De-mystifying the NHS – What you need to know about the NHS as a market for your health technology

Are you a global market access lead looking to understand the challenges faced by your UK affiliates? Or do you work at a national level with responsibility for bringing a new health technology to the NHS in England? In July 2024, Global Whispers and NHS Whispers came together, to bring you an overarching view of what it takes to access the NHS with a medtech or pharmaceutical innovation.

Guest speaker Dr Faris Al-Ramadani who shared his experience of introducing new technologies to the NHS from both sides of the fence: as a PCN Clinical Director and GP Partner, and as a HealthTech and Venture Capital Consultant.

The NHS in England is complex and ever changing. Recent years have seen the introduction of new structures, new decision-makers and new priorities. If you’ve fallen out of the loop of what’s happening with the NHS, this webinar is here to help.

After de-ciphering some of the new(er) NHS terminologies and structures, we discuss:

• The key steps for introducing a new health technology to the NHS
• Who to speak to, when and where
• What to include in your value proposition to appeal to NHS decision-makers
•  How to best meet key stakeholders’ needs
• The challenges of bringing a new technology to the NHS in England
  
  

Learn more about this webinar at: https://mtechaccess.co.uk/de-mystifying-the-nhs/

Discover more about how we can support your UK launch strategy at: https://mtechaccess.co.uk/strategic-uk-market-access/

This webinar was first broadcast live as a webinar in July 2024

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Chapters

• 0:00 Introductions and welcome
• 6:08 Overview of NHS organisations and structures
• 9:50 Who should you talk to when launching a new health technology in the UK?
• 12:57 Needs, pressures and tensions between NHS organisations
• 17:35 Health inequalities and demonstrating outcomes for particular demographics
• 21:26 What is the DES? What are ARRS roles?
• 24:50 What evidence is most convincing?
• 31:43 What timescales does the NHS look to for ROI?
• 33:12 Targeting communications to HCPs and NHS stakeholders
• 37:17 How can we make NHS-industry collaboration as smooth as possible?
• 43:16 How not to scare off a skittish NHS?
• 46:35 How are medical devices funded in community settings?
• 48:56 Are there ways to speed up implementation and adoption across the NHS?

Transcript

0:00

- [Announcer] Welcome to this Mtech Access webinar. At Mtech Access, we provide health economics and outcomes research and market access services from strategy through to implementation. Our unique NHS relationships guide and validate everything we do in the UK. We work with over 80 NHS associates to bring our pharmaceutical and med tech clients authentic insights into the NHS. We can help you answer key questions related to the NHS, from how to communicate with integrated care systems, places, and primary care networks, to how to capture pathways of care. Get in touch today to discuss your market access goals. First, though, I hope you enjoy the webinar.- Hello and welcome to this Mtech Access webinar. Today's webinar is all about demystifying the NHS, and today we're going to be talking a lot about, you know, what do you need to know to get your technologies, whether that's med tech or anything else into the NHS. Today's session is really focused towards our global market and our global clients. So we welcome everybody from there, but also from from the UK. And the idea is we thought it'd be really helpful to sort of give a bit of an insight into how you can verify what your affiliates might be telling you in the UK, but also just to give a bit more in depth knowledge and insights around the UK market and the sorts of information that you need to gather, the sorts of people that you need to be talking to and how to make an entrance into this market. I'm going to give a quick overview of some bits about the, about the NHS and then we're joined here by Dr. Faris Al-Ramadani, who I'll give a, a better intro to in a bit, who will give us his insights and takes on these topics. So there we go. The slides are now working. So when you bring, you know, innovation to the NHS, you know, what do you need to know? What do you need to do? We're not going to be talked too much about the regulatory processes today. So, you know, the UKCA marking versus, you know, CE marking for Europe, it's much more going to be around bringing a global innovation to the UK market. The sorts of information you need to bring, so you know what sort of questions you need to be asking. What do the key decision holders want to hear? Who are they and how do they interact through different levels of the NHS system? And then once you've got into, so one part of the NHS, how can you sort of aid that adoption and spread so you can sort of travel out more broadly and increase your market? So we thought it'd be helpful for our global audience. You know, who or what is the NHS? So, you know, we say it very easily, but it's our National Health Service. So it's the health and care provider across England in particular with some of the devolved nations having their own, but it's not just one organisation, it's a myriad of many small kingdoms. So, but the larger organisations which cover larger areas are called integrated care systems, or ICSs, or you might hear them called integrated care boards, which is a slightly different designation, but there's 42 of them and they're spread across the UK and inside them are NHS trusts, which might be formed of hospitals and things like that. There are primary care networks. We've sort of grouped together sets of GPs. And there's also other organisations that are like the National Institute for Health and Care Excellence and the NIHR, sort of more of the research arms, the National Institute for Health and Care Research. And these are all stakeholders across the UK that when you're coming from a global perspective or internally in the UK, that you should really be thinking about as stakeholders who you're going to have to need to convince that your technology or innovation is valuable and worth using, in order to get that uptake that you need. So when I'm talking about innovation, you know, it could be literally anything, we talk about med tech, whether that's, you know, a syringe or a pacemaker or any sort of, you know, digital tool as well alongside, you know, the things you might more traditionally think of as, you know, in terms of drugs and pharmaceuticals and medicines and things like that. But today I'm very excited to be joined by Dr. Faris Al-Ramadani as I said. So he's a former primary care network clinical director and a GP, but wears an awful lot of different hats. So it gives me huge pleasure to welcome you Faris, and could you give us a little bit of an overview of those different hats that you have worn and continue to wear?