Secondary care media consumption

The healthcare industry has gone through some significant changes in the last year and half, affecting how secondary care healthcare professionals consume news and educational content.

Earlier this month, a survey was sent to our secondary care community of healthcare professionals via our media brands Hospital Healthcare Europe and Hospital Pharmacy Europe.

Taken by hospital healthcare professionals across the UK and Europe, the survey sought to understand how our audiences’ habits have evolved during the pandemic in order for us to provide the most accurate, and reliable information across the most important topics.

Results

  • 89% of our secondary care audience spend at least an hour or more weekly reading clinical content
  • Just under 80% of our audience prefer to consume content digitally
  • 95% prefer to be notified about new content via email, showcasing how actively engaged our community are with our brands
  • Almost half of the audience sample are interested in participating in more regular discussions on a range of topics, demonstrating the relationship we have with our audience as a trusted source of medical information
  • 44% of our audience are interested in congress review content

For further information about how Cogora can help you reach your target community, please contact Michael McConaghy at michaelmcconaghy@cogora.com.

Hospital Pharmacy Europe serves a growing community of senior clinical and hospital pharmacists across Europe and the UK, delivering a potent combination of timely news, opinion pieces, original research and concise, authoritative clinical articles in every issue.

Endorsed and supported by the European Hospital and Healthcare Federation (HOPE), Hospital Healthcare Europe is an indispensable resource for best-practice information, pan-European guidelines and case studies from key opinion leaders at centres of excellence in clinical care and specialist services across Europe and the UK.

New Cogora report reveals what GP primary care networks are really thinking

The NHS’s newest organisations, primary care networks, are going to be central to the health service in the next few years, and Cogora has produced a new report revealing their leaders’ true feelings about the state of healthcare in England.

The report ‘Primary Care Networks: Controversy, Covid and collective working’, is based on a survey of around 200 clinical directors of the 1,250 PCNs across England, as well as in-depth interviews with them and integrated care systems leaders, who will be the lead commissioners of health services over the coming years.

PCNs have been further thrust into the limelight since the outbreak of the Covid pandemic, and now they are responsible for providing the bulk of the Covid vaccination programme – the biggest public health programme this country has ever seen.

The publication, with its unrivalled access to healthcare leaders, is intended to inform those working in healthcare about these new organisations, as well as support industry in staying up to date on how PCNs are evolving and how it can best engage, educate and support PCNs as their new NHS customer to improve local care.

The report highlights the effect PCNs have already had on primary care since they were established in July 2019, as well as analysing the adequacy of funding for PCNs, the effect of COVID-19 on the evolvement of the networks, and how other NHS structures and industry fit within this change of scenery.

It reveals that there is support among leaders for the project, with 68% of the PCN respondents feeling positive to very positive about it, but it also found that there are a number of challenges they are facing.

The workload involved in the role of clinical directors to manage their PCN is far more time-consuming than expected or costed. One big concern is that clinical directors spend more time on PCN work than they are funded for: around 61% spend more than nine hours a week on PCN work, which takes GPs away from frontline.

The additional roles reimbursement scheme (ARRS) that brings funding to hire pharmacists, social prescribers and other roles is far less flexible than one would have hoped for. Common concerns include struggling with recruitment for the specified roles, not being able to use all of the funding, inadequate funding, and staff that is needed is not included in the scheme, resulting in only 42% of the ARRS funding being used in 2019/20.

However, despite problems around funding, PCNs are clear as to what they expect to be spending their budgets on over the next five years. Clinical directors think PCNs should focus on mental health (40%), elderly care (36%), and diabetes and obesity care (14%).

Merry Christmas from Cogora

With year-end quickly approaching, the Cogora team would like to wish you a Merry Christmas and Happy New Year!

2020 brought new challenges and new ways of working. Covid-19 had a major effect on healthcare professionals’ media and educational consumption, with the industry then forced to look at ways to embrace these changes for the future.

Across our media brands we saw a greater demand for access to information and guidance as it emerges and the need for a reliable and trusted source to deliver it. Regular Covid-19 specific news articles have consistently proven to be the most popular type of content, so our streams of updates attracted swathes of online traffic. All our brands set up dedicated Covid-19 sections on their websites to help readers easily navigate the myriad of information related to the crisis.

With only three face-to-face events delivered before the pandemic hit, our media brand Events team pivoted to virtual events and, through Autumn, over 6,500 healthcare professionals logged in to our Pulse, Nursing in Practice and Management in Practice Events to experience live and on-demand webinars and visit virtual exhibition stands.

Cogora: The Agency hosted numerous advisory boards and roundtable meetings, both face to face and virtual, across many different therapy areas with delegates ranging for c-suite personnel to clinical multi-disciplinary teams in primary and secondary care. Included was what was meant to be a two day live conference in the field of rare diseases, which instead became a highly successful virtual meeting.

Delegates from across the world were able to learn and engage with leaders in the field. Meeting feedback was so well received that a second meeting is already being planned for 2021. The annual Primary Care Respiratory Academy Roadshow also had to be converted to series of regional interactive webinars with over 600 attendees.

Other highlights included the development and launch of an app for young people with cystinosis as they transition from paediatric to adult care, the launch of a digital hub hosting varied resources including animation, clinical paper summaries and talking head videos as well as CPD accredited learning modules.  

Within our CME division, PCM Scientific, we hosted our 18th annual IOTOD conference in a virtual environment for the first time, with over 350 delegates from over 40 countries in attendance across the two day live-streamed event. Two new educational platforms were launched in cardiology education for a European and USA audience, we hosted educational webinars discussing the diagnosis and management of allergies during a beyond Covid-19 in five local languages, and launched a series of educational e-Learning modules within the areas of coeliac disease, thyroid cancer and acute myeloid leukaemia across our educational platforms.

A Cogora survey on CPD needs and perceptions of European HCPs during Covid-19

Over the past six months, the global pandemic has led many industry providers to reduce their provision of education and engagement activities with healthcare professionals, restricting the volume and breadth of professional and service development information available.

To help provide our industry partners with guidance on clinical or business-related education and support materials likely to be most useful to healthcare professionals in the next six-twelve months, we distributed a survey to our primary and secondary care community via our media brands Pulse, Nursing in Practice, Management in Practice, Healthcare Leader, The Pharmacist, Hospital Healthcare Europe and Hospital Pharmacy Europe.

The survey was completed by 990 healthcare professionals across the UK and Europe, 71% secondary care and 29% primary care.

