New opportunity – Clinical Therapeutics Specialist – Orphan products – Northern UK/ Southern UK/ Ireland – Excellent reward package – 4724

Clinical Therapeutics Specialist – Orphan Product – New product launch opportunity.

Three territories:-

1. Northern England & Scotland

2. Southern England & Wales

3. Ireland

As a medical sales professional launching a new entity in to the market is one of the most thrilling and challenging career landmarks. For our client, there is just one chance to bring their new product to market; hence we are in search of an elite salesperson who can establish a breakthrough treatment in key centres across your territories. You must:
– Thrive in a fast-paced working environment
– Be able to work with your internal and external stakeholders to drive through results
– Understand the market dynamics, particularly around funding and use of Orphan status products
– Have sound planning skills with strong commercial judgement
– Be motivated by the ultimate goal of improving patients’ lives

Critical to your success will be the ability to remove any barriers to usage of the specialist product so as all relevant patients who would benefit have access to the drug. You would need to;
– Develop and execute specific account plans
– Communicate disease and product knowledge effectively
– Create a long-term ‘partnership’ and value propositions with all key stakeholders

This is a high profile sales role requiring a range of transferable skills and knowledge; it is likely you can demonstrate the following:
– A proven track record of sales success in your pharmaceutical/biotech career to date
– Experience of selling in a highly specialist market (Orphan products, other high cost:low volume areas)
– An understanding of the healthcare regulatory environment
– Excellence in selling skills, account management and networking
– Prior product launch experience will be an advantage
– Degree level education
– Valid UK driving license (max 6 pts)
You will need to able to cover your territory effectively so a willingness to travel/stay overnight, as the business requires, is a must.

The successful person will be joining a new sales team and be at the forefront of future growth plans for this ambitious company. On offer is a top end basic salary plus an extensive benefits package.
To be considered for this exciting vacancy please send your CV to administrator@2020selection.co.uk or call our specialist team on 0845 026 2020.

http://ping.fm/mJhe3

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

Trainee Recruitment Consultant – A Day In The Life Of Chris

Last week I started a training contract within an established Medical Sales recruitment company  As a virgin to the industry I prepared myself as best I could for what I was about to undertake. I did all my reading around the career area and the company itself and eventually it came down to taking the plunge and accepting a 2 week trial in a very unpredictable time period for a recruitment consultant, the 2 weeks preceding the Christmas break. This is obviously an odd time in the industry as our Clients will be in one of 2 camps, the 1st of which being the “lets get the most out of our budget spend before the end of the year before its taken away from us in January”, and the 2nd being, “I’ve done all I can this year, lets start again in 2012”.

My 1st day was, as expected, the birth by fire. This is how we operate, take in as much as you can and see if you can keep up. This gave me a great insight into the speed, efficiency, and accuracy required from a consultant. If you’re not 1st, you’re last. This ethos opens up possibilities for huge success but at the same time great falls. After all we are competing against several other companies with differing approaches to achieving the same goal, luckily for me I’m working on the basis of quality rather than quantity. But that doesn’t mean quantity doesn’t get it right some times.

The harsh reality of the other side of recruitment fast became apparent. You really have to shine to get noticed in the current climate and the vast array of approaches that candidates use to attain this is eye opening. The role itself is very diverse. Admin is air tight, and has to be. It can be the difference between placing and missing out, a point regularly re-enforced during my training thus far. Combine admin with confident selective telephone manner, excellent knowledge of your clients and candidates, and the foresight to combine the two and you may have what it takes to take on the world of recruitment.

The industry requires you to effectively sit on a knife edge, the whole game is in balance, continually changing as both clients and candidates change their ‘requirements’, which can either push you right to the top or plunge you back to square one. This makes for a very exciting work environment as we are challenged with the task of keeping the balance in our favour right until the very last minute and then if all goes to plan, we can tip the scales and reap the benefit.

The team currently have the task of not only managing business but also managing me. As a fresh starter I am as keen and eager as you’d expect. I want to get my hands dirty and dive straight in but my lack of experience leaves me blind to the consequence. I am effectively stood on top of a diving board blindfold, trusting my team for direction and timing so I land on soft success rather than the hard ground of misconception. Time will tell……

Monoclonal Antibodies

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	RAPJIA PA AS CD P	YesNo Yes Yes Yes Yes
Anakinra	Kineret (Swedish Orphan)	Anti-IL-1	Recombinant human ‘mab’From E Coli	RA	No
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	RAPA AS	YesNo No
Infliximab	Remicade (Schering-Plough)	Anti-TNFα	Recombinant human ‘mab’	RACD UC AS PA P	YesYes 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	RACLL NHL	YesYes 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	RAPJIA	YesNo
Etanercept	Enbrel (Wyeth)	Anti-TNFα(soluble receptor specific)	Fused protein formed by recombinantDNAtechnology from hamster ovary	RAPJIA PA AS P	YesYes 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 July 2011. Please refer to NICEwebsite for latest guidance http://www.nice.org.uk/

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

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

What I Wish I’d known As A Hiring Manager……….