- Yeah, thanks Rob. Yeah, really nice to be with you today. I'm first and foremost I'm a GP, so general practitioner or family doctor as it's referred to in other nations. And I do that, that's my bread and butter. I also run a clinic delivering those services. I worked a level above that as a primary care network clinical director. We're probably going to come on to primary care networks shortly, but they are essentially the coming together of several local practices to form a bigger grouping and be able to work at a slightly larger scale. Above that, I've also worked in what we used to call the CCGs, which have now been replaced as Robert said, by the what we term ICBs, which fall under ICSs. Lots of abbreviations. So I've worked at that level as well. And so I've worked sort of from the patient facing side, but also from the higher levels of organisation really. So sort of seen, seen it from across the board, but fortunately managed to see, experience and help implement innovations across each of those areas. So yeah, really happy to share some thoughts with you.- Thank you. So yeah, it's the, the primary care system is where we're going to focus on for today's session. So in our next slide here, here are some of the different organisations that we have within that system. So we've got, you know, general practitioners, GPs and individual practices going up to, you know, the primary care networks to sort of group those together and then the integrated care boards. Would you be able to give just a bit of an overview of what, you know, who those different organisations and stakeholders are? And maybe a little bit about what do you see as the different pressures that each of those faces?- Yeah, sure. So I mean, looking at this graph at the moment, so it starts with the GP. So if you imagine, I think within the UK or at least within England, we often say that 90% of patient interactions occur within primary care. So primary care is sort of high volume activity. And because it's high volume activity, it makes it quite open to innovation because the sort of efficiency advantages and quality advantages that you can gain through innovation can, you know, really can be felt within primary care by that sheer volume really. So within the UK general practice is the first port of call patients will be normally registered to a local practice or a local clinic and they will obviously be able to visit their general practitioner at that site. So that's the GP, they're working within the GP practise. And a GP practise can sort of look after anywhere, normally between five and 25,000 patients. Some are smaller, some are bigger, but that gives you a bit of a feel. I think the average size of a GP surgery is about nine and a half thousand registered patients that they deliver services to. Within a GP surgery obviously there are significant demands and pressures and lots of that will really focus. There's a big focus at the moment on access. There is a real push at the moment to increase the access for patients into primary care services. So really to try and drive down the waiting times of patients into seeing their GP. Waiting times can be up to two plus weeks. So it's really important to do something there. So that's a real pressure. There are financial pressures often within primary care and within GP surgeries felt as well. And there's always that need because of those financial pressures to maintain efficiency. So really always open to anything like improved electronic patient records automation and other things like that. Practices can then come together and form a bigger block called a primary care network. This was mandated by NHS England and a primary care network will often work at a bigger footprint of somewhere between 30 and 50,000 patients and has the benefit of bringing practices together under a new NHS contract, but allows those practices to work together at a larger scale. Below that, you can see the GP federations, they, their role in the system is perhaps less well-defined and more variable across the country, whereas PCNs are mandated GP federations are not. So they're more of an agreement between practices or between PCNs to sort of come together and sort of share resources and maybe work again at a larger scale. But that role is, is not as clear cut as the primary care network role and function. And then we've got the ICBs, so the ICB is the Integrated Care Board. They are responsible for the delivery of care across their patch and their patch could be serving anywhere up to several million people. And so they work at a very, very big footprint. And they are responsible for maintaining or ensuring services are delivered within their, within their patch. They can commission services as well. And so lot of decision making happens at that level. And then if something's come through the ICB and decisions are made at the ICB, they can commission services, which then can be fed back down to PCNs and back down to GP surgeries as well. So it's cyclical in that sense.- Thank you. That's really interesting. So you've got these sort of different levels of stakeholder, but if you were thinking of, you know, bringing something new to the UK or to expand a market where in that chain would you try and get that first initial foothold? Who do you think are the best people to talk to? Is it better to go in, you know, right at the top with the, with the ICB or maybe slightly further down?- It's going to be very dependent on the product that you're wishing to sell and to whose agenda it resonates most significantly. So where is the greatest appetite for the innovation or the product that you've got? And that the truth is there is no rule and you can start where wherever you feel best placed or you could target all simultaneously. There's no right or wrong, but I think it just depends on where you, where your product has the greatest immediate benefit that could be realised. So sometimes it really is worth just going to a GP surgery. They have a budget that's agile that they can spend quite quickly if they've got anything left over that is, and so they can often be very responsive and manage to pick up and adopt or implement technology very, very quickly. I could listen to a product or see a product today and have it implemented and funded next week. It can work at, you know, real significant agility there. You can go to primary care networks. Primary care networks are normally led by a clinical director and the clinical director has responsibility for those budgets and they're able then to spend that money and do as they see fit. So there is some agility and flexibility within the primary care network, but going to the clinical directors is often a good way of doing that. They also have roles like digital transformation leads that you can also approach and discuss product with ICBs are much bigger. So obviously if you can sell into a an ICB or provide a product into an ICB, it has the possibility of being commissioned for literally everybody. So there is a, there is a win there, but the tendering processes that go with that, the commissioning side of that will obviously be much more complicated and very rigorous as well. So there's not always, and sometimes the two go, I mean, and if an, if an ICB is willing to adopt you, adopt your technology, your innovation, brilliant because it'll probably be doing that for everybody under their, under their wing, which would include all of those PCNs and those practices. If you go to the PCN all the GP practice, you gain the benefit of agility and quicker decision making, but you won't be accessing necessarily the same scale that the ICB is able to. And the truth is, sometimes you have to do a bit of everything and often with new innovations, it's often really good to start at the ground and work with the GP practises, perhaps in the PCNs to gain a body of evidence that your innovation works and identify the benefits that are realised both in terms of quality of care that might be delivered or the financial and economic benefits of your product. And you can use those levels to really build your case because if it works at a GP practice or a PCN level, you start to make a really good argument for why an ICB might want to commission your product or service at a much bigger level.