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

Top 25 UK Pharma Company Recruiting For Hospital Representative To Cover Yorkshire

Springboard your career with a New Job in medical sales – Key Account Manager, Hospital Sales Representative, Yorkshire (North Yorks, York, Wakefield, Leeds, Hull, East Riding)

An opportunity to take your career forward selling to specialist customers in secondary care and also pulling this through with selected primary care customers with a relevant interest; this is a key account management role with responsibility for the sales and market share growth of a specialist product on your territory.

You would be working for an established yet evolving pharmaceutical company who are focused on developing lasting business partnerships with their customers in the NHS.

This position does require that you are ABPI qualified and have a proven track record of delivering against your targets in your career to date. If you have worked this territory and have proven your ability in key hospital accounts then this will be a distinct advantage. Importantly you will be;
– Highly motivated, enthusiastic and driven to succeed
– Have excellent business planning skills
– Be able to develop relationships and networks within your key accounts
– Want to be part of a high performing specialist team
– Be willing to go the extra mile to differentiate yourself, your product and company within the marketplace.

On offer will be an attractive basic salary, car, bonus and other benefits associated with the pharmaceutical industry. 2011 has been an exciting year in this organisation; be part of it in 2012.
The team at 20:20 Selection Ltd is here to discuss your background and suitability for this fantastic opportunity. Call us on 0845 026 2020 or you can also email administrator@2020selection.co.uk with your CV.

NICE to review local formularies to end post-code prescribing lottery

NICE is to produce a best practice guide to help trusts develop local formularies, as part of a move to ensure that all patients in England have access to clinically and cost-effective drugs.

Local formularies provide a list of selected or preferred drugs available to local prescribers and have an important role in underpinning safe and effective use of medicines.

However, there is currently no standard process or advice for putting together a local formulary which has led to variations across the country.

Medicines Management departments within many PCTs currently operate a controversial traffic light sytem of red lists and green lists, which does not necessarily reflect NICE guidance.

A recent report into innovation in healthcare by The Department of Health has highlighted that not all local formularies are including all of NICE’s technology appraisals. This can lead to a postcode lottery where patients miss out on drugs approved by NICE.

In some cases, local formularies are duplicating NICE assessments and challenging appraisal recommendations, acting as a barrier to the uptake of NICE-approved medicines.

The report states that the Department of Health is “committed to ensuring that NHS patients have access to clinically and cost-effective drugs and technologies, and that NICE appraisal guidance is promptly delivered throughout the NHS.

“There should be no local barriers to accessing technologies recommended in NICE appraisals, beyond a clinical decision relating to an individual patient.”

The report recommends that formulary processes should proactively consider the impact of new NICE Technology Appraisals, and all NICE Technology Appraisal recommendations should – where clinically appropriate – be automatically incorporated into local formularies.

This process should take place within 90 days to support compliance with the three month funding direction and the NHS Constitution ensuring that these medicines are available for clinicians to prescribe, should they choose to, in a way that supports safe and clinically appropriate practice.

To help achieve this, NICE will develop a best-practice guide covering the creation and review of local formularies to assist local trusts and clinical commissioning groups.

Dr Gillian Leng, Deputy Chief Executive of NICE said: “NICE will embark on a specific piece of work to look at how local formularies are put together. At the moment there is no standard process for them and there tends to be a lot of variation and inconsistencies across England. This has been flagged up in the recent NHS Innovation report.

“NICE will produce a best-practice guide on how to develop a local formulary. We will be holding a workshop to develop the guide, which will then go out to consultation before being published later this autumn.”

“NICE-approved drugs should not be excluded from local formularies on the grounds of cost. We want all patients to have access to medicines that we consider to be effective,” added Dr Leng.
Elsewhere, the report outlines plans to introduce, within three months, a NICE Compliance Regime for the funding direction attached to NICE technology appraisals to ensure rapid and consistent implementation throughout the NHS.

The Department of Health will also establish a NICE Implementation Collaborative (NIC) to support the implementation of NICE guidance. The NIC will bring together the NHS Commissioning Board, NICE, the Chief Pharmaceutical Officer, the main industry bodies, the NHS Confederation, the Clinical Commissioning Coalition and the Royal Colleges.

Reference: http://www.nice.org.uk/

20:20 Selection is a specialist recruitement agencies which places candidates into roles within the UK pharmaceutical and healthcare/devices sales industries. The agency has been established since 2002. If you are seeking a role within pharmaceutical sales please visit our website to view our live vacancies http://www.2020selection.co.uk

GP/Hospital Representative – North West England – Superb Opportunity…Hurry As This Will Go Quickly!

We are seeking an experienced Medical Sales Representative (GP/Hospital) to cover the Lancashire and Cumbria territory working for a global leader in healthcare.

This is an opportunity for you to take control of your business results; the successful person will be charged with maximising sales across this territory for a portfolio of prescription products selling to General Practitioners, Hospital Customers, other relevant HCP’s and retail pharmacies throughout the territory.