Results:

  • 79% noticed a reduction in the provision of industry funded education or service support materials and campaigns over the past 6 months
  • 93% of respondents agree that industry funded materials offer benefit to their continuing professional development
  • Despite the pandemic 30% of respondents are still finding time to dedicate more than 3 hours to CPD per month, and over 46% between 1-2 hours
  • Preferred learning formats included virtual webinars (42%), articles (29%), interactive modules (21%), videos (6%) and podcasts (2%)
  • Only 32% of respondents felt that advertising or product detailing was of use to them professionally, with as few as 17% agreeing that it influenced their approach to patient interventions
  • 60% find CPD areas of industry company websites a useful and reliable source of personal or practice education 
    • “Helps with refocusing and application of research-based interventions”
    • “Expands my knowledge and teaches new approaches”
    • “Can provide more in-depth knowledge to practise”
    • “It is important to have a rounded view of all that is available to support patients”

Download our survey results infographic here.

For further information about how Cogora can help you reach your target community, please contact Edward Burkle at edwardburkle@cogora.com.

The Covid-19 effect: Changes in healthcare professionals’ media consumption and how you can embrace it

Covid-19 pandemic has major impact on healthcare professionals’ media consumption which industry must embrace, reveals new report.

The global Covid-19 pandemic has had a major effect on healthcare professionals’ media and educational consumption and industry must look at ways to embrace these changes for the future, according to a report published today.

The report, published by Cogora, highlights the impact the global crisis has had on those working across primary and secondary care and how the new demands of their roles have triggered a shift in the way they consume digital content and embrace remote events.

Based on its own analysis of its audience of around 220,000 healthcare professionals, Cogora found that GPs, practice managers and practice nurses have had to adapt their jobs and reorganise their practices, moving to triage-first models and implementing remote consultations.

Community nurses have been working on the frontline whilst community pharmacists have faced a massive increase in their workload as they quickly became the first port of call for patients.

With routine capacity in hospitals greatly reduced to focus on coronavirus emergency care, hospital consultants have had to decide which patients to prioritise with their limited resources, whilst their pharmacy colleagues have had to manage issues with medication supplies.

All this has resulted in a greater demand to access information and guidance as it emerges and the need for a reliable and trusted source to deliver it, according to the report, which Cogora’s seven media brands have quickly adapted to.

Amongst the changes in media consumption are the need for specific advice on more specialist medical issues, help in debunking clinical myths often written about in the consumer media, seeking quick guidance on remote working and wanting to read content that praises their profession.

In addition, healthcare professionals have embraced virtual events more than ever before, with 48% of HCPs surveyed by Cogora saying they are confident with using new communication platforms.

Remote meetings have proven to be an efficient alternative to face-to-face advisory boards and virtual webinars have proven to be hugely popular, offering more globalised audiences, a greater pool of key opinion leaders and lower costs to run, according to the report.

“Challenges for our audiences translate into opportunities for our clients,” it says. “By recognising and embracing the interests of healthcare professionals, our clients can position themselves to reach out to them in interesting new ways.”

 

The full report can be accessed here: The Covid-19 effect report

Healthcare Worker Safety

The Insight team recently successfully delivered a roundtable on Healthcare Worker Safety, which was attended by seven key opinion leaders, with representations from across Europe.

This meeting is expected to fuel the development of publications and shape the strategy towards addressing healthcare worker safety in Europe. In the meantime, the team are also working on a project focusing on the structure of oncology multi-disciplinary teams in hospitals across Europe, where the collected insight will be used to inform the client’s market access strategy.
 
 

The State of Primary Care report

Nearly half of the primary care workforce is considering quitting their professions this year, according to Cogora’s latest survey, which unveils a sector struggling with rising stress levels, low morale and unrealistic patient demands. 

An overwhelming 44% of the 2,386 GPs, practice managers, practice and community nurses and community pharmacists surveyed reveal they are thinking of leaving their jobs in the coming year. This includes a quarter of respondents who are not even close to retirement age. 

The worrying findings are presented in Cogora’s sixth Primary Concerns report, which this year takes the title of The State of Primary Care 2018, and provides an insight into the current state of the sector from the healthcare professionals who know it best. 

The survey of the readers of Cogora’s five primary care publications- PulseManagement in PracticeNursing in PracticeHealthcare Leader and (for the first time) The Pharmacist– suggests that rising workload, lack of resources and feeling ‘overworked, overwhelmed and underpaid’ are driving the workforce to quit. 

One GP partner describes the job as ‘unsustainable’, with them starting each day with dread and ‘firefighting’ from the moment they walk into the practice. A salaried GP says they want to get out before they become the ‘last man standing’, ‘We are too small an army for the job required,’ they said. 

Many respondents describe the job as having devastating effects on their mental health. One-third report that stress at work has become so bad that they have already taken time off work or expect to the coming year. 

Their battle with stress and burnout is even spilling over into patient care. Around half of superintendent pharmacists, pharmacy contractors and salaried GPs say their stress levels are having an impact on how they treat their patients (58%, 54% and 48%, respectively). 

Readers were quizzed on a range of aspects of primary care, including how often they face patient abuse, changes in their prescribing habits, the effect of medicine shortages and what impact the GP Forward View and Sustainability and Transformation Partnerships (STPs) have had on patient care. 

For the sixth year running, morale remains low among staff, with the decision makers- GP partners, pharmacy contractors and superintendent pharmacists- feeling it the most. 

Across all job roles, the highest influencer of low morale is unrealistic demand from patients. Feeling unappreciated by management and workload from other sectors (‘workload dumping’) are also high on their lists. 

And as the original deadline for Brexit approaches, respondents give their verdict on how they believe it will affect the NHS, with less than an optimistic response. Three-quarters thought it would have a negative impact on the number of nurses working in the NHS and 71% said it would adversely affect the number of GPs. 

But it is the effect on medicine supplies that is causing the most concern, with 64% saying they thought the UK leaving the EU would have a negative impact on the availability of drugs and 54% thought it would lead to community pharmacies stockpiling. 

For more information on the report and survey, contact Cogora’s Group Editor, Gemma Collins, gemmacollins@cogora.com or 0207 214 0614. 

State of Primary Care survey

Cogora has launched the State of Primary Care survey, a multi-topic survey to our community of 220,000 healthcare professionals to gather novel insights on the current state of primary care across the UK. 

The survey, previously known as Primary Concerns, is running for the sixth year, across Management in Practice, The Pharmacist, Pulse and Nursing in Practice to help inform us about the current state of primary care across the UK.