- Thank you. So yeah, on the next slide we just sort of put some bullet points down about the sorts of things that the different stakeholders are interested in that system. You know, everybody wants better patient outcomes, but they also, you know, have have their own their own needs and pressures as we've termed it. I guess having worked all throughout that system, could you tell us a little bit more about some of the tensions that people might come across in, you know, in terms of the different makeups of the organisations and what they need to do in their immediate and maybe the slightly longer term?- Sure, yeah, I mean GPs, so accessing GPs is useful because GPs are in the GP practices and they have their own as you've you've said there, their own unique pressures. They all want to do the best they can for their patients, but they're often overwhelmed by maybe the volume of patients they're having to see. They may be, their work might become under greater pressure through the administrative functions that they have to serve. Lots of our work is not automated and there are sort of inefficiencies with the way that we communicate between organisations. And so GPs come under the pressure of volume, lack of time and lack of, I'd say automation or administrative function. So those are the real burdens on a GP, on a GP's time. The GP practice, again, it's looking out like we've said there for better patient outcomes. It wants to deliver better care as good care as it can, but its pressures are often financial and limited resource that they have available to spend. They may have inefficiencies which are impacting on their service. They may have processes that are long-winded and convoluted. There may be issues around recruitment of staff that might be an issue for them, but really the GP practises want to, I'm sure would want to hear from people that were able to improve the efficiency of a practice it's running, the service it's delivering to patients because actually if we can make, if we can gain some efficiency, that then improves the financial outlook of those GP practices, but also resonates with this ongoing need to improve patient access to GP services. So if we create efficiency and we reduce waste, we may create more capacity to see more patients, which then delivers the needs and aspirations of the system and the patient and the practice and the GP. Primary care networks are mandated to deliver the primary care network. We call it DES, Direct Enhanced Service. It's a contract with NHS England, which stipulates the requirements of the service that they need to deliver. So if we're going to sell into or provide product into a PCN, we need to understand that, we need to understand what it is primary care networks are seeking to achieve, what are their goals, their objectives. And really new innovations can definitely help with a lot of that. Primary care networks are looking at delivering new and innovative services at a higher scale. And if those services work well, then there is the chance that that will then reduce pressure on GP services inside their practices so you can actually benefit the system. So I think primary care connectors will always be open to that. And anything that benefits a GP practice will probably benefit a primary care network because it's able, they're able to then disseminate, those benefits back down to practices. And ICBs want to see a good level and quality of care delivered throughout their, throughout their catchment. There are the financial pressures which you've written there, and that is huge, really the financial pressures on ICBs are very, very significant. So again, if we're approaching a system that is under pressure, the benefits might be realised in improved quality, but improved efficiency, efficiency gains can definitely deliver benefits which an ICB may feel resonates with their needs and their demands as well. And ICBs have a mandate and have a agenda which is often set by NHS England, but it does play into patients being able to access services easily, freely of good quality and also other activities such as addressing inequalities within communities and populations under their umbrella, with the aim then of course of improving outcomes and wider population level outcomes.- Thank you. Yeah, I think you covered that a little bit in the next slide as well. So think on the health inequalities side, we use Core20PLUS5 is, you know, one of the catchall phrase, not catchall, it's called, you know, five or six areas depending how you count them of, you know, areas that the government or the previous government. I believe this is being continued by Labour are really interested in hitting. So, you know, we've got cardiovascular, maternity, severe mental illness, respiratory, I think smoking is, is now included in there. Net zero I think, yeah, is very much becoming each year sort of a greater waiting to of any procurement exercises. But may maybe you could just expand, you know, in terms of local priorities, what if, what should companies be trying to do to demonstrate to that their product really works well for a particular demographic? You know, where should they look to find the information and what sort of information should they be looking for? What would be valued?- Really, really good point actually, Rob. And there's not always an easy answer to that and who holds the data is often a big key. So lots of the data on those demographics will be held within the health service that you may or may not have access to. It's always worth remembering that lots of this data is held within the councils as well. So there are councils which operate across the country and they often aggregate a lot of this data and there are many tools that they use and you may be able to publicly access things like JSNAs, which are joint strategic needs assessments that are produced by councils which identify population needs and unmet needs within communities. So it is possible I think to access some of that data. It'll be really hard for someone developing a product to be able to go into the granular detail locally of different areas. But there are certainly some key points that do apply to everyone across the country. And I think if you're looking at needs, I mean if you looked at health inequalities, which is what the Core20PLUS5 is tapping into there actually inequalities are experienced across the country in a myriad of different ways. And it's always useful to think about the product that you've developed and think about whether it could potentially address some of those inequalities that people might be experiencing. Perhaps your product can be displayed in different languages or it's got