The document provides guidance and templates for joint working between the NHS and pharmaceutical companies, outlining best practices for developing agreements, projects, and measurements that benefit both parties through open collaboration while prioritizing patient outcomes. Key points include defining joint working and distinguishing it from other types of partnerships, emphasizing transparency and preventing inducement to prescribe certain drugs.

1. Joint Working
Workshop
Kevin Blakemore, National NHS Partnership Manager |ABPI

2. Our common goal
Win:Win:Win:Win:Win
Public
NHS
Academia
Voluntary
Sector
Industry
Social
Care

3. Quick Start Guide – May 2012

4. Flow Chart

5. Customer Quotes on Joint Working
“The NHS is
strapped for
cash, the medicines
are too expensive
and national
therapeutic tendering
is the only answer.” –
Finance
Director, primary
care
“JW with
governance –
fantastic! This is
exactly what is
needed.” – Lead
Pharmacist, prima
ry care
We want industry to get
involved in the projects at
the embryonic stage. We
want a long-term
sustainable relationship.”
- Consultant secondary
care
“I wish this JW criteria
existed before. It makes
the NHS feel safer
working with
industry, especially as
the ABPI is endorsing
it.” – Governance
Manager secondary
care
“Why doesn’t
pharma just provide
sponsorship and let
the NHS do the
rest?” – Primary
Care lead
“I’m interested in
JW, but what does
industry have to
offer?” –
Innovation Lead
secondary care
“It’s disappointing
when pharma
provides financial
resources but no
other resource.” –
Governance Manager
secondary care
“The CCGs are
gagging for JW with
industry, but it has to
be open &
transparent.” – Lead
Pharmacist, primary
care
“NHS is wary to
work with
pharma, so you
have to sell the
concept of JW.” –
Pharmaceutical
Advisor primary
care

6. DH definition of Joint Working
“A situation where, for the benefit of patients, one or more pharmaceutical
companies and the NHS pool skills, experience and/or resources for the
joint development and implementation of patient-centred projects and share
a commitment to successful delivery”

7. Joint Working is n0t…….
• Clinical trials
• Standard product promotion
• MEGS
• Patient support programmes
• Meetings/symposia and the like
• Discounting/trading deals
• Package deals
• Tenders
• Patient Access Schemes
• Risk sharing/ Outcome agreements
• Donations/grants/sponsorship
• Commissioned work

8. Joint Working must…….
• benefit patients (expected to also mutually benefit the
parties).
• be conducted in an ethical, open and transparent manner –
overall arrangements made public.
• take place at a corporate organisational level and not with
individual health professionals or reps
• be in accordance with the ABPI Code, government
guidance, NHS rules and relevant professional codes, etc.
• have all materials certified in advance, including a formal
signed agreement

9. Agreements must include…..
• Name, parties, start date and term of the project.
• Expected benefits for patients, the NHS and pharmaceutical company.
• Outline of the financial (and other resource) arrangements.
• Roles each of the parties will undertake, how success will be measured.
• Contingency arrangements.
• Exit criteria.
• Summary of Joint Working agreements to be made public by the
pharmaceutical company.
• Reasonable and appropriate for both parties to consider return on investment
(ROI) before committing to any project.
• Commercial benefit to either party must not be the sole benefit.

10. The project may include……..
• staff training
• staff and/or patient education
• facilitation of pathway redesign
• support for guideline implementation
• funding of project staff requirements (e.g. provision of
administrative, clinical, analytical health economic
and/or management resources by either party)
• secondments
• audit
• economic analysis
• nurse services

11. JW using your brand
•Disease management (e.g. design and implement a disease
protocol) that may increase usage of medicines in a
therapeutic area can be acceptable
•Use national or local guidelines
•There must be no inducement to prescribe your product
•Beware perception of inducement if JW likely to increase use
only of your medicines (rather than class/group of medicines)

12. Make the basis clear
For example:
“On the basis that the Primary Care Trust / Health Board
has previously placed [company x’s] medicine appropriately in
the treatment guidelines for the treatment of [the condition] in
line with local / national guidelines, the NHS Organisation and
[company x] have agreed to work together and provide funding
and other support for this project.”

13. Be transparent about benefit
“This Joint Working project is intended to create more
opportunities for the appropriate use of medicines, including
[company x’s] medicines in suitable patients in line with [insert
treatment guidelines, e.g. NICE/SIGN/AWMSG
guidelines, National Service Framework targets, locally agreed
protocol]. If this improvement occurs, we are likely to see an
increase in prescriptions of [product y] roughly equal to our
current proportion of prescriptions in this therapeutic area.”

14. Measurement is mandatory
•Patients
•NHS
•Company
The outcome of every project should be measured and the
taking of baseline measurements at the start of a project
are helpful to track success, particularly patient outcomes.

15. Targeting
•It is acceptable to target Joint Working geographically
according to:
–Identified patient need
–Availability, experience and commitment of relevant
personnel to deliver the project
–Areas where the NHS has expressed a need or desire to
improve benefits to patients by working together with the
pharmaceutical company/ies
•Pharma ROI must not be the sole or primary criterion

16. Communication within Your Company
•Communication should be clear and unambiguous to ensure
that the Joint Working agreement is not infringed and that the
project is not used inappropriately by sales representatives to
gain access to customers or to influence prescribing.