The survey covers a range of topics, including staffing, stress and burnout, financial cutbacks, NHS funding and the effects of Brexit and it is the first time it will also go out to our community pharmacy audience, capturing the relationship between pharmacists and GPs.

The results of the survey will be used in aggregate terms in future coverage of all the publications mentioned earlier as well as Healthcare Leader. The findings will also be published in a publicly available report due to be released early next year.

Cogora: Market Access is awarded at ISPOR Europe 2018

We are thrilled to announce that the Cogora Insight and Market Access team were the recipients of this year’s Best New Investigator Research Poster Presentation Award at ISPOR’s 21st Annual European Congress in Barcelona.

The award recognises the scientific merit of poster presentations as only the top 10% of accepted research abstracts, based on peer review scoring, are eligible for the award. To be selected as the best of the top 10% in this category is a particularly impressive achievement for the team given the calibre of the other entries.

Cogora’s Senior Insight and Market Access Analyst, Ejike Nwokoro, attended ISPOR to present the winning poster and to judge several other research contributions in turn.

The poster provided a retrospective review of the reimbursement decisions made by the Commission d’Evaluation des Médicaments at Haute Autorité de Santé (HAS) in 2017 and the underlying rationale for medicinal products with insufficient actual medical benefit.

If you missed us at ISPOR, you can access the full poster online or contact the Insight and Market Access team for more information.

ISPOR is the world’s leading educational and scientific organisation for health economics and outcomes research (HEOR) and their applications for healthcare decision-makers. Each year, ISPOR organises a European conference to highlight the latest research and publications in the sector.

Cogora: Market Access provides our clients with strategy and evidence-generation solutions that maximise the return-on-investment for products throughout their lifecycle. For more information on how we can support you please contact our Market Access team.

Research Poster Presentation Award

We are thrilled to announce that the Cogora Insight and Market Access team have been identified as a semi-finalist for the Research Poster Presentation Award at ISPOR Europe 2018 in Barcelona. 

With only the top 10% of accepted research abstracts, based on peer review scoring, eligible for a research poster award this is a great achievement. 

Cogora’s Senior Insight and Market Access Analyst, Ejike Nwokoro, will be attending ISPOR to present the poster.

Modelling the cost effectiveness of alcohol interventions- methodological hurdles

The National Institute for Health and Care Excellence (NICE) is the agency in England responsible for creating guidelines on the treatment of diseases and prevention of illnesses.1

Over the years, NICE has developed a widely recognised reputation based on the robustness of the methodology it applies in the appraisal of clinical interventions. However, in 2005 it also acquired the remit to produce guidelines for public health interventions.2 Through its Centre for Guidelines (CfG), NICE makes recommendations for England based on a thorough review of what is known from research and practice about the effectiveness and cost effectiveness of interventions and broader programmes.3, 7

Although the value of economic evaluation as a tool to determine value for money is hardly in doubt, actual implementation in the context of public health interventions presents a unique challenge. This is because the applied methods were originally developed for constructing clinical guidelines and are based on the principles of evidence-based medicine (EBM),4 rather than the relatively newer concept of evidence-based public health. Cost-effectiveness analysis of public health interventions is made difficult by the breadth of the evidence base for such interventions, different analytic levels of possible explanations, and length of the causal chain between interventions and the desired public health outcomes.2

To manage these difficulties, NICE adopts a ‘social determinants and health inequalities’ approach when designing public health guidelines.3 Furthermore, the framework within which such guidelines are developed ensures the multiple analytical levels of explanation for an observed effect are accounted for, and that four specific vectors (population, environment, society and organisations) are used to articulate the mechanisms of cause and interventions.3

Cogora’s Senior Insight & Market Access Analyst, Ejike Nwokoro, attended a recent meeting of a NICE Public Health Advisory Committee (PHAC) which further illustrated the adaptation of economic modelling approaches for public health interventions. As part of the development of a new NICE guideline, the meeting participants discussed the effectiveness and economic evaluation of various school-based alcohol interventions (targeting children and young people aged between 11 and 18 years). 6

Click here for more on the proposed economic modelling approaches.

Cogora sits at the heart of a highly engaged community of over 220,000 healthcare professionals. Our Insight & Market Access division combines HEOR expertise with an in-depth knowledge of reimbursement structures and requirements to provide solutions that maximise ROI for our clients’ products.

For more information on our HEOR capabilities and offerings please contact:
Ejike Nwokoro, MD MPH
Senior Insight & Market Access Analyst
E: ejikenwokoro@cogora.com
T: +44 (0)20 7214 0529

General Practice Prescribing Trends in England and Wales

An analysis of prescribing trends provides credible insight into changes in clinical practice and can facilitate the identification of spending patterns and cost-saving opportunities for the NHS. Given this value, the Cogora Insight & Market Access team have carried out an analysis of primary care prescribing in England and Wales for the 2016 calendar year.

Overall trends

Prescriptions for diabetes drugs, respiratory corticosteroids, analgesics, antiepileptics and oral nutrition products were associated with the highest spend on prescriptions for 2016. Together, the total Net Ingredient Cost (NIC) for these therapy areas amounted to £3.3bn, making up 35.1% of the total NIC for all prescriptions in all general practices in England and Wales in 2016 (£9.5bn). Furthermore, compared to 2015, there was an increase in the quantity of prescriptions for diabetes drugs and antiepileptics whereas analgesics, respiratory corticosteroids and oral nutrition products witnessed a fall in the number of prescriptions relative to 2015.

Diabetes drugs

There was a 5.2% rise in the NIC spend for diabetes drugs, from £992.9m in 2015 to £1.0bn in 2016, perhaps a sign of the increasing burden of diabetes on the NHS. Of the aforementioned five therapy areas, diabetes drugs were associated with the highest NIC spend. Similar to 2015, the largest proportion of NIC spend associated with diabetes in 2016 was observed in The Midlands and East England (29.6% of total NIC) while North England was reported to have the lowest proportion (27.7% of the total NIC).

Respiratory corticosteroids

Although prescriptions for respiratory corticosteroids were responsible for the second highest spend in 2016, in terms of associated NIC, the number of units prescribed appears to have plateaued relative to earlier years (1.2% fall compared with 2015). Our analysis also revealed an 8.5% decrease in the number of units prescribed generically, which corresponds with official guidelines stating that generic prescribing of inhalers should be avoided – due to the risk of patients being unfamiliar with devices and using an incorrect inhalation technique.