ways of overcoming people's maybe sensory needs and differences. Maybe it's more accessible and available online and or through an app and therefore doesn't require someone to be open and speaking to somebody. If you break down barriers to access communities that maybe got left behind through other means, then you're starting to address some inequalities and you can certainly with your product, better identify where it may work best. So if I was developing a, let's say a stop smoking app, for example, I'd want to know where the smokers are, wouldn't I, that would be natural. And then it's reasonable to understand that smoking can be associated with increased levels of deprivation and urbanised populations. So then you can start to hone in on more urban centres and then if you're hone in on the urban centres, you can access more detailed data on what those communities are suffering at that time. So definitely you can speak to local needs and it's often, I wouldn't necessarily say be the driver of your product, but if you are looking to access the markets, understanding how your product meets the unmet need of our communities gives you a really good head start, really good head start into making in ways inroads into the system.- Thank you. Would it, yeah, there's some really good points there. I'm going to jump into them I think on the next slide'cause they expand them a little bit more, but could you, for our international audience, maybe explain a little bit more about the DES? I think you touched on it earlier, but also what, what the ARRS roles as we call them are and maybe how companies can make sure that they're sort of making best use of it or providing as much value as possible?- Yeah, absolutely. And this is where having local understanding really, really counts. If you imagine GP surgeries, so the clinics that the GPS and the general practitioners or family doctors operate from, they run under a contract called GMS General Medical Services. So they've got their own NHS contract. When the NHS decided I wanted to create primary care networks, it needed a contractual mechanism for that and it created the primary care network DES, Direct Enhance Service. So it's essentially an enhancement on what was already being delivered and it's then delivered by primary care networks. So DES is a reference to the contract that primary care networks are attempting to deliver. ARRS roles are an extension of the primary care networks and a part of the DES the Direct Enhance Service and ARRS roles is essentially reimbursable roles which primary care networks can employ. So primary care networks will be given a sum of money every year to spend on a specific list of staff. So staff members are explicitly made clear of who you can and can't employ. And there is a budget made available for the primary care network to spend on those staff. It isn't cash that the PCN can take away. And if it's not spent, then it comes back as cash. No, it can only be claimed against the salaries of those new roles that are being employed. That opens up some window of opportunity when you are developing product because primary care networks give you a slightly bigger scale. So instead of trying to speak to five or 10,000 patient list size in one clinic, you can now speak to a group at 30 to 50,000 patients who share some of that agility like we said before. So the primary care network gives you a new opportunity to sort of work with new partners at a slightly bigger scale. And it's really important to remember that those primary care networks are working under that DES, that contract and they employ people to deliver the DES under the ARRS roles. So those people are helping deliver the contract through those roles. So I suppose that's where we are at with that. And I suppose from new, from a new product perspective, it's understanding who those new roles are, what they're there to do, what's the contract there to deliver. Because if you understand that, you then understand the needs and once you understand somebody's needs, you start to get the fit because you start to fit your product around that need. And the truth of the matter is general practice, the clinics, the primary care networks all have needs, but finding the solutions is often really difficult. So the better the two sides understand one another, the more more chance of success.- Absolutely. So I think, yeah, that's right. So I think it's, yeah, I think it's definitely about demonstrating that you, that you understand, you know, who the clients are and you know, which different parts of the healthcare system that is. But I think you touched on a really important point before that, you know, different patient groups are going to have different needs. And we by no means, you know, if you're bringing something new into a healthcare system, you don't want to introduce a new health inequality. So I think, yeah, it is really important to be able to demonstrate and this will be part of the evidence that when you've gone and developed this piece of tech, that it's been, you know, trialled on diverse populations and you know, different social groups and different settings even when it's localised. I think, you know, during COVID there was that an issue around sort of pulse oximeters where, you know, people with darker skin tones, they weren't as effective and a new health inequality being introduced. But I guess while bearing that in mind and making sure that people are, you know, developing things with patients not just for them. So what sort of bits of evidence have you found are sort of most convincing? Got a sort of a couple of there on the slide, but don't feel limited to those at all, okay?- Yeah, and I suppose tapping into that point, Rob, which is a really, really important point about those inequalities, and I sometimes feel like there can be a pessimistic narrative or a optimistic narrative and sometimes it's useful to say when you're bringing in innovation because you will meet resistance, it's often useful to say, we accept that this does not solve everybody's problem or it doesn't solve every community's problem, but it is a solution for some. So there's never going to be one solution that fits all. And I think for those who are listening who are developing product and innovations, it's really important to be upfront and honest about that and get that out early that this is not a solution that will solve all of your problems, but actually for some groups this really will solve a problem. And I think in the NHS one thing that we are learning more about and moving towards is this, or sort of the panacea if you like, is of personalised care and essentially what personalised care is saying that there isn't one size fits all, not one thing will work for everybody in the community. And the fact that we do have inequalities and we do have differentials in health outcomes speaks to the fact that people are a lot more complicated. There is not one thing that that will work for everybody. So I do think as we move to a greater maturity and understanding of this idea of personalised care, meaning that we tailor services and care around an individual rather than try and get the individual to fit into the box that we've created is a really useful thing, especially around innovation. It's about saying that it's