17. ABPI/DH Joint Working Toolkit
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAnd
Guidance/DH_082840
Or just google ABPI Joint Working toolkit

19. What do you think?
A Pharma company gets involved in
a jointly resourced venture with
a GP practice
to supply spirometry kits
A Pharma company gets involved in a
jointly resourced venture with a
PCO to carry out diabetes diagnostics
A Pharma company gets involved in a
jointly resourced venture with a
hospital department to
redesign renal pathways
A Pharma company gets involved in a
70/30 resourced project with a PCO to
carry out angina population metrics
Ref: Wellards module NHS-Industry Joint working

20. Case study review
In your groups:
• Review the 3 case studies using the checklist
• For each discuss and agree: (Baxter/Pfizer COPD/BMS HIV)
– Background/Overview/Outcomes/Services offered/Behaviours demonstrated
– Is it Joint working? – yes/no/cannot say
– If not, what are the reasons?
– If can’t say -what extra information do you need to decide?
– Prepare to share your feedback to the group

21. Ways of Working
PHARMA
Sponsorship
Medical
Educational
Goods and
Services
(MEGS)
Joint Working Promotion

22. Pharma activities
Joint Working
• Secondments
• Audit
• Nurse services
• Facilitation of pathway redesign
• Economic analysis
• Support for guideline
implementation
• Staff and/or patient education
• Staff training
Not Joint Working
• Clinical trials
• Commercial payments for
consultancy advice
• NHS tenders
• Package deals (medicines &
other benefits)
• Meetings and hospitality
• Gifts and benefits in kind
• Commercial arrangements e.g
risk share, outcomes
guarantee, pricing, margins, disc
ounts
Ref: Wellards module NHS-Industry Joint working

23. Promotion Joint
Working
MEGS Sponsorship
For patient benefit
Yes Yes Yes Yes
NHS/Pharma company pool resources
X Yes X X
Pharma company investment
Yes Yes Yes Yes
NHS investment
X Yes X O
Detailed agreement in place
X Yes X X
Shared commitment to successful
delivery
X Yes Yes Yes
Details of the agreement are made
public
X Yes O X
Prospective ROI Yes Yes X X
Outcomes must be measured
X Yes O X

24. 4. Manage and Engagement
3. Understand
2. Analyse and Prioritise
1.Identification
Stakeholder Management: 4 Stages

25. Identification
Does the person:
1) Get directly/indirectly affected by the project?
2) Hold any influence over the project?
3) Have an impact on the project’s resources?

26. Analyse and Prioritise
INFORM MANAGE
MONITOR ENGAGE
Low
Outcome
Interest
High
Outcome
Interest
High Process Influence
Low Process Influence

27. Understand, Manage & Engage
• Develop a clear understanding of what the customer wants to achieve, make sure that
you spend enough time doing this to ensure that all the details are covered, make sure
there are no surprises.
• Manage expectations. Do not promise what you cannot deliver.
• Engage all customers who will have a stake in the project. Identify those who will have
the following roles:
– The individual(s) who will be responsible for delivering the project
– The individual who will be accountable for the project delivery
– The individual(s) who need to be consulted on the project
– The individual(s) who need to be kept informed of the project

28. What is a TOR?
Terms of reference (TOR) describe the:
“purpose and structure of a
project, committee, meeting, negotiation,
or any similar collection of people who
have agreed to work together to
accomplish a shared goal.”

29. What are we going to cover…
•What is a TOR?
•What should be included in the TOR?
•What are the benefits of agreeing a TOR in Joint
Working?
•What might be the challenges for developing the
TOR?

30. Getting it right…..
•Levels the playing field
•All pharma partners understand
how they will work together
•NHS partner understands what
is expected of them- a “two way”
relationship
•Reinforces the “code of
conduct” (ABPI & NHS)
•Sets out roles of the JW
committee e.g revolving
Chair, minute taker etc.

31. Challenges….
• Legal and compliance re-
drafts by each party
• A misunderstanding of the
objectives of a TOR
• Lack of agreement
• e.g. who will chair, how
the voting system should
work

32. What should be included in the TOR? – (minimum)
•Name of group
•Membership and appointment
•Chairing
•Frequency of meetings and quorum
•Record of meetings
•Reporting mechanism
•Functions & delegated authority

33. Project Initiation Document (PID)
•What is the PID?
•What are the primary use of the PID?
•When would you complete a PID?
•Understanding the jargon of the PID?

34. What is the Project Initiation Document (PID)?
“The purpose of the PID is to define the project, in
order to form the basis for its management and an
assessment of its overall success.”
PRINCE 2

35. What are the primary uses of the PID?
1. Ensure the project has a sound basis before asking the JW committee
to make any major commitment to the project
2. Act as a base document against which the JW committee and project
manager can assess progress, issues and ongoing viability questions
3. Provide a single source of reference about the project so that people
joining the “temporary organization” can quickly and easily find out
what the project is about, and how its being managed

36. Example
Background
Brief statement on the explaining the context of the project, and steps
taken to arrive at the current position of requiring a project
The East of England Pharmaceutical Alliance (EPA) was created to support
the implementation of the National Strategy for COPD and Asthma across
the East of England SHA. The EPA members consist of a number of
pharmaceutical companies working jointly together with the NHS.
Before the EPA can start to implement a project to support the training and
education of health care professionals in line with the national strategy, it
wishes to fully understand the training requirements across the locality.
The EPA has identified the need to develop a project to implement a full
training needs analysis (TNA) of healthcare professionals for COPD &
Asthma.