Analgesics

Analgesics were one of three therapy areas that witnessed a drop in NIC spend relative to 2015. The number of prescriptions was however relatively unchanged. Approximately one-third (34.6%) of analgesics prescriptions were for opioids, with Morphine as the single most-prescribed opioid (819.5m units, increasing by 8.6% compared with 2015). The North of England was, for the third year running, responsible for the greatest proportion (33.7%) of the total spend on analgesic prescriptions in England and Wales.

Top-performing brands

We carried out an analysis to identify the top performing branded pharmaceuticals in terms of the percentage increase in total NIC between 2015 and 2016. The top two performers were drugs used in diabetes (Performa®and Toujeo®). Four of the top-ten drugs in the list were indicated for diabetes, making this the most prominent therapy area. In terms of the highest numerical increase in total NIC in 2016 relative to 2015, Lyrica®, for the second year in a row, experienced the largest numerical increase (increased by £30.6m). This may, at least in part, be due to the High Court ruling made in February 2015, according to which all prescriptions of pregabalin (active ingredient) for neuropathic pain must be made under the branded name Lyrica®.

Click here for more information and to download the report.

2018 Analyst of the Year Award Finalist

We are pleased to announce that Cogora: Insight is, for the second year running, shortlisted for the Best of Business Intelligence (BOBI) Analyst of the Year Award.

As part of the competition, the team analysed numerous data sets containing various healthcare data and produced sales forecasts and an interactive dashboard to be used by a fictional sales manager.

If your company is attending the BHBIA conference dinner, where the BOBI awards will be announced, on 15 May and would like to meet up with the team to learn more about our analytics and data tool solutions please email ellenmurphy@cogora.com

 

Checkpoints and CAR-Ts

The field of immuno-oncology is booming and the ability to activate (or inactivate) the immune system as a way of treating cancer has produced considerable expectations.

Checkpoint inhibitors inhibit the mechanisms by which tumour cells inhibit T-cell activity (a key component of the normal cellular immune response) and overcome the immune system. The success of monoclonal antibodies targeting these checkpoints, including PD-1 (for example, nivolumab and pembrolizumab), PD-L1 (for example, atezolumab) and CTLA-4 (for example, ipilimumab) in a range of cancers is obvious.

The past five years have also seen great progress in the development and application of cell engineering in an effort to personalise cancer treatment. Say hello to chimeric antigen receptor T cell (CAR-T) therapy – a combination of immuno-, cell- and gene therapy, and the next big thing in oncology.

The basis of CAR-T is the use of engineered T-cells that express a chimeric antigen receptor on their cell membrane. This receptor acts with an external target-binding domain that is designed to recognise a specific tumour antigen, and an internal activation domain, which is responsible for activating the T-cell when the CAR-T binds its target. T-cells are extracted from the patient and genetically modified and expanded in vitro before reinfusion.

There has been rapid and extensive development in CAR-T therapy, and clinical trials have demonstrated impressive remission rates. The race to bring the first CAR-T drug to market has intensified recently. In March 2017, a US biologics licence was filed for tisagenlecleucel-T (CTL019) for the treatment of relapsed and refractory paediatric and young adult patients with B-cell acute lymphoblastic leukaemia. An EMA filing is expected later in 2017. Phase II results presented at the 2016 American Society of Haematology meeting showed that 82% (41 of 50) of patients infused with CTL019 achieved complete remission or complete remission with incomplete blood count recovery at three months post-infusion.1

Targeting solid tumours is a big challenge in the field of immuno-oncology. Low T-cell infiltration and an immunosuppressive environment prevent the immune system from effectively attacking these tumours and some think that the way to go for CAR-T is combination therapies combining checkpoint inhibitors with CAR-T cells. Data presented at the AACR 2017 from a Phase I dose escalation trial of T4 CAR-T therapy in head and neck squamous cell carcinoma showed a disease control rate of 44%, and that all patients in one cohort achieved stable disease. Treatment-related adverse events were found to be grade 2 or lower, with no dose-limiting toxicities observed.2

Whether or not CAR-T will represent future standard of care for previously unresponsive haematological cancers is to be revealed, but there is plenty going on in the CAR-T space in the meantime. To this end, the Summer issue of Hospital Pharmacy Europe will include an article by Dr Tiene Bauters, HPE editorial board member, on this hot topic.

References
1. Grupp S et al. Analysis of a global registration trial of the efficacy and safety of CTL019 in pediatric and young adults with relapsed/refractory acute lymphoblastic leukemia (ALL). https://ash.confex.com/ash/2016/webprogram/Paper90831.html (accessed May 2017).
2. Papa S et al. T4 immunotherapy of head and neck squamous cell carcinoma using pan-ErbB targeted CAR T-cells. In: Proceedings from the 2017 AACR Annual Meeting; 1–5 April 2017; Washington, DC: Abstract CT118.

2017 Analyst of the Year Award Finalists

We are pleased to announce that Cogora: Insight’s Victoria Stanway and Mahmoud El-Ghannam were amongst the finalists of the Best of Business Intelligence (BOBI) Analyst of the Year Award.

The BOBI Awards are a set of highly prestigious awards given to business intelligence professionals through the BHBIA, and the only healthcare-specific business intelligence awards in the UK.

In this brand new BOBI Award category, entrants were given several complex data sets relating to sales performance of a fictional company’s field team and tasked with creating an engaging report based on these. The team created an interactive data tool that allowed users to see how different sales representatives ranked based both on the  change in sales in their region and the ‘difficulty rating’ of their region, which took into account e.g. epidemiological data.     

Have a look at our case studies for a few examples of how we have previously helped clients refine their strategy, make portfolio decisions and create bespoke data tools to support their field teams. For more information on our business intelligence solutions, please contact ellenmurphy@cogora.com

 

NHS England considers cuts for over-the-counter medications

Almost two-thirds of healthcare practitioners would support funding cuts to over-the counter medications and 65% believe there should be a public debate to decide which treatments are provided for free by the NHS, according to a Cogora survey of more than 1,700 healthcare workers conducted in August and September of last year (Cogora, 2017). It would appear their prayers may be answered.

In March 2017, NHS Clinical Commissioners (NHSCC) sought national support to recover £400 million in NHS spending currently allocated to “low priority items” in order to reallocate the funds to “high priority areas” e.g. mental health and primary care (NHSCC, 2017).

In a statement outlining how these funds could be recovered, the NHSCC has released a list of the first ten products considered to be “low priority” for NHS funding. Low priority items were identified as those matching one or more criteria, including having little or no clinical value, having cheaper alternatives available and products available for less if purchased over-the-counter rather than provided on prescription (NHSCC, 2017).

