6	Recombinant human ‘mab’ from hamster ovary	RA	Yes
Ustekinumab	Stelara (Janssen-Cilag)	Anti-IL-12/23	Recombinant human ‘mab’ from murine cell line	P	Yes
Abatacept	Orencia (Bristol-Myers Squibb)	T-cell modulator	Fused protein formed by recombinantDNAtechnology	RA PJIA	Yes No
Anakinra	Kineret (Swedish Orphan)	Anti-IL-1	Recombinant human ‘mab’ From E Coli	RA	No
Etanercept	Enbrel (Wyeth)	Anti-TNFα (soluble receptor specific)	Fused protein formed by recombinantDNAtechnology from hamster ovary	RA PJIA PA AS P	Yes Yes Yes Yes Yes

 

KEY

RA = Rheumatoid arthritis

PJIA = Polyarticular juvenile idiopathic arthritis

PA = Psoriatic arthritis

AS = Ankylosing spondylitis

CD = Crohn’s disease

P = Psoriasis

CLL= Chronic lymphocytic leukaemia

NHL= Non-Hodgkin’s lymphoma

NICEapproval status correct as of May 2011. Please refer to NICEwebsite for latest guidance http://www.nice.org.uk/

Sources:NICE, manufacturers Summaries of Product Characteristics, and BNF vol 61

VALUE BASED PRICING (VBP) – How the NHS will purchase drugs

 The government intends to reform the way in which drugs purchased by the NHS are priced by the end of 2013. It aims to ensure that drug costs more fully reflect clinical benefit and to improve patient access to new treatments. At present the prices are determined by the Pharmaceutical Price Regulatory Scheme (PPRS). These prices are usually reviewed at 5 yearly intervals. Pharmaceutical companies are relatively free to set the price of a newly launched product (assuming it is accepted for use by NICE, the Scottich Medicines Consortium or the All Wales Medicines Strategy Group in the first instance). The PPRS then reviews these prices so that the profits that are made from the sale of drugs to the NHS are not considered to be excessive.

The Office of Fair Trading argues that drug prices should reflect their clinical benefits and current policy wastes NHS resources. The pharmaceutical industry welcomes the concept of value-based pricing, but is concerned about the impact on profits which are needed to make research viable. The Office of Fair Trading (OFT) estimates that up to 25% of world pharmaceuticals sales reference UK prices to some extent. Companies are thus particularly sensitive about any agreement that reduces the UK list price of a drug as this can have a knock-on effect on the profits made on sales elsewhere in the world.

Successive price cuts and exchange rate movements mean that UK prices are currently amongst the lowest in Europe. This has led to parallel-exporting (the opposite of the practice of parallel-importing cheaper non-English language versions of the same branded product from the EEU to the UK) of UK branded medicines to the EEU, by wholesalers, pharmacies and NHS trusts for commercial gain which has led to severe shortages of many popularly prescribed medicines in the UK.

Under the new system of value-based pricing, the Government would apply weightings to the benefits provided by new branded medicines, which would imply a range of price thresholds reflecting the maximum they are prepared to pay for medicines. These thresholds or maximum prices would be adjusted to reflect a broader range of relevant factors that are not fully taken into account by the current sytem of using Quality Adjusted Life Years (QALYs) by NICE so they could be used to calculate the full value of a new product.

The Government proposes that the price threshold structure is determined as follows:

• there would be a basic threshold, reflecting the benefits displaced elsewhere in the NHS when funds are allocated to new medicines
• there would be higher thresholds for medicines that tackle diseases where there is greater “burden of illness”: the more the medicine is focused on diseases with unmet need or which are particularly severe, the higher the threshold
• there would be higher thresholds for medicines that can demonstrate greater therapeutic innovation and improvements compared with other products
•  there would be higher thresholds for medicines that can demonstrate wider societal benefits.

 

Designing the new system to be both stable and transparent would allow companies to predict well in advance how prospective products may fare, and to focus their research efforts on the treatments that society values most. Companies would be informed of these weightings – allowing them to orient their research and development investments appropriately. This may well draw to a close the ‘me too’ concept of launching ‘newer versions’ of drugs which treat similar conditions with little demonstrable benefit over the original.

Thus, a new product would be launched, then reviewed by the Government to access its impact on patient health and the others factors discussed above, and the price to the NHS adjusted accordingly over a period of time.

The work of NICE as a provider authoritative advice and information would continue, but the decision as to whether a new medicine will be used in clinical practice will ultimately be made by the clinicians themselves.