a menu of options. We need more on the menu. The more we got on the menu, the more likely someone's going to pick something out that's going to work for them. So I just to, just to get that narrative out there, I think. But in terms of what evidence do I need, I suppose it depends on what level I'm working at. If I'm working at a GP surgery level and the budget is readily accessible, I suppose, and doesn't need to go through the same processes that the ICB needs to actually, maybe the evidence doesn't need to be as strong or maybe I can take a chance on something that maybe isn't as worked up or thorough, but I'm not sure that's necessarily true either. I think the reality is what you are dealing with is a health system that is under strain as every health system is in the world, I'm sure. And so people don't always have the time to spend taking your product and implementing it and working out the nuances around its implementation. How are we going to do it? Who is it going to speak to? Best of all, there will be some willing to take that chance, but there's not many. So I think if you are going to access this system, you need to have worked with some partners who are in that industry who have done it, who have helped you implement it, who have worked up the solution with you. So we've said case studies, but I think that that probably is right. You want to be hearing from someone that has implemented their solution within maybe a clinic setting, got some data to say how it's performed, identified ways in which it meets my needs and maybe improves my efficiency, give me some value that I can understand. So for example, a 30% efficiency in new patient registrations means I can work out how much money that's going to save my practice and if you can work it out for me then even better. So you need to have some of that work already done. And I think that's the thing that I'm seeing at the moment that isn't there. People are trying to get in, they want free pilots of their products and the work hasn't been done around how do we implement this product? What work have we done to identify if it actually works, what work have we done to identify which populations and which communities will benefit most from that? And what work have we done to understand where else in the system this change has benefited. And I think that's the other thing to bear in mind. We work in a system so whatever we implement in one place will likely have impact somewhere else. And actually if you're developing an innovation, that's really good to know because you can say that I've improved the efficiency within a GP surgery, which is then created 25% more capacity for appointments in that GP surgery, which means there's fewer patients having to revert to going to A&E or emergency departments, which is then putting budgetary pressures and clinical safety risks within a hospital environment. So it really is important that you are thinking about the wider system benefits of your product, which I suppose goes to the middle item there in terms of localised pressure there. And then obviously health economics comes along with that too. So you know what, you know, what's perfect if you want to sell to an ICB or actually to anybody and you want your product to really gain traction, how does it help the patient? How does it improve the quality of the service that the patient is experiencing? How does it allow us to deliver that service in a more efficient way, which then has some financial benefit in terms of service delivery so that we can spend our finite resources on helping more people. How does that change help a practice, a GP surgery, maybe it's reducing the number of appointments and therefore creating new capacity and then how's that helping the system because we've created one capacity in one place, we've reduced a pressure somewhere else. And actually when you're getting into that level of detail and understanding and work and rigour, then you've made a really good argument to an ICB to say, you need to employ this across our patch. And then you're talking about a deployment across a huge population and then if it works in one ICB, maybe it works for all ICBs and in which case why haven't you got national uptake of your solution?- Yeah, that's really good. I guess in terms of like, you know, budget impact and sort of health economics, I think we've heard from some ICBs that, you know, they're looking for a return on investment within a year. Is that, is that something that you recognise or do you think other organisations have a slightly longer view or, you know, what sort of timescales do you think people should be looking at there?- I think it's really hard and I think it will depend on the ICB and it will depend on the agenda that you are looking to fit. Probably also depends on which phase of an election cycle you're in. I don't know. So that's really, really variable and I suppose it's just, it's very, very dependent on all of those factors and it depends on what you're seeking to achieve. I mean, the reality is if you are seeking to achieve true system transformation, it isn't going to happen in 12 months. It's going to take a lot longer than that. And I suppose then, you know, you are making that argument as to, you know, what is the perceived benefit here? You know, how significant a benefit could be reaped by this intervention. If it's very significant, then time may be more, you know, more flexible for you. So I think it just depends. And actually, you know, if you're going to ICB, sometimes they'll have a tendering process. They're looking for a product with immediate, you know, immediate implementation and sometimes they're looking at sort of larger scale pilots, in which case the time will be defined. But yeah, I think it's really hard to define that. It's very dependent on the project, the product, the aims, the aspirations. So yeah, a few caveats.- Thank you. So say a company, they've done, they've done a lot of work, they've got a couple of case studies from somewhere else. Maybe it's in the UK, maybe it's not, they've got a quite a good health economic argument. Who do they reach out to? You know, is it sort of a scatter gun approach of emails or is it, you know, as you maybe you said said earlier, just walk straight into a GP practice and ask if you can talk to someone, how do you reach these people or identify them, if first, to you know, let them know this great new thing that you've developed?