Over-the-counter medicines, more formally known as General Sale List medicines, are medicinal products which can be sold retail without a prescription from a healthcare professional (Medicines & Healthcare products Regulatory Agency, 2014). NHS advocates are increasingly concerned about the cost of healthcare professionals prescribing these medications to the NHS.

Of the ten products currently under review by NHS England (NHS England, 2017), two groups (some gluten free foods and travel vaccinations) are available for general sale and could as such be purchased directly by consumers. Despite this, prescriptions for some gluten free foods and travel vaccines cost the NHS more than £30 million in 2016 (NHSCC, 2017).

In addition to reviewing the prescription and reimbursement policies for “low priority items”, NHS England are under pressure from CCGs to conduct a similar review of so-called “self-care” treatment options, including over-the-counter remedies for coughs and colds, antihistamines, indigestion and heartburn medication (NHSCC, 2017).

An in-house review of branded products falling within these categories conducted using Cogora’s proprietary Rx tool revealed that in 2016 the NHS spent more than £14 million on Gaviscon for the treatment of heartburn and indigestion, more than £300,000 on Piriton and Benadryl for the symptomatic relief of hay fever and other allergies, and over £30,000 on Sudafed decongestants. However, these expenditures dwindle into insignificance when compared with the sum spent on paracetamol tablets (£54.8 million) and capsules (£4.5 million) (NHS Digital, 2017) (Table 1). In addition to reducing the number of items available on prescription via the NHS, NHS England have announced an increase in prescription charges. From the 1st April 2017, the set prescription charge increased by 2.4% from £8.40 to £8.60 per medicine or appliance dispensed (Department of Health and Philip Dunne MP, 2016), a figure only slightly higher than the current estimated inflation rate of 2.3% for March 2017 (ONS, 2017).

As demonstrated, increased budget pressures in the healthcare system are forcing payers to consider a range of approaches to constrain costs and free up funding for high priority therapies. Recent developments suggest this may cause funding for over-the-counter medicines and products available on retail, such as gluten-free foods, to be restrained or cut.

While greater cost containment is needed to ensure patient access to primary care and mental health services, it remains unclear what impact these measures will have on patient groups reliant on these treatments for their wellbeing e.g. coeliac patients on low income.

References

Primary Concerns 2016

We surveyed our community of 220,000 healthcare professionals to gather novel insights into abuse of NHS staff, quality of NHS care, impact of funding on NHS services, impact of recent NHS reforms and the expected impact of Brexit on NHS budgets and services. 

Cogora’s Primary Concerns report surveyed 1,734 primary care workers, including 747 GPs, and found that experiences of physical, verbal and written abuse had gone up across the board. Around 70% of GP practice staff faced some form of abuse in 2016, up from 57% the previous year.

Verbal abuse was the most common form, with 64% of respondents reporting such incidents. It also found that 6% had faced physical abuse- including 7% of nurses and 9% of practice managers.

The survey also found that around 70% of staff believed that the quality of patient care had worsened over the past 18 months.

GP leaders have been reporting a crisis in general practice, with underfunding and lack of available staff leading to increased waiting times and an increased number of practices closing.

Across nurses, practice managers and GPs the reports of abuse stand at:

  • Any form- 70% (up from 57%)
  • Verbal- 64% (up from 54%)
  • Physical- 6% (no change)
  • Written- 24% (up from 12%)

One practice manager contacted in relation to the survey said they were subjected to abuse ‘on a weekly basis’ added: ‘I have no idea why they feel that this is appropriate behaviour. The message that keeps coming through is that they feel they are entitled to privileged treatment that they are not getting even though they have paid for it.’

Dr Richard Vautrey, deputy chair of the BMA’s GP Committee, said: ‘It is very concerning that any patient feels that they can act in this way when GPs and their staff are doing their best to help and care for them.

‘The NHS must not only adopt a zero tolerance policy to abusive behaviour but must also back up practice staff when they are subjected to these type of incidents.’

The report also found that practice staff believed patient care had worsened- with 69% saying it had got worse, with only 6% saying it had got better.

Download the Primary Concerns 2016 report here, or for any more information, please contact Ellen Murphy on 020 7214 0576 or ellenmurphy@cogora.com

Please attribute this to Cogora, the healthcare research and consulting agency.

 

Notes

1. The survey was answered by 1,734 primary care staff. They included: 747 GPs, 564 nurses, 255 GP practice managers, 66 commissioners and 16 health visitors/ midwives.

2. The survey was distributed to subscribers of The Commissioning Review, Management in Practice, Nursing in Practice and Pulse between 10 August 2016 and 21 September 2016. Respondents who were not currently working as healthcare professionals due to e.g. retirement, or who worked abroad, were excluded.

Pulse survey reveals that 60% of GPs say Brexit will negatively affect NHS staffing

Around 60% of GPs say that the number of staff working in GP practices will decrease as a result of Brexit, a survey by the publishers of Pulse has revealed.

The survey of 1,734 NHS primary care staff, including 750 GPs, found that there are concerns the triggering of Article 50 would have a negative effect on staffing and budgets.

Only 3% of staff believe that Brexit will have a positive effect on staffing levels, with more than 50% saying that it will have a negative effect. The study by the research division of Cogora found that GPs are more pessimistic than their primary care colleagues around staffing and budgets.

It also found that more staff thought Brexit would have a negative view on the number of patients accessing NHS care than a positive one- which contradicts the Leave campaign’s claims that leaving the EU would help address ‘scandalous’ NHS waiting times.

The main survey findings resolve around the negative effect on staffing levels, with 50% of all staff saying the numbers of GPs will decrease, and 60% saying the number of nurses will decrease.

The findings come amid a recruitment crisis in general practice, with the Government’s pledges to increase the GP workforce by 5,000 by 2020 currently struggling. Official figures last year revealed that the number of full-time equivalent GPs in the NHS decreased in 2015-16, while Pulse studies have revealed that vacancy rates for GPs are increasing every year.

Around 10% of registered doctors and 4% of nursing staff come from the EU, according to the GMC. And NHS England has made a concerted effort to target GPs from the EU through a £20m scheme to ease the recruitment crisis, with 25 GPs already recruited in Lincolnshire and more set to be recruited in Hull. But the status of these EU nationals post Brexit has yet to be confirmed or guaranteed by the UK Government.

For any more information on this survey, please contact Victoria Stanway, analyst in the research division of Cogora on 020 7214 0629, or victoriastanway@cogora.com.