To be considered for this position you will have the following skills/abilities:
– Commercial background and a good understanding of Key Account Management
– Strong team working will be important as you will have to work effectively with your customers and NHS Liaison Managers
– Preferably educated to degree level or equivalent.
– Proven track record of sales success
– Strong commercial awareness coupled with an in depth understanding of the key stakeholders within the NHS
– Flexibility and adaptability to operate in dynamic working environment
– Be accountable for own work load/decision making and actions
– Results orientated (set personal goals)
– Impact, enthusiasm and self motivated coupled with drive and determination to succeed

In return for your skills and contacts this organisation will offer the successful person a comprehensive salary & benefits package (basic salary is commensurate with experience) plus ongoing development throughout their career. Want to know more? Call us now on 0845 026 2020 or submit your CV here. This opportunity does have the potential to move quickly.

20:20 Selection Ltd promises to treat your application as important and will review your profile against our client’s requirements. However, if you have not heard from us within 7 days please assume that on this occasion you have not been successful. There are many more opportunities like this one advertised on our website daily……all our jobs are live
Visit http://www.2020selection.co.uk/ to learn more……it’s free

Global Top Ten Pharma Company based in SE England recruiting for a Training Manager

This is just one of many live vacancies that are being advertised by 20:20 Selection. Please visit the website to see all these exciting opportunities in the UK Pharmaceutical Industry.

Training Manager, specialist products division within the pharmaceutical business of a global healthcare company.

An opportunity currently exists for a talented training and development manager to be responsible for delivering programmes in line with agreed company training strategy. You will focus on specialist therapy areas such as renal and neurology (Parkinson Disease). Additionally you would also be the point of contact point and coordinator, for the UK implementation of the E-Learning strategy

This is a Head Office based role (Berkshire) requiring you to work cross functionally with marketing, medical and sales management in order to offer the highest quality training solutions, your responsibilities will include:
– Coordinating and running induction/initial training
– Providing ongoing support across the franchise for new campaigns, conference etc.
– Working with brand teams to identify desired training outcomes that will support brand plan execution
– Supporting growth plans within division and working with other Training Managers to develop and deliver training plans
– Annual planning, ensuring adherence to budget and deadlines.
 
To be considered for this exciting position you are likely to:
– Have healthcare related sales experience having demonstrated achievements in sales & your career to date
– Have some prior training experience with a training qualification being an advantage
– Show potential to be innovative and creative in approach to both the design and delivery of training programmes
– Demonstrate good coaching and counselling skills
– Possess well-developed interpersonal skills with the adaptability to work cross-functionally within the company
– Have excellent planning skills with the drive to see projects through to completion
– Be able to work well under pressure & have a high level of flexibility.
It is likely that you are educated to degree level and are ideally ABPI qualified.

On offer to the successful person will be a highly competitive basic salary and benefits package. This is a superb opportunity to join a forward thinking team in a company who truly believe in investing in people.

Please don’t delay in applying. Email your CV to administrator@2020selection.co.uk and/or call on of our recruitment consultants on 0845 026 2020.

New Role Just In – Hospital Sales Specialist ( NE, Yorks, East Mids)

Hospital Sales Specialist – Basic to £45k, OTE £60k++

Many more live vacancies can be viewed at http://www.2020selection.co.uk

An opportunity to develop your talents working for a leading global Healthcare Company. Our client is currently looking for a Sales Specialist to develop the business in key hospital accounts throughout the North East,YorkshireandEast Midlands. Although a large geographical area this is a focused and targeted role with an emphasis on key account management.

This organisation has built an enviable portfolio of products and services that push back the frontiers of medical care and ultimately ensuring a better quality of life for people everywhere.

This opportunity for a Sales Specialist is an integral part of a specialty sales team reporting to the National Sales & Marketing Manager. You would be fully supported by internal functions such as marketing, customer services, logistics and shared services; YOU would be the interface of the company and the customer. With a drive for increased Patient Safety, in the NHS, when administering medication, our client is an excellent position to develop partnerships in hospital trusts. This role will involve selling new  as well as some established products and services.

Key responsibilities would include:

– Developing and implementing appropriate strategies for agreed customer targets with the objective of driving sales results and achieving or exceeding budgets.

– To identify key finance and clinical decision makers within Consortia, Hospitals and Units and arrange meetings to promote relevant products and services

– Gathering intelligence on customer plans and purchasing intentions and recommend responsive, timely and appropriate action.

– Maintaining a high level of knowledge of the therapy area and related products

– In conjunction with the National Sales Manager and wider commercial management team, provide informed input into/manage the tender process.

– Calling on key customers as per your business plan (Clinical/Aspectic/Purchasing Pharmacists, Procurement, Clinicians, Specialist Nurses)

To be considering for this exciting opportunity you are likely to have

– Previous hospital sales experience (2 years)

– Knowledge/Experience of NHS structure & buying processes

– Life sciences degree, nursing qualification, business degree (or equivalent experience inUKhealthcare market for minimum of 2 years)

– ABPI qualification and/or willing to study if required.

In return for your expertise if successful you will be offered a competitive salary & excellent benefits package including an uncapped bonus scheme. You will also receive first rate training and ongoing development.

To discuss this role in more detail please contact us on 0845 026 2020 or alternatively please submit your details by emailing administrator@2020selection.co.uk

20:20Selection Ltd promises to treat your application as important and will review your profile against our client’s requirements. However, if you have not heard from us within 7 days please assume that on this occasion you have not been successful.

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

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/