- Really good point, Rob. Really good point. And it's the golden question, isn't it really? Is it a scatter gun approach going to work? No, it's not. The one thing about health systems, particularly our health system is very relationship based. You know, people are very busy, they're under pressure, they get tapped up by companies all the time wanting to sell their product and they normally just go straight into the bin. So it's really hard to do it that way. And I don't think the scatter gun approach will get you anywhere in a system inundated with offers and with scarce resources and limited time, it's going to take, it's going to take more than that. Really it's about understanding your product where its value lies and understanding how that value can be, who can benefit most from that value. And if I, you're talking to a GP or a GP surgery, you really need to know the intricacies of the pressures that they face and you really need to have done some homework and spoken to people in that role first to understand how this product will benefit them. You have to have done that first because you will often only get limited time and limited access. So it's making sure that when you do try and when you do gain some access that you, you've got the right message to sell and you understand everybody's agenda. One great thing about working in in the health system is it is a constant thing of just trying to identify what's your needs and wishes, my needs and wishes and what's the patient's needs and wishes and you know, I'm thinking of a Venn diagram. It's, and really you're just trying to find really that middle point where everybody's aspirations can be achieved and you can find it, it's really easy to find, to be honest. It's not as hard as people would think, but it just takes some creativity, some thoughts, some research. And if you're looking to go out, I would probably say you need to try and identify, you need to identify mechanisms of doing that. So there will be people who work within healthcare who are innovators, who are interested, who are willing to work with you to try and do that. And maybe you'll need to engage a third party to have those conversations, but it is really hard to get your foot in the door, but you probably need to be looking at getting pilots underway to identify those benefits so that you can then start to roll this product out. But I think it's very hard to do anything unless you've really got some meat on the bone, some real world experiences. So yeah, so I think it's trying to find out who those innovators are, who are those people who are willing and willing to listen and you'll find those through, you know, people who are in this industry, you know, LinkedIn, we always talk about LinkedIn, don't we? But you'll often find people who are innovating, who put themselves out there in that space and trying to form those connections and relationships.- Thank you. I think that that's really helpful. I think this is a very important message to, you know, don't guess as to, you know, sort the questions that you need to answer with your health economics, your case studies. Go and ask the people, that's one of the strengths of Mtech Access is we've got this, large group of NHS associates that we can draw on to, to ask, if you were implementing X, Y or Z, whatever it might be, what would you need to see? What sort of questions would you be asking so you can make sure that you, you know, the research does the right questions and is as impactful as possible. So like we looked a little bit at this already, but I guess it's, you know, when you are in, when you are in this role and you're, you're very busy, it's, you know, what can we, how can, how can industry make that collaboration as smooth as possible? I think it's probably me only to put too much time on it because it's, you know, it's making sure it's already worked up, I think you said, and that there's not too much to do on the implementation side, but is there anything else that you'd like to add to that message?- Yeah, and it's really key, you know, because the health service is delivering great services, but it needs the cooperation, it needs to work with industry to identify those efficiency gains, identify those new innovations, which will make improvements in terms of clinical care. We have scarce resources, so we have to maximise those efficiencies and that's where this collaboration with industry really kicks in those innovations can really kick in. What does good collaboration look like? Well, as with any collaboration, it's done best when there are shared and agreed values and goals. And I always think that as long as you focus on the patient, I've always, in my medical career, I've always concentrated on, if I concentrate, if I prioritise the patient, this is about the patient and nobody else. So my focus has to be the patient, the individual, that one person who I see day in day out in my clinic room, that is the person that this is all about. So as long as you can get that really clear that those, the collaboration needs to be around that patient, giving them the best, the best quality of service, the most efficient service, and helping as many of those individuals as we possibly can. If we can all agree on that, then actually things will naturally flow and naturally follow. We all need to be respectful of each other's needs and wishes in that. And I think, you know, I can think of a collaboration that I've done recently, which reconfigured primary care mental health services and it's given phenomenal results, but that was because it was all very much about the patient and then recruiting different services, different products, different things around the patient to try and think how am I, how does this product or how does this innovation raise that bar? More efficiency and better quality. As long as you keep working towards that, then, then you'll always do it. Don't forget the health service cannot develop products easily itself. So it needs people out there who are developing new products with a new fresh set of eyes and the health service is really open to that. So the collaboration should work well, but it really needs goods interlocutors, it really needs those people that are bringing that, creating that interface needs a really good interface, I think to be successful.- Thank you. Yeah, I think it, it is just making sure that all those bits fit together as you say, and when industry comes, I think, you know, some of the things that are really valued, I think so are thee additional bits of support that can be provided. I don't know if in in your experience whether you found any of these areas, you know, particularly helpful or do you think it's, you know, more customised to a localised area, but have you, have you ever found anything sort of offered by industry in this way? You know, absolutely essential or, you know, particularly helpful in convincing colleagues that actually yes, we we should adopt this or that?- Yeah, I mean, if I think of work that I've done recently, I can think of digital tools that we've used to provide patients with a service or a new service and I suppose, you know, if you think about, you know, what's the value there? Well the value is in creating a product that didn't exist that has then created greater access to treatment for more people who couldn't seek traditional treatment or didn't have the time to. So creating so value can come from a new product in itself. I think the really big thing is how new product can then allow us to rethink and reconfigure our clinical pathways and even our administrative pathways. I often talk that we often work in legacy, so we often have legacy clinical pathways. They've been set up for years, they never mention a patient, they just at a starting point from a professional to another professional to another professional, but they never actually mention the patient or actually never focus on, on the patient and the patient journey. I'm personally an advocate for really rethinking clinical pathways, making them patient centric. The patient is the first part of that. And then rethinking the pathway around new product, new