Notes
1. The survey was answered by 1,734 primary care staff. They included: 747 GPs, 564 nurses, 255 GP practice managers, 66 commissioners and 16 health visitors/ midwives.
2. The survey was distributed to subscribers of The Commissioning Review, Management in Practice, Nursing in Practice and Pulse between 10 August 2016 and 21 September 2016. Respondents who were not currently working as healthcare professionals due to e.g. retirement, or who worked abroad, were excluded.
3. Full survey results:

What impact do you think the triggering of Article 50 will have on…
The NHS budget
Negative impact 39% (GPs: 45%)
No impact: 26% (GPs: 25%)
Positive impact: 10% (GPs: 7%)
Unsure: 25% (GPs: 23%)

Number of GPs working in the NHS
Negative impact: 51% (GPs: 61%)
No impact: 25% (GPs: 22%)
Positive impact: 3% (GPs: 2%)
Unsure: 20% (GPs: 15%)

Number of nurses working in the NHS
Negative impact: 58% (GPs: 68%)
No impact: 21% (GPs: 16%)
Positive impact: 3% (GPs 2%)
Unsure: 18% (GPs: 14%)

Number of other primary care staff working in the NHS
Negative impact: 50% (GPs: 60%)
No impact: 26% (GPs: 20%)
Positive impact: 3% (GPs: 2%)
Unsure: 21% (GPs: 18%)

Time spent by staff assessing patient eligibility for NHS care
Negative impact: 46% (GPs: 52%)
No impact: 18% (GPs: 16%)
Positive impact: 10% (GPs: 9%)
Unsure: 26% (GPs: 23%)

Time spent by staff assessing patient eligibility for NHS care
Negative impact: 21% (GPs: 21%)
No impact: 32% (GPs: 35%)
Positive impact: 18% (GPs: 17%)
Unsure: 29% (GPs: 26%)

Will 2017 be the year of digital healthcare?

Although healthcare has recognised the potential of technology, it has faced major obstacles in becoming a truly digital industry.

Connecting customers to their desired services through the click of a button and the rapid dissemination of digital interventions in several key industries has led technology gurus to coin the term “the uberisation of our daily lives”. Although healthcare has recognised the potential of technology, it has faced major obstacles in becoming a truly digital industry.

During a period of promise where the National Information Board (NIB) initiated the “Personalised Health and Care 2020” framework which promises to “use information and technology to transform outcomes for patients and citizens”1, the NHS still faced difficulties in its endorsement of healthcare related apps. In March 2013, NHS Choices started hosting a “Health Apps Library” which allowed users to identify NHS reviewed apps designed at improving patients’ health. However, with some apps operating without encryption, there were growing fears that patient data were not adequately protected. As a result, NHS choices closed its Health Apps Library in October 2015, less than three years after its inauguration, highlighting a major obstacle of integrating technology into healthcare2. Furthermore, the lack of robust clinical trials and reliable data on the use of digital health interventions poses further scepticism over the use of technology in healthcare.

It is not all bad news, however. NIB vowed to use experiences from the app library, and digital health has returned as a key priority. In 2016, NIB worked closely with Public Health England and the National Institute for Health and Care Excellence (NICE) to devise a standardised process for evaluating healthcare apps. Furthermore, in its first annual report, NIB boasted impressive achievements by a number of practices and hospitals across the country3. For example, Northampton General Hospital implemented an electronic observation system to monitor patients’ vital signs as opposed to the time consuming, manual process where nurses had to make notes of numerous procedures on charts placed at the end of patients’ beds. Replacing this manual system reduced errors by 300% over a 2-year period from 2013 to 2015. In addition, a GP practice in north Leeds with over 13,000 patients launched an online system that allowed patients to access their records, book appointments and order repeat prescriptions.

Emerging apps are building up on some of these developments. For example, Echo, a healthcare technology start-up allows its users to make medication requests through its app. In addition to digital prescription, Echo offers a comprehensive service that allows patients to order their prescription in just two clicks. The app allows prescriptions to be dispatched by Royal Mail from pharmacies, which eradicates waiting time and concerns over pharmacists’ capacity4. The in-app tracker also sets reminders and instructions on how to use the medication.

The increasing diffusion of online prescriptions is an example of how digital interventions could potentially improve a key area of healthcare – medical adherence. A study published by the World Health Organisation (WHO) found that adherence among patients with chronic diseases in developed countries averages at only 50%5. Barriers such as taking time off-work to attend a GP appointment makes medical adherence difficult for patients with repeat prescriptions. In a survey issued by research firm Aurora, it was found that patients aged between 25-34 years of age are worst at adhering to their medicine, with 37% overall, admitting to forgetting to request a repeat prescription on time. The research goes further to state that 27% of those surveyed, needed to book an emergency appointment whilst 7% had to attend A&E as a result of not receiving their prescription6.

With the NHS facing growing challenges and strict efficiency demands in 20177, tech solutions such as Echo offer some hope and with NIB making promising strides in digital health, it seems that healthcare may be ready to fully capture advances in technology to simplify the lives of patients. 

References

Qualitative methods in market research

Qualitative market research can add significant depth and scope to research and market access projects. Where quantitative market research provides a statistical overview of consumer thought and behaviour, qualitative market research can deliver in-depth summaries of what consumers are thinking, their attitudes and opinions, and explore the very motivations driving consumer activity. Qualitative research is therefore an ideal approach for deriving insight into payer and prescriber activities and the factors influencing their behaviour.

My personal interest in qualitative research methods stems from a year of postgraduate qualitative study wherein I used narrative inquiry, a highly collaborative and phenomenological qualitative research method, to explore the ongoing experiences of breast cancer survivors.

Whilst qualitative research methods in market research can be very useful, variations in method and a lack of theoretical foundations can detract from the significance of the findings and reduce their client value(1). For market researchers new to qualitative research it is important to have a good understanding of the different qualitative methods available and their philosophical underpinnings. With this in mind, there are three core research methodologies from the fields of sociology, anthropology and philosophy, and these are grounded theory, ethnography and phenomenology respectively(1–3).

Grounded Theory

As a method, grounded theory is the identification and sorting of categories which emerge from the data and the subsequent formation of a theory which is grounded in the data (4). Grounded theory is a popular research methodology, aspects of which (coding and memo-writing) are largely adopted across the qualitative research spectrum (5). In market research grounded theory has been used for approximately 20 years, predominantly in experiential consumer behaviour studies(1).