VBP models are already implemented in many European countries including Germany, Sweden, France, Spain and Italy.

QIPP

FACTSHEET

WHAT IS QIPP?

The QIPP agenda is undoubtedly one of the most significant NHS policies that all organisations who conduct business with the NHS will have to take onboard.

Quality

Innovation

Productivity

Prevention

The agenda will have to run through the every thought and every process that takes place throughout the NHS from Primary Care Trusts to Secondary Care to General Practice.

QIPP will affect every department and individual who works for the NHS – for example front line clinicians, PCT commissioners, estate managers, laundry services, ward staff, ambulance trusts, etc.

Why?

The year 2010/11 is the last year in which the £102 billion that is spent on the NHS is set to get an increase in funding of around 5.5%. For the foreseeable future the growth will be limited to inflation. The NHS needs to identify £15-£20 billion of efficiency savings by the end of 2013/14 that can be reinvested within the service so that it can continue to deliver year on year quality improvements.

HOW WILL QIPP AFFECT PHARMA?

 

In order to do business with the NHS in future, organisations will need to focus on how the products/services that they offer fit in with the local QIPP agenda. Clearly organisations will have to attain immediate overviews as to how the QIPP agenda is going to be adopted at local levels, as it is anticipated that new, complex information resources will be required to deliver tailored solutions for each NHS customer.

PCTs will be looking to move services into primary care to reduce cost and improve Quality and Productivity. Pharmaceutical companies are already working on how to utilise their existing knowledge of World Class Commissioning to drive their targeting and market access strategies – so the platform may already be there, but the message will need refining for the QIPP.

Specifically, some of the areas which the pharmaceutical industry might be concentrating on refining their messages and strategies could include:

• to reduce preventable hospital admissions resulting from sub-optimal medicines use in chronic medical conditions (e.g. COPD)
• to identify patients who are currently undiagnosed or misdiagnosed as having a treatable chronic medical condition (e.g. COPD, diabetes, cardiovascular disease)
• to improve medical adherence and thereby improve health outcomes and reduce waste by reducing levels of non-adherence to medicines (e.g. community pharmacy monitoring schemes, GP staff training)
• to improve adherence to NICE guidance (e.g. hypertension, DVT prevention)

 

RECOMMENDED EXAMPLES

There have already been some significant improvements made to Quality and Productivity and Department of Health has provided some recommended examples.

• Atrial fibrillation – detection and optimal therapy in primary care.

Opportunistic screening by pulse palpation of patients over 65 has been used in 18 regions to improve detection of atrial fibrillation. Quality is improved by the optimal treatment of patients with atrial fibrillation reducing risk of stroke. Productivity is increased by the reduction in costs associated with stroke and its complications.

• Fractured neck of femur: rapid improvement programme.

Ten pilot trusts have succesfully implemented service re-design for the Fractured Neck Femur patient pathway. This improved quality by: improving multi discplinary and cross agency teamworking, reducing mortality, and time to theatre, and earlier mobilisation. Productivity was improved by reduced length of stay, readmissions, and delays to the theatre.

• Stroke pathway: delivering through improvement.

The NHS Institute supported Chief Executives and senior leadership to champion change and improvement across NHS organisations in all areas of the stroke pathway. Quality was improved by reducing mortality, time in A&E, and delay in CT scanning. Productivity was increased through reduction in length of stay and readmission.

• The productive ward.

The NHS Institute has supported ward leaders and nursing teams with innovative methods to improve the ward environment and process. Over 60% of NHS Acute Trusts are implementing the Productive Ward programme. Key improvements from the programme include improved quality through increasing direct patient care time and staff satisfaction and improved productivity through reduced staff absence and reduced length of hospital stay.

• Electronic blood transfusion systems.

Oxford Radcliffe Hospitals have successfully implemented an electronic blood transfusion system. This has improved quality by reducing transfusion errors and the time taken to deliver blood. Productivity has improved by reduced blood usage, wastage, and staff time.

• Enhanced recovery for elective surgery.

Enhanced recovery programmes use evidence based interventions to improve pre-, intra-, and postoperative care. They have enabled early recovery, discharge from hospital, and more rapid return to normal activities. Quality is increased by reducing complications and enabling a more rapid return to function. Productivity is improved by reducing hospital stay.

To improve the uptake of QIPP by clinicians the Department of Health has published a guide entitled:  The NHS Quality, Innovation, Productivity and Prevention Challenge: an introduction for clinicians www.somaxa.com/docs/file/QIPP_2010.pdf

Further information on QIPP can be found at:

www.link-gov.org/content/view/463/188/

www.library.nhs.uk/qipp/

 

Securing your next role – What NOT to do!