services. And I think, you know, you've got their business support, clinical support tools, training and education. So actually all of those feed into new pathways and new ways of potentially doing things. I think just be wary the industry offers, offers things we don't have, you know, different skills, different viewpoints, a better understanding of what efficiency is, you know, we care about patients, that's what we do. And maybe we haven't got so many people that understand those sort of efficiency gains and how to run processes in a more efficient way. You know, it's amazing, we barely use much in the way of RPA and automation, but industry's been doing it for decades. Why aren't we using that? You know, why, you know what? We need more conversation with industry to understand how industry does things and how that can then benefit the way that we do things. I think industry is, you know, obviously very has high levels of understanding of those sorts of processes that maybe we don't. So I think those are areas where we can certainly gain industry, have more diverse workforces and programmers and other things that can create new solutions that we don't have. So this is where we really need to get that relationship right. It's really important. So what can industry offer and where's its support most value? I think it's across the board in delivering a new set of skills, a new set of products, new ways of doing things, but we just need to get the interface right. We need those thinkers who sit in the middle to see how one side's doing it and how it can then be implemented by another side.- Thank you. Yeah, I think that's really important, building those relationships so that you can understand what needs to be developed. But I think what I sometimes hear or, and have experienced actually is that sometimes the NHS can get quite skittish around, around industry and being, get worried about there being a perception of being overly influenced. I don't, don't know if you've ever had any experience there or any words of wisdom so that, you know, people coming, maybe looking from outside the UK can get it right in terms of not scaring off the NHS.- Yeah. And really interesting and I suppose it comes from the fact that the NHS is a public service. It isn't motivated by profit or income generation. It is about public good and public service. And I suppose that's why it will often perceive maybe industry as being something separate, something different, maybe coming from a different land and a different world somewhere else, because that doesn't apply, you know, so much to industry. They're not necessarily public bodies. So I think maybe sometimes that hesitation maybe comes from that. And then a sort of uncertainty about what you're doing here and what, why are you here and what are you trying to take away from us? And you know, and that probably is some in some way goes to understanding why that happens. But it's not insurmountable. It's definitely not insurmountable and it obviously in the various sense, it's quite naive because the health service is a health service, but there's a lot more that underpins the health service than just the delivery of the health service. There's not a doctor in the country that doesn't need a desktop computer with an operating system and an electronic patient record to do their job. And that doesn't come out of the health service that comes from outside. So we sometimes maybe naive about that, but I think it's really about shaping the narrative on building and developing that relationship. You have to realise that if you want to work in this sector, relationship means everything because trust means everything. So you need to be building individual relationships, building trust and making it really clear what your agenda is. And if you set your agenda to be about how do we make your service better, how do we make it better for your organisation, but better for your patient too, then you start to form that common ground. It's about reconfiguring the relationship and understanding how you can develop that relationship in a way that brings everybody together. I suppose that's the essence of collaboration, isn't it? But this is one of those absolutely key areas because as, as you said, Rob, there will be some pessimism, some suspicion and that sort of thing. So it's really important to set the tone, the narrative, the relationship and the values of that relationship really early and there is common ground, it just needs to be done well. And I think when things don't go well, it's often, you know, the communication that wasn't right from the outset.- No, I very much agree with that. You know, it's definitely a case of collaborate with not quite selling to in terms of the language and the thinking. So I think we've got a little bit of time left, so I've got some questions that we've received from the audience sort of pre-submitted, so we could run through a couple of those. I think that'd be, that'd be really helpful. So the first one is, you know, how are medical devices funded in community settings? Do you have any take on that?- So again, it's variable. So if we take the community setting itself, I think the things to point out to you within the community and there will be increased focus in the NHS around communities, there is a focus now around creating integrated neighbourhood teams. The new government is talking about bringing care closer to the community or bringing care into the community. So community is going to be a, the really big building block here going forward. So if you're looking to bring your community, your product into the community, a couple of things. So the GP surgery is a fundamental part of that. So as we've spoken about before, speaking to the GP surgery and the GP surgery is able, to fund product if they wanted to. Primary care networks are in that community, they can do the same too. I think the only bit that we are maybe not putting in there is community services. There are often community contracts to deliver care from other wings and other arms of healthcare such as district nurses and district nurses and occupational therapists and physiotherapists that they will be commissioned perhaps differently depending on the area that you're looking at, which is where sometimes the NHS can be more difficult to navigate as there is some variation locally. So in my area it'll be the acute trust. So the acute trust is the group that runs the hospitals, but they can also deliver community services. So it's understanding which organisation it is that's delivering community care. There'll always be a GP surgery, there'll always be a primary care network and there will be some sort of community offering and that might be run by any organisation. It might be the hospital trust, like I said, but it could be somebody else and you can have those conversations directly with those organisations. So those would be the ways, those are the people who are delivering the services and you can speak to them, you can speak to an ICB who can deliver across the patch, but that might be more difficult. And so I would probably say start from the ground up and look at who delivers the community services in those areas. And then absolutely they have their own budgets so they will be able to do their own tendering.