Grounded theory is a particularly useful methodology for those new to the field, the logical development of codes into categories and categories into theory is an ideal starting point and one that recommends a less than comprehensive knowledge of previous theories. Furthermore, grounded theory is particularly useful for analysing previously unstudied phenomenon and the development of new theoretical bases (6), such as pioneering investigations into healthcare practitioner prescribing behaviour (7–10). Market researchers conducting grounded theory research will likely appreciate grounded theory as it requires less intensive preparations compared to other methods; however, the practice of collecting and analysing data until no new points of enquiry emerge (known as “theoretical saturation”(4)), can make it difficult to produce client proposals with accurate data collection timelines.

Ethnography

Like grounded theory, market researchers have been applying the principles of ethnography to market research for two decades, particularly in studies focused on understanding consumer behaviour and “getting beneath the surface”(11). Ethnography thoroughly investigates consumer lives, their connections and webs of meaning. As a method, ethnography can be time consuming and expensive, it requires total immersion of the researcher in the life of the consumer through multiple mediums including unstructured interviews and periods of consumer observation(12). In the healthcare sector ethnography has been used to explore a wide variety of scenarios including physician-patient relationships(13, 14), prescribing behaviour(15, 16) and clinical trials(17).

The intensive nature of traditional ethnography means that is not always feasible, particularly for researchers who are unable to enter and establish rapport in participant communities. This has led to the development of quasi-ethnographic techniques (18, 19) and virtual ethnography where online activity and consumption behaviour is monitored externally (20).

Phenomenology

Finally, we have phenomenology, a methodology applied regularly to studies of human experience, where experience is considered subjective and dependent on the greater context of a person’s life world. From a phenomenological perspective consumer behaviour is shaped by pre-understandings related to other aspects of their lives, such as their physical environment, personal relationships and past experiences (2, 21).

Phenomenology is well placed to examine consumer health discourse because of the emphasis on “informed, goal-directed activity” (21) such as purchasing behaviour. By adopting a phenomenological approach market research can explore the underlying meaning of consumer experiences and how they relate to their extensive lives, details which are not made implicit by other methods(1). In particular, phenomenology is used to explore co-occurrence of medical conditions (22), therapy adherence (23, 24) and drug misuse(25, 26).

A great deal of emphasis is placed on not asking leading questions, and as result phenomenological interviews can be very unstructured, ideally comprising a central participant monologue. Like in grounded theory, it can be difficult to provide clients with accurate timelines for a phenomenology study as researchers avoid going straight to the point. Despite this, phenomenology remains a popular approach for exploring consumer health experiences.

Conclusion

We have considered three popular qualitative research methodologies and their applications in pharmaceutical and health market research. Historically, taking a qualitative stance has yielded significant commercial benefits ranging from an improved understanding of consumer identities, motivations and belief systems to unearthing original information on medical device interactions and relationships (1, 27). Hardly the new kid on the block, qualitative market research is established and here to stay.

 

Click here for the references.

Could digital interventions be used to treat depression?

When people think of virtual reality, they often associate it with games or science fiction. But could this technology also be used in the treatment of depression?

In a recent study cited by, amongst others, BBC news, Dr Caroline Falconer and colleagues showed that putting patients with clinical depression through a series of virtual reality sessions, in which they were taught ‘self-compassion’, reduced their depression. Cultivating self-compassion has previously been shown to reduce depressive symptoms by countering destructive and maladaptive thought patterns. The study by Dr Falconer and colleagues built upon this research and used virtual reality as a novel method to facilitate this process.  While their results still need to be validated in a large sample study, this is one of many examples of how researchers and healthcare bodies are exploring new technologies for the improvement of healthcare services.

Another example of technological innovation for health care is the rise in the development and use of ‘health apps’. In 2013, NHS England launched a pilot website to host apps designed to help patients with a variety of conditions. While the original site has temporarily closed amidst concerns regarding the potential leak of personal and health data, a NHS England site containing information on digital interventions and health apps specifically for mental health patients is still active. NHS England’s investment into such a pilot demonstrates the willingness of payers to explore new modes of delivering healthcare interventions for patients with depression.

Current clinical guidelines recommend that depression is treated by traditional ‘talking therapies’ coupled with pharmacological interventions. However NICE also recognises computerised CBT as a treatment option for patients with mild to moderate depression. In addition to potential cost-savings compared to face-to-face therapy, digital interventions could hold several benefits over traditional psychotherapy. As noted by Dr Falconer, whose research focusses on the use of digital interventions for mental health patients, digital therapy could be especially appealing to younger patients who are familiar, and more comfortable, with digital technology than older patients. Furthermore, using digital interventions could potentially increase adherence to therapy by removing the potential stigma or discomfort associated with attending a mental health centre.

However, Dr Falconer also notes that the use of digital interventions for the treatment of depression or other psychopathologies still requires more research. Currently, there are few published meta-analyses that investigate what digital interventions that work best and what patient subpopulations that are most likely to benefit from them. Furthermore, while it is often claimed that digital intervention could decrease the costs to the NHS through reduced therapist time, it is unclear whether this claim truly stands up to scrutiny. For example, if a digital intervention consists of a remote therapy session rather than a healthcare app, the number of therapist hours needed is likely to be the same as in traditional face-to-face therapy sessions. Further, to ensure adherence to digital interventions delivered over a long period of time it might be necessary to build in support from a therapist as this has been shown to increase patients’ engagement with the therapy. As a result of these, and other, factors, the potential cost-savings are likely to vary between different types of digital interventions.

Nonetheless, there is huge potential for the use of digital interventions as supplementary treatments for depression. With the surge in digital healthcare research we can expect our understanding of what digital interventions are effective, why, for whom and under what circumstances to increase.  But this begs the question:  will doctors be willing to prescribe apps instead of medication?

One third of GPs think NHS should stop funding IVF

Download a copy of the report here

Exclusive

A third of GPs believe that the NHS should stop funding IVF treatment for patients with fertility issues, while one in five believe that bariatric surgery should not be funded for obese patients.

The survey of 521 GPs, conducted by media and marketing services company Cogora, also found that more than half of GPs believed people should be charged for using A&E for excessive alcohol consumption, while two-thirds felt that missed appointments should be charged.

Cogora’s Primary Concerns 2015 report – which, in total, surveyed nearly 1, 000 health professionals, including commissioners and nurses – found there was little support for alternative medicines, such as homeopathy, chiropody and osteopathy.

It comes as the NHS faces its biggest financial problems for years, which has seen commissioners tasked with saving £22bn over the next five years by NHS England and the Government.

