Pathway Over Product – five questions from the front line
Following my recent webinar on why strong NHS strategies fail to land (which you can watch a replay of here), I opened the session up for questions.
What struck me was not the variety of questions. It was the consistency.
Although the attendees represented different companies, different therapy areas and different parts of the healthcare industry, the questions all revolved around the same underlying challenge.
How do we actually make NHS adoption happen? Not how do we get a meeting or how do we get interest and not how do we secure clinical support – how do we move from a good idea to a change that genuinely becomes part of the way care is delivered?
The questions reinforced something I have been seeing for several years now. Most NHS adoption challenges are not product problems. They are pathway problems.
That is why I keep coming back to the idea of pathway over product. The NHS does not adopt products in isolation. It adopts workable models of care.
With that in mind, here are five of the questions that came up during the webinar and the answers I believe matter most.
1. How do you actually map an NHS pathway?
This was probably the most practical question of the session.
People often hear me talk about pathway mapping but then want to know what that actually means in practice. The answer is surprisingly simple. Start by mapping every step in the patient journey.
For each step ask:
- Who delivers it?
- What staff grade are they?
- How long does it take?
- What consumables are used?
- What systems are accessed?
- What happens next?
Once you have done that, start looking for bottlenecks, backlogs, delays, hand-offs, workarounds and duplication.
This is where the real insight usually appears.
One of the biggest mistakes people make is assuming they understand a pathway because someone has explained it to them. They do not. They understand what people think happens. What matters is understanding what actually happens.
I often use the analogy of making a cup of tea.
If I asked someone how they make a cup of tea, they would probably describe six simple steps. What they would not describe are the interruptions, the delays, the trips down the corridor, the distractions and the rework that happen in reality.
NHS pathways are exactly the same. The process on paper and the process in real life are often very different things. That is why observation is so valuable. Go and see the pathway. Watch the clinic. Understand the reality. That is where opportunities emerge.
2. What if clinicians do not have time to engage?
This is one of the most common frustrations I hear from industry teams. You are trying to arrange meetings, you are trying to discuss support services, and you are trying to explore opportunities, but clinicians are simply too busy.
The temptation is to assume the problem is access. In reality, the problem is often relevance.
Many conversations begin with, “we would like to talk about our support service.” The NHS hears, “someone wants an hour of my time.”
Instead, start with the pathway pressure.
Ask questions such as:
- Where is demand increasing?
- Where are patients getting stuck?
- Which clinics are struggling?
- What workload challenges are emerging?
- What part of the pathway feels unsustainable?
That changes the conversation. You move from talking about your service to discussing their problem. The support service then becomes an enabler of the pathway solution rather than the subject of the meeting.
That subtle shift can completely change engagement levels.
3. What if budgets are siloed?
The logic often sounds compelling – move activity upstream, reduce hospital demand, deliver care closer to home and improve outcomes.
The problem is that the budget often sits somewhere else.
The answer is that budgets may be siloed, but increasingly the NHS is finding ways to move both activity and funding.
This is where concepts such as subcontracting, risk share agreements, gain share arrangements, provider collaboration and left shift funding models become important.
I have several examples where hospitals have subcontracted services into primary care or community settings because doing so reduces pressure elsewhere in the pathway. The money follows the activity and that creates a mechanism for change.
The important lesson is that pathway redesign is not simply a clinical conversation. It is also a contracting and finance conversation.
Many projects fail because they stop at clinical agreement and never move into operational design.
4. What if our solution adds another step?
This is an uncomfortable question because many innovations do add an extra step, such as an additional review or a homecare process.
The instinctive response is often to avoid mentioning it, but I think that is a mistake.
We should be asking if the additional step creates more value than it consumes. A pathway should never be assessed by looking at one step in isolation. It should be assessed end to end.
I am involved in several projects where activity is being moved into homecare models. On the surface, homecare may appear to introduce additional administration. However, when the entire pathway is mapped, the reduction in outpatient appointments, clinical resource consumption and operational burden often creates significant net benefit.