Landing a job is never easy, as the industry is now in a state of flux it is more competitive these days. There are fewer vacancies and more people chasing them than in more than a decade. But even now — more than ever — it’s still on you. Despite the fact that the job market is everything but easy right now… have you ever stopped to consider that the reason you’re still sitting there unemployed … might in fact be … you?

It’s a hard concept that most job seekers have trouble wrapping their heads around, but applicants frequently — inadvertently — raise red flags to recruiting managers that immediately scream, “Don’t employ me!” You might not be raising them on purpose, but there are ways to avoid them.

Not sure if you’re unknowingly blowing your chances at securing your dream position? Here are 10 red flags to be wary of during your next job hunt:

 

Red flag No. 1: Your CV is lacking any specific achievements that distinguish you from other Medical Representatives

When you’re crafting your CV, you should focus on highlighting relevant skills and accomplishments that are in line with the position for which you are applying. Highlighting your sales successes is key!

 

Red flag No. 2: You have long gaps between jobs on your CV

Even if your long departure from the work force is valid, extended lapses of unemployment might say to an employer, “Why weren’t you wanted by anyone?” Anytime you have more than a three-month gap of idleness on your CV, legitimate or otherwise, be prepared to explain yourself.

 

Red flag No. 3: You aren’t prepared for the interview

There are many ways to be unprepared for an interview: You haven’t researched the company, you haven’t researched the products & therapy area, you don’t have any questions prepared, etc. Plain and simple, do your homework before an interview. Explore the company online, prepare answers to Competency Based questions and have someone give you a mock interview. The more prepared you are, the more employers will take you seriously.

 

Red flag No. 4: You didn’t provide any evidence of success

In today’s competitive market use of evidence/brag file can be the difference between progressing to the next stage and being told that there ‘where stronger people on the day.’  You need to prove how successful you have been (the more specific you can be the better) and differentiate yourself from other candidates.  Do not wait to be asked for your evidence, use it as a sales aid to illustrate your answers.  YOU are your product!

 

Red flag No. 5: You only have negative things to say about previous employment

If you feel aggrieved or down-beat about your current/prior employer, it could be very tempting to want to tell anyone who will listen how much of ‘bad time’ you have experienced– but a recruiting manager for a coveted job is not that person. There are hundreds of ways to turn negative things about an old job into positives. Thought your last job was a dead end? Spin it by saying, “I felt I had gone as far as I could go in that position. I’m looking for something with more opportunity for advancement.”

 

Red flag No. 6: You’ve held seven different jobs — in the past six years

Job hopping is a new trend in the working world. Workers are no longer staying in a job for 10-20 years; they stay for a couple and move on to the next one. While such a tactic can further your career, switching jobs too often will raise a prospective employer’s antenna. Too many jobs in too little time tells employers that either you can’t hold a job or you have no loyalty. Be prepared to explain your reasoning/rationale

 

Red flag No. 7: You give inconsistent answers in your interview

One tactic recruiting manager’s use during the recruitment process is to ask you the same question in several different ways. This is mostly to ensure that you’re genuine with your answers and not just telling an employer what he or she wants to hear. Keep your responses sincere throughout the entire process and you should be good to go.

 

Red flag No. 8: You lack flexibility

Most people know what they want in a job as far as benefits, basic salary, bonus, etc. If you’re unable to be flexible with some of your (unrealistic?) expectations, however, you’re going to have a difficult time finding a job. Have a bottom line in terms of what you want before you start the job hunting process and be willing to bend a bit if necessary.

 

Red flag No. 9: Your application was — in a word – lazy

Only doing the bare minimum of what’s asked of you won’t get very far — in life or in your job search. Applying to jobs with the same CV and the same cover letter (or none at all) is pure laziness. And, if you won’t spend extra time on yourself and your application materials, you probably won’t do it for a client either.

 

Red flag No. 10: You lack objective or ambition

If you have no long-term goals, then you really have no short-term goals either. Long-term goals may change, however you need to have some concept of where you want to go. Know where you want to go and how you plan to get there. Otherwise you seem unfocused and unmotivated, which are two big no-no’s for an applicant.