It’s been almost a year since I joined 20:20 Selection Ltd as a Recruitment Consultant; and as we approach the shortest day and start the wind down for Christmas, I feel that it’s a good time to reflect on what I’ve learned over the last twelve months.

Firstly, I’ve realised that in the world of recruitment there isn’t a wind down for Christmas at all! In fact, at 20:20 Selection Limited we are still flat out busy, working on new vacancies as well as existing ones, for our clients who want jobs offered and filled over the next two weeks, in time for ITC’s on 4^th January. I had naively thought that we would be starting on the mince pies and sherry by now, but in fact I suspect that the Season’s merriments won’t begin until 4pm on Friday 24^th December.

When I was a hiring manager, both as a Regional Business Manager, and as a National Manager, I thought I knew quite a bit about recruitment. I thought I knew how to spot an outstanding candidate from an average one. I thought I knew how to really dig down deep to get to know the ‘face behind the mask’, so that I could recruit the best of the best; the gem who would fit into the team quickly and would add value from day one.

What I’ve now realised, is just how little I actually knew about recruitment when I was a hiring manager.

If only I’d known that:

• An awful lot of work goes on behind the scenes, long before a manager receives CV’s to review.

 

• For every strong potential candidate, the best agencies reject another hundred CV’s from the ‘Average Joe’.

 

• The recruitment industry is incredibly competitive, with most clients now choosing a multi agency Preferred Supplier List.

 

• Achieving exclusivity with a client, is worth it’s weight in gold, as it gives the agency the luxury of time to really match the best candidates to every role, and to deliver all the KPI’s, without being pulled into the ‘bun fight’ of trying to speak to candidates about a job first before the other agencies get to them.

 

• Candidate loyalty only comes from delivering outstanding service. If people are registered with too many recruitment agencies, it is actually much more difficult to find them a job.

 

• Not all agencies are ethical and professional, and some still work on a volume principle, sending far too many CV’s out for a vacancy, rather than only selecting candidate’s who really fit the brief.

 

• We’re all fishing from the same candidate pool, and only the most skilled and experienced recruitment consultants know which bait to use to attract the most suitable, highest calibre people.

 

• The world of recruitment is full of highs and lows. Nothing beats the feeling of placing a candidate in their perfect job. Equally, nothing matches the heart sink feeling when your super prepped candidate gets down to the last two, and gets beaten by a whisker.

 

• It is extremely hard work, energy draining and soul destroying at times. It is also the most fulfilling, satisfying, people focused job I’ve ever done.

 

• The role of the recruitment consultant is the ultimate selling role. You need to sell to clients to win the business in the first place, sell the job and the company culture to candidates and to sell candidates’ to hiring managers to encourage them to shortlist your people.

 

• The term KAM is overused, and means so many different things to different companies and different people.

 

• The pharmaceutical market place is very still unstable. Candidates seem to have very high expectations about their employability, and so a key part of the recruitment consultant’s job is to manage expectations and to really explore motivation in a very competitive environment.

 

• As more and more companies choose to install electronic CV logging systems, it becomes increasingly difficult to ‘sell’ the candidates into hiring managers. Therefore, it is even more critical for a candidate’s CV to be absolutely outstanding, to differentiate them from the rest of the crowd, and to be as clear and as achievement focused as it can possibly be.

 

So, one year ends and another is just around the corner. I have learned a huge amount over the last 12 months, both about my job as a Recruitment Consultant, and also about myself, my own motivation and what makes me smile. I’d forgotten the buzz that is to be had from working in the toughest sales arenas, and I’d forgotten just how much I still want to win and to succeed. Every day is different, every day is action packed, and every day I live on my wits, and I’m ready to deal with anything that comes my way. I’m looking forward to the Christmas break, but I’m also optimistic and hopeful that 2011 will be a very fruitful year for 20:20 Selection Limited and for our selected candidates.

by Sam Harrison

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/

 

Exclusive to 20:20 Selection Ltd – Crucell Team expansion

In 2009, Crucell – the largest independent vaccines company in the world
– launched a dedicated Sales & Marketing function in the UK. Since the
establishment of its own dedicated sales team, Crucell has been able to focus
on expanding market share for its portfolio of travel and respiratory vaccines
in the UK. Recent changes to the reimbursement status of oral vaccines by the Department of Health mean that Crucell can now further expand this sales
team in England.
The expansion of the sales team is a reflection of the successful first year of
the UK Sales & Marketing function, and represents an excellent time to join
the team as they capitalise on their achievements to date. Crucell firmly believe that investing in their people is investing in the future, and is dedicated to developing employees’ competencies and promoting individual performance.
Brand new opportunities now exist for Territory and Regional Business
Managers to join the company throughout England and Wales.
These are senior sales roles where you will be responsible for the cash and
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vaccines to general practice. If you have previously sold vaccines, this may be an advantage: however, it is your attitude, drive, tenacity and enthusiasm that will be the key qualities you will need to succeed.
On offer to successful candidates will be a highly attractive basic salary,
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full investment from their headquarters in Holland. This is a genuinely exciting opportunity for you to develop your career within a company that is dedicated to bringing meaningful innovation to global health.