NHS negotiations – how to challenge commissioning objections

I sat in a meeting recently with one of my Pharma, MedTech and Devices industry contacts where I was coaching my client, who had run up against a brick wall with the NHS commissioner. In their most recent meeting, they had barely got started and the answer coming back from the NHS was: “No. Nope. We can’t do that. No, we haven’t got any money. Nope.”

Basically, they weren’t prepared to listen, meaning my client didn’t even really get the chance to pitch the concept and the idea they had brought them.

But there was absolutely no way they were going to leave the discussion there – there was too much at stake and too many benefits for the NHS – they just needed to recognise them. This is why they had come to me for support.

Is the cheapest option working?

So I challenged the Commissioner’s thinking and said: “For them to directly say no, they would have to be 100% happy with their current outcomes. Is that the case? Are they happy with the outcomes currently being delivered/achieved in terms of the number of appointments into general practice and referrals into hospital outpatients or non-elective admissions?”

Sometimes the hospital gets direct referrals of people who are really unwell, other people are taken to hospital by ambulance or go under their own steam to A&E and ultimately end up with an admission into hospital that could have been avoided if the outcome was better. I asked if the Commissioner was happy with the number of people in those situations.

I then went on to explore what the next step is once the Commissioner, of course, says no. The key at that point is, what are they going to do to change that – because if they keep going with the same input, they are simply going to get the same outcome.

This should provide the Commissioner with a moment of clarity, which should take the conversation on a slightly different trajectory. But be ready to be hit with another, and common, hump in the road – the issue of price. It’s natural they will want to challenge price. The problem is they often know the price of everything and the value of nothing. Commissioners are often fixated on the cost of (the incumbent) product A versus the cost of product B (your proposition), losing sight of what really matters – the patient outcomes.

Steer the narrative to the best possible patient outcome

You need to quickly refocus the discussion back toward patient outcomes – the single most important thing.

It’s important to remember this point: The most expensive product/device/appliance/technology is the one that doesn’t work or doesn’t get the patient the outcome we’re pursuing, because it’s just cash poured down the drain.

Healthcare professionals prescribe and refer in pursuit of an outcome for the patient – they want the patient to get better. And that’s the basic truth you need to keep anchoring your meetings back toward.

The Commissioner has to understand that, while product A had been chosen on the basis that it was cheaper than product B, where product A is not delivering the outcomes needed, it will drive appointments, referrals and admissions into the NHS.

The time has come to examine what outcomes product B might deliver in terms of patient outcomes. Product A has had its chance.

There’s no way around the logic of this argument and the Commissioners are starting to see and accept this (not all by any means).

Overcome the objection of finding time to test the idea

To avoid any potential logistical objections my suggestion is that you pilot product B in just one practice. Work with Commissioners to find a motivated individual with an interest in this particular disease area who will be enthusiastic to try this out. Not one Primary Care Network with several practices – literally just one practice.

Now the risk is reduced. That allows us to move away from what product A costs compared to product B and gets us looking solely at what product B can deliver. We get to find out if it can cut unnecessary appointments, unnecessary referrals and unnecessary admissions.

The next objection is almost always with General Practice saying they haven’t time to try this. In which case, I put the same argument forward – not happy with your outcomes, yet no plans to change = poor outcomes that will stay the same.

With this particular project, a typical practice of 10,000 patients will have somewhere between 100 and 150 patients to review in this particular disease area, so to overcome the fear or burden on time,  a pilot could be phased over a longer period of time. Simply reduce the number of patients reviewed in a week to free up breathing space. If it’s impossible in a month, do not allow the idea to be dismissed altogether – just be flexible and take a little longer so that every patient gets a review. Take six, nine or possibly 12 months if necessary. It’s much better that it takes longer and all patients get a review to impove outcomes, than nobody gets a review. Please also keep in mind the Primary Care Networks can now also put this kind of project into their Enhanced Access.

Of course, you may want to look at prioritisation and risk stratification of the order that the patients get reviewed, but, over time, they will all get to use product B so outcomes can be measured.

Convert into a two-cycle audit to offer extra value

It’s also worth adding that whenever we do anything involving an audit in general practice, we automatically look to convert it into a two-cycle clinical CQC audit for them. It adds huge value for the practices who have to do a minimum of three of those every 12 months.

It doesn’t actually change the project but adds significant value. And if we can get a trainee GP, a GP registrar, foundation GP or a foundation pharmacist, they all need an audit as part of their training. So there’s value for them there that might encourage them to work and engage.

So – unless you’re 100% happy with all your current outcomes:

• Take a step back and think about how you can change this.
• Take a bit longer if necessary, phase it over a period of time to keep the workload manageable.
• Always pursue the outcome.

The result of this approach, I’m glad to say, was a happy commissioner with a small pilot running and a happy Primary Care Network with one practice running this on their behalf.

If it delivers the desired outcome, we’ll also have an agreement that we can scale across other practices.

My client ended up with a real opportunity to do something different, simply by being prepared to negotiate, compromise and challenge when the default answer was no.

Scott McKenzie helps pharmaceutical, medical technology and device firms increase revenue by getting their products and services in front of the right NHS decision-makers. If you want to get your products fully embedded into treatment pathways we can help you. We’ve doubled revenue for our clients and can share these processes with you too.