We are specialists in Medical & Pharmaceutical Recruitment, to secure your next role in this sector call us at 20:20 Selection Ltd on 0845 026 2020 and speak to one of our consultants or visit www.2020selection.co.uk to view our current Medical Sales vacancies

(Adapted from CareerBuilder)

Pharmaceutical Sales – A spark of interest

Having embarked on a career as a medical representative in 1987, I still reflect on the route that led me to the pharmaceutical industry.  Being a Pharmaceutical Sales Representative doesn’t often appear in the list of careers that we aspire to as teenagers hence it is invariably something people come across coincidently.  For me I spent five years in a hospital Biochemistry Dept completing post graduate studies and developing a strong clinical understanding of various diseases and illnesses.  It was here I met Sales Representatives selling laboratory diagnostics and equipment which sparked an interest in sales (I have to admit to being initially impressed by the suit, car and perceived flexibility of their job).  In fact what did appeal to me about a sales role was the inherent challenges working towards targets and ultimately being rewarded (bonus) and recognised for exceeding goals (working in the NHS could not fulfil that need) as well as selling products which genuinely make a difference to people’s lives.

Hence I started buying the New Scientist and Daily Telegraph; there was no internet job searching in those days! Quite quickly I secured two interviews for Laboratory Territory Manager positions before seeing an advertisement for Trainee Medical Representatives with a major pharmaceutical company.

Have to confess at that stage that pharmaceuticals was a bit of a mystery to me, but my Dad said that company was great (blue-chip), and there was a number to call to apply.  Two interviews later, including being flown to head office, I was offered a GP/Hospital Representative position.

Looking back I do wonder how I got that job as these days we expect entry level candidates to know so much more about the day to day practicalities of the role, the NHS and how the business works.  Clearly the company were looking for the basic ingredients which they could then train, develop and mould to reflect their values and culture in the eyes of their customers;  GP, Nurses, Pharmacists, Consultants, Registrars, SHO etc.

Over twenty years later in a different NHS landscape I still believe this to be true so what are some of those basics;

Personal Qualities – An inner drive, self-starter, the ability to work on your own initiative, enthusiasm, can-do attitude, tenacity, the ability to problem solve, good interpersonal skills, the willingness as well as aptitude to learn.

Clinical Foundation – This means an interest in medicine, the ability to learn and apply technical information.  You will need to communicate this knowledge to customers of all levels.  ‘A’ level standard Biology should help with ABPI. 

Business & Selling Skills – Understand you are there to increase sales; it is a sales job & not a promotional or educational position.  Have a consultative selling style, i.e. probe to understand the customer needs and agenda before offering solutions. Key Account Management & Networking Skills. Understanding local NHS politics, targets, agenda and how these may impact on your business.

Clearly a lot of clinical and business skills can be taught as long as you have the right positive attitude. In summary I would describe the role of a Medical Sales Representative, whether that be GP, GP/Hospital, Hospital or Generics as the opportunity to run your own local business.

I have enjoyed a varied, challenging and satisfying career in the pharmaceutical industry. I also know others, who embarked on their career at the same time, who have had similar experiences and taken their careers in to different functions in the industry including: Marketing, Senior Sales Management, Training, Consultancy as well as others who are now Senior Representatives such as Hospital Specialist Representative or Healthcare Development Manager.

If this sparks an interest in you fantastic!  To discuss your background and transferable skills then contact 20:20 Selection Ltd on 0845 026 2020 or visit www.2020selection.co.uk . We have current opportunities Nationwide with hot-spots in London, Kent, Sussex, Essex, Somerset, Wiltshire, East Anglia.

Key Account Manager Roles – Catching a KAM

Many articles have been written about the best way to engage with our customers in the NHS. How best to partner with this new breed, made up of payers, commissioners, and medicines management gurus. How best to tap into their agenda. In fact, many careers have been built on telling us just how to sell to our customers, and an awful lot of consultancy fees have been paid to experts so that we can all be scared to death about this ‘new’ customer group who we are told work hidden away, been firmly shut doors in an increasingly complex and confusing NHS maze.

In my simple world view, yes, of course we do need to speak the same language as our customers, but we also need to ensure that we are getting the balance right, to ensure that our customer partnerships are mutually beneficial. We need to be truly customer focused, but we also need to achieve the win:win equilibrium, to avoid promising the world in value added services for very little commercial return.

Over the last few years, Key Account Management has been the new pharma industry term that seems to be bandied about on a daily basis. It is used often and widely and it seems to mean different things to different people in different companies. Every hiring manager seems to be looking for the elusive KAM. Does it mean a hospital representative? Does it mean an NHS Liaison Manager? Is it a bit of both? Or is it just a very good salesperson with the right attitude, the right skills and the common sense to convince key influential customers to sit round a table, to weigh up the pros and cons, and to agree on decisions that will help them to achieve their desired outcomes, but that will also grow product sales for their company?