As a result, Pulse has already revealed that CCGs across the country are embarking on rationing drives, including targeting funding for IVF despite NICE stepping in to reprimand CCGs.

Meanwhile, some commissioners are increasing the thresholds for bariatric surgery.

This is despite NICE’s most recent guidelines, published in 2014, recommended a lowering in the threshold for referral for bariatric surgery to a BMI of 30 kg/m2 for patients newly diagnosed with type 2 diabetes, or to appropriately lower BMIs in black or ethnic minority patients in line with separate public health guidance.

However, a significant number of GPs have given their support to IVF treatment being stopped on the NHS, with 34% calling for commissioners to withdraw funding, compared with 26% of the 291 nurses surveyed.

One female GP, who did not wish to be named, said: ‘It is very complex, but personally I don’t think infertility is a disease. I appreciate for some people it is and it’s very stressful. But it concerns me that people feel that having a child is a right.’

One in five GPs – 21% – said they believed that funding should be stopped for bariatric surgery for obese patients.

But Dr Andrew Green, chair of the GPC’s prescribing committee, said: ‘When there is pressure on what you might call basic services, it’s fairly understandable that people look to things that aren’t life or limb and think “well that should be cut”.

‘But the evidence to improvement to individuals from bariatric of surgery is quite substantial, we do many things that are less effective than bariatric surgery.’

On the issue of IVF, he added: ‘If you look at the unhappiness, distress and indeed depression that can come from having difficulty starting families, it is difficult to say they should not receive treatment.’

 

About Cogora
Cogora is a leading, pan-European media and marketing services company that sits at the heart of a highly-engaged community of 220, 000 healthcare professionals.

For over 25 years we have produced incisive and inspirational content through our market-leading portfolio of media brands: Pulse, Nursing in Practice, Management in Practice, The Commissioning Review, Hospital Pharmacy Europe and Hospital Healthcare Europe. These, in turn, provide the data and insight that give us a deep understanding of what our audiences think, what they do and what they really need.

Our in-house agencies combine these resources to create innovative and flexible solutions, educational programmes and marketing campaigns that deliver measurable, impactful outcomes.

For content specific questions, please contact:

Ellen Murphy
Head of Insight
Cogora
ellenmurphy@cogora.com

T +44 (0)20 7214 0500

For more information about this report or, more broadly, about Cogora, please contact:

Alex Beaumont
Managing Director
Cogora
alexbeaumont@cogora.com

T +44 (0)20 7214 0500

What do healthcare professionals really think of the NHS?

In Primary Concerns 2015 we report the findings from our third annual survey of UK primary care staff.

For the second year in a row, respondents reported that the quality of care offered to patients had worsened. The vast majority (90%) of respondents cited shortage of clinical staff as a contributing factor. This shortage of staff was reflected in the use of locum GPs, with almost one-half (47%) of practice managers and GP partners stating that their practice had increased their use of locum GPs in the past 12 months. Interestingly, we also saw a similar trend in data collected from Cogora’s job recruitment site, Pulse GP Jobs, where an equal number of employers reported plans to advertise jobs for locum GPs and GP partners (internal data).

Related to the staff shortage in general practices, four-fifths (82%) of respondents also reported having insufficient time to provide patients with quality care. Shockingly, nurses and GPs reported needing a 50% and almost 100% increase in the length of their consultations, respectively, in order to provide quality care.

Not surprisingly, the NHS budget was also a hot topic. Almost all (93%) of respondents believed that patients should be made aware of the true cost of their care to the NHS and three-quarters (75%) of respondents believed there needs to be a public debate on what treatments that should and should not, be provided for free. Notable, only approximately one-tenth (12%) of respondents believed that care should always be free for patients.

For the second year in a row, primary care workers also reported low levels of morale. The main reasons for the low morale were a feeling of being overworked, there being too much bureaucracy and unfair NHS criticism from politicians. Shockingly, over one-half of healthcare professionals also reported having received abuse from a patient in the past year.

To be e-mailed a copy of the report when it is published, please email insight@cogora.com.

Research: Healthcare professionals increasingly pessimistic about NHS

Most healthcare professionals believe that the quality of NHS patient care has worsened over the past 18 months, according to a new survey of 1171 GPs, nurses and practice managers by Cogora, a media and marketing services company.

The findings, published in the Primary Concerns 2014 report, represent a dramatic decline in healthcare professionals’ perception of the quality of NHS care; 63% of respondents in the 2014 survey believed that it had deteriorated in the preceding 18 months, compared with only 35% of respondents in Primary Concerns 2013

“The fact that the majority of the respondents believe that care has worsened in the last 18 months is truly shocking and upsetting for both professionals and patients, ” said Cogora’s Primary Care Editor-in-Chief, Victoria Vaughan.

“General practices are facing unprecedented pressures from all angles and it is clearly making it difficult for them to carry out their chief function which is to care for patients.”

The new report also reveals a lack of support for ‘clinical commissioning groups’ (CCGs), which were introduced by the government two years ago. English GPs and nurses neither feel engaged with their CCGs, nor perceive CCG decisions to be reflective of their own views.

Cogora also found opposition from healthcare professionals to a number of new government proposals, including: the naming of GPs who fail to refer suspected cancer patients to hospital; giving the Care Quality Commission power to place GP practices who underperform under ‘special care’; and the co-location of GP facilities in hospital A&E departments, with over half of all GPs believing it would be the ‘final straw’ for already overworked practitioners.

For the second year in a row, the Primary Concerns report further describes a widespread morale problem among primary healthcare workers. In addition to factors related to the NHS such as bureaucracy, low salaries, and poor management, healthcare professionals also cited undeserved criticism from politicians and the media and unrealistic patient demand as reasons for their low morale.

For media enquiries contact:
Victoria Vaughan
Editor in Chief, Primary Care

T: 44 (0) 20 7214 0500
M: 44 (0) 7951554374
E: victoriavaughan@cogora.com

For all other enquiries contact:
Alex Beaumont
Managing Director

T: 44 (0) 20 7214 0500
E: alexbeaumont@cogora.com

About Cogora
Cogora is an integrated media and marketing services company that sits at the heart of a community of 220, 000 highly-engaged healthcare professionals.

For over 25 years we have produced inspirational and incisive content via a range of brands and channels. These in turn provide the data and insight that gives us a deep understanding of what our audiences want.

We combine these resources to create innovative, flexible solutions for clients looking to access and influence commissioners, primary and community care nurses, GPs, practice managers, hospital pharmacists and hospital managers across the UK and Western Europe.

For more information visit cogora.com