The key is pathway costing.
Map the current pathway and map the proposed pathway. Understand capacity released, resources released, costs avoided and workload transferred. Then have an evidence based discussion.
A small amount of additional friction may be entirely justified if it unlocks significant capacity elsewhere.
5. What if the disease area is not an ICB priority?
This is another question that comes up repeatedly. People often assume that unless their therapy area appears in an ICB strategy document, meaningful progress is unlikely.
My experience is that this is not necessarily true. Many successful projects begin because a passionate clinical leader identifies a problem worth solving.
The NHS is still full of individuals who care deeply about improving services, meaning a strong clinical champion can be enormously influential.
What has changed, however, is the route into the system. Increasingly, I am seeing provider led change rather than commissioner led change.
The sequence often looks like this:
- Win the clinical argument.
- Engage operational leaders.
- Build the financial and delivery case.
- Bring contracting and finance into the conversation.
- Engage the ICB when a credible proposal exists.
In many areas, providers are now driving pathway development and taking proposals to commissioners rather than waiting for commissioners to lead the process.
That is an important shift for industry teams to understand.
The pattern behind the questions
Although these questions appear very different on the surface, they all point toward the same conclusion.
People are not struggling with products, they are struggling with implementation, they are struggling with pathways, and they are struggling with operational reality.
That is why pathway over product matters. It is not a slogan. It is a practical way of thinking, because when you understand the pathway, you stop asking, “how do we get this product adopted,” and you start asking, “what system problem are we helping the NHS solve?”
That is where the conversation changes, and in my experience, that is where adoption starts.
The reality of market access – every case is different
One thing that struck me after the webinar was that the questions were all different.
One person wanted to know how to map a pathway. Another was struggling to get clinicians to engage. Someone else was trying to navigate siloed budgets. Others were wrestling with homecare, digital adoption, pathway redesign or scaling a pilot.
While the pattern was the same, the circumstances were completely different, and that is often the reality of NHS market access. The principles are surprisingly transferable, but the application rarely is.
Understanding pathway over product is one thing. Applying it to your customer, your pathway, your stakeholders and your local system is something else entirely.
That is why I created Ask Scott.
Ask Scott is a focused advisory session where you bring a live NHS challenge, and I help you work through what is really blocking progress and what to do next.
It is designed for situations where you do not necessarily need a full project, workshop or NHS Sprint, but you do need experienced, practical input on a specific issue.
That might be:
- a pathway that has stalled
- a market access strategy that is not landing
- a customer conversation that has gone quiet
- a left shift opportunity that needs shaping
- a pilot that is struggling to scale
- a funding or contracting question that needs sense checking
- a stakeholder map that does not feel right
The aim is simple, to help you leave with more clarity, sharper thinking and a practical next step because very often the issue is not the quality of the product, it is understanding where the pathway is pushing back.
If you are facing a real NHS challenge and need help working out what happens next, Ask Scott may be the quickest way to move from uncertainty to a practical plan.
At www.scottmckenzieconsultancy.com, I work directly inside the NHS, supporting provider collaboratives, commissioners and system leaders to implement real change. I then help pharma, medtech and device companies interpret what’s happening, so they can engage the right stakeholders, align with NHS priorities and get their innovations embedded into care pathways.
With more than 20 years working within the NHS and Pharma, medtech and devices companies, I bring a unique dual perspective, now captured in my book, Embedded: How Pharma, MedTech, and Device Companies Can Get Their Products into NHS Pathways and Stay There, which distils everything I’ve learned into a practical playbook.
Reserve your seat: The inaugural Embedded Seminar – London on September 30. If you’re trying to win work in the NHS, knowing the policy direction isn’t enough. You need to understand how decisions are really made, what creates confidence at Board level and what causes things to stall. This seminar brings that into the open. A small, focused group working through real examples of what gets through, what doesn’t, and how to position your work so it stands up under scrutiny. If you want to move beyond access conversations and into something that actually converts, this is where that shift starts.