In many ways, Key Account Management is a philosophy; a way of thinking, rather than some magical process. Account plans and systems can of course help to keep business on track, but they cannot be the golden ticket on their own. People still, and always will, buy from people.  Outstanding KAM’s need to be outstandingly talented sales people. In the ‘good old’ days, when sales people were autonomous, and they had full accountability for their results, the successful ones managed their own business and they managed it well. Naturally, they identified and involved all key stakeholders, naturally they engaged with clinicians, and non clinicians alike, and naturally they engaged the people who ultimately held the purse strings. They were unblocking the clinical and funding barriers that KAM’s and Market Access Manager’s do today, whilst always remembering to sell.

This breed are driven, competitive, innovative, competitive, hardworking, flexible responders to change and above all, as superb net workers and communicators, they can be relied upon to consistently achieve results.

At 20:20 Selection Limited, we know that recruitment agencies are mainly fishing from the same pond. The skill we use to catch the KAM’s is to recognise the specific species, and to know which bait to use.

Interview Guidance

Interview Guidance

PRIOR TO the Interview

Research

• Look committed and find out as much as possible about the company.

 

• Visit their web site for more information on the company.

 

• Find out who will your competitors be and as much as possible about the market/customers you will be selling to 

 

Job Description

• Make sure you are fully aware what the role is you are being interviewed for.  Your consultant at 20:20 Selection Ltd will have fully briefed you on this. 

 

• Be confident that you are technically qualified to do the job.  We would not have spoken to you about the role if we didn’t think your profile matched the client’s criteria!

 

• Have examples from your previous roles to demonstrate your ability to do this job and evidence in your brag file to back this up

 

FOR THE INTERVIEW

Personal Presentation

• Look your smartest and show your most professional side during the interview. A company is more likely to employ someone who is well presented and who will therefore best represent their company to customers. 

 

Punctuality

• Arrive to start the interview on time (be early if possible)

 

• Obtain clear directions for the location of the interview and plan your journey, allowing plenty of time to arrive.

 

INTERVIEW DO’S

• Introduce yourself courteously (first impressions last!)

 

• Express yourself clearly.

 

• Show tact, manners, courtesy, and maturity at every opportunity.

 

• Be confident and maintain poise. The ability to handle your nerves during the interview will come across as confidence in your ability to handle the job.

 

• Be prepared to show how your experience would benefit the company.

 

• Ask questions concerning the company or products and the position for which you are being interviewed for. An interviewer will be impressed by an eager and inquisitive mind. You will also be able to demonstrate that you can contribute to the company or industry if you show an interest in its products and/or services.

 

• Take time to think and construct your answers to questions to avoid rushing into a vague and senseless reply.
• Demonstrate that you are sufficiently motivated to get the job done well and that you will fit in with the company’s organisational structure and the team in which you will work.

 

• Show willingness to start at the bottom and work up.

 

• Anticipate questions you’re likely to be asked and have answers prepared in advance. Uncertainty and disorganisation show the interviewer that you are unprepared and unclear what your goals are.

 

• Be assertive without being aggressive (ensure you close – remember you are a sales person & ‘you’ are your product)

 

• Thank the interviewer for their time

 

Interview Don’ts

• Be late for the interview. Tardiness is a sign of irresponsibility or disorganisation and the employer could take it as what to expect in the future.

 

• Arrive unprepared for the interview.

 

• Say unfavourable things about previous employers.

 

• Make excuses for failings.

 

• Give vague responses to questions.

 

• Show lack of career planning – no goals or purpose could convey the impression you’re merely shopping around or only want the job for a short time.

 

• Show too much concern about rapid advancement.

 

• Overemphasise money. Your interviewing goal is to sell yourself to the interviewer and to get an offer of employment. Salary discussion is secondary.

 

• Show any reservations you may have about the role/company. You can always turn down second interviews and job offers after you have had time to appraise your concerns in the cold light of day.

 

• Express strong prejudices or any personal intolerance.

 

• Leave your mobile phone on during the interview.

 

These are general tips that can be applied to any interview situation.  Part of the service we offer at 20:20 Selection Ltd is to help you prepare for specific client interviews.  We have key account managers specifically working with clients & members of the team who come from a pharmaceutical sales management background so you will get personalised expert advice relating to your interview!  To find out more about 20:20 Selection Ltd visit www.2020selection.co.uk