- Thank you. Okay, the next question I've got here is, you know, if you're implementing sort of a diagnostic device, is it, or you know, diagnostic service I suppose is there, is there any way that you can speed up that implementation? So maybe, maybe you've started that journey in a GP practise or in a PCN, but you feel that adoption's a bit slow. Is there any way that you can speed it up or is it the pace is going to be set by the system?- Going to be interesting, isn't it? Because part of that is going to have to be around where you benefit. So what's the benefit that you're delivering? If you can prove a distinctive benefit and you can quantify that benefit, then more people are going to listen to you. So it depends on the, the quality of the evidence that you've got available, but if you've got really good evidence, there's nothing stopping you reaching out to far and wide and going across different ICB areas up and down the country. But it's really dependent on you being able to identify the benefit of your solution, who benefits from that solution and how can you quantify that benefit of that solution and do you have good evidence of how to implement that solution? If you can do those things, then you've got a really good chance of being able to spread that solution and that intervention far and wide. And that could be a a obviously a diagnostic intervention.- Thank you. That's really good. Yeah, I think yeah, having that evidence right is essential. So my third question, so I guess quite often there are large pots or one-off pots of money from central government to tackle a problem. Do you have any advice for companies who may, you know, they may have got some implementation or adoption off the back of one of these large pots, but they're really struggling to get sort of continued funding or, you know, beyond that initial lump sum from central government. Is there anything they can do to increase their chances or is it sort of back to the, you know, demonstrate that what you've done is valuable?- Well, really tricky, isn't it? And you are right, this is something that we come across where there is one-off funding non-recurring funding for solutions and the funding stops and then we've got nowhere else to go. It's really difficult. And what's the solution to that? Well, you've got to prove the benefit. If you can, you've got to be able to prove that your intervention is making benefits somewhere in the system and creating an efficiency and an improvement in the allocation of the scarce resource that makes it worthwhile. If you could do that and you can integrate well and you can maybe meet many different agendas rather than just the one agenda that you set out to solve, then actually you start to make yourself indispensable. It's about becoming indispensable. It's about saying that this intervention is so beneficial that even if the one-off funding stops, there are so many other areas where this can impact and improve services that actually it's a no brainer. And this is where it's about understanding that you work in a system, it's about being agile, it's about moving your offering depending on changes of agenda and you know, being responsive to the feedback that you are getting. If you can have that agility, that responsiveness, that awareness of the wider system, that understanding of the implications of your intervention throughout the system, you can really build yourself a robust case. And it's about becoming indispensable as it would be a member of staff that we might be employing. We might be asking them to do a basic task, but actually those who become indispensable are the ones who go beyond just the basic task. Those people who are actually impacting on other areas of the business and other areas of the work that we're doing who are actually thinking about the new solutions that's driving us forward. So I think solutions, you know, if we're developing innovations by the very nature, they need to be responsive, they need to be looking at those other opportunities. And even if the one-off pot dries up, if you can show a financial benefit immediately people aren't daft. You know, people aren't daft. They're not going to turn down something that is going to free up significant resource somewhere else in the system. So it's about making those logical arguments.- Thank you. Yeah, I think that that's a, it's a really good note. So I think that's, I think we, we are sort of drawing to a close now, so I was just thinking, is there anything you think I should have asked you that I haven't, just for anybody's coming, you know, coming in from globally to the UK and thinking about coming in, is there anything that we, you know, I've missed?- No, I don't think so, Rob. I think that was pretty, pretty thorough. I think you've, you've kind of, you've kind of got some really good coverage there across primary care and across the system. So not at all. I would say, if anything, it's just highlighting that importance of relationships, relationships and understanding. It's that next level of collaboration, really'cause if you could get that right, there's so much benefit that follows and flows and that's how we overcome people's pessimism and their inertia by really understanding each other's needs and wishes. So yeah, relationships forms the core part of that.- Thank you. Okay, in which case, sort drawing to a close, if you've found this useful and you'd like to see the slides, I'm reliably informed that they're in the documents tab. And if you'd like to come to sort of a future set of webinars on the 29th of August, we've got another session sort of focusing on winter planning with a former director of commissioning. And then later on in September we've got the budget cycles, just had an election in the UK with a fairly significant change in government. So if you'd like to understand more about, you know, the potential impacts on that, the implications of different policy changes and new secretaries of health, et cetera, then we are doing some really good bespoke deep dive sessions for anybody who's interested. And then in sort of, yeah, in November we have our symposium, so that draws together some really, really interesting NHS experts, sort of right from the very top of the NHS and then throughout, sort of really deep diving into, transforming healthcare and what industry needs to know and understand. So it'd be great if anybody in the audience is interested in that. Do reach out for any of these. I guess more broadly, if you'd like to contact us on any of the topics we've spoken about today, you know, whether that's health economics or how to get the market access right, or just talking to the right people in the NHS, then do, grab that email info@mtechaccess.co.uk and we can, you know, we can have a chat or work through a session or something like that. But it just, yeah. Leads me to say, Faris, thank you so much for your insights that you've brought today. I've certainly learned a lot and I found it really interesting. So thank you so much. And thank you to to everybody who's been listening today.- [Announcer] Thank you for watching. If you'd like to find out more about our work with the NHS or how we could support your market access goals, please email info@mtechaccess.co.uk or visit our website at mtechaccess.co.uk.