“At one point, there were more suits in theatres, than hospital staff in scrubs”. This quote, recounted at a recent NHS conference, is from a theatre manager describing the number of commercial visitors who were accessing theatre areas. From the nods around the conference theatre, it’s an experience familiar to many other hospitals.
Lord Carter also recognised this issue in his interim and final reports on operational productivity and unwarranted variations in NHS hospitals. “Whilst there will always be a need for companies to provide clinical support for NHS clinicians…the proliferation of sales representatives selling in the NHS is a huge cost”, he observed. “In one hospital, there were 650 sales reps targeting the hospital with 65 on site at any one time”.
Commercial partners bring valuable product innovation, new techniques and training to support clinicians in improving patient outcomes. However, with an often-large population of potential purchasers at each hospital, being targeted by a great number of representatives of commercial companies, it can be difficult not only to protect clinicians’ time and patients’ safety, but also to ensure procurement policies are enforced.
This month it will be two years since Lord Carter published his interim report, and over a year since his final report. However, our survey indicates that many hospitals are still facing this challenge.
The survey, undertaken with delegates at the recent NHS Procurement Conference, and adding to survey data collected at both the HCSA and HFMA annual conferences*, revealed three key themes:
1. Unsolicited visits
94% said they experience commercial visitors arriving without appointments. These unsolicited visits pose challenges to both clinical teams and procurement. One of our customers, Dorota Kugaczewska, Theatre Business Manager at Chelsea and Westminster Hospital’s main theatres, said, “We used to have a lot of people coming to sell products, so they’d go to see the surgeon, who didn’t want to be rude and allowed them to come. We didn’t know who was in. We had no control”.
This had also been a problem at NHS Tayside, where Judith Willis, Deputy Head of Procurement, explained that staff often felt “obliged to meet with those commercial visitors who turn up unannounced…. resulting in diary management challenges and distractions from patient care”.
To quantify the scale of this, unsolicited visits were found to account for more than half of commercial visits to main theatres at Chelsea and Westminster Hospital. After implementing commercial visitor management, overall commercial visits fell by around 60%, without impacting visits for required services. In addition to unsolicited visits, the survey also found that 94% encountered commercial visitors side-stepping procurement policies.
2. Unsanctioned products
Another survey insight was that 70% of budgets were impacted by unsanctioned product purchases and pricing disparity.
Although the challenge of managing off-catalogue purchases and variation in prices is not new, and many hospitals have made significant progress in this area, the survey indicates that this remains a challenge for hospital finance and procurement teams.
Unsanctioned products are also a critical concern for clinicians tasked with ensuring the safety of patients. Unapproved ‘product samples’ left in hospital areas can be inadvertently used to treat patients, without appropriate risk assessment.
3. Knowledge of commercial visitors on site
The survey also found that only 9% knew how many commercial visitors are in their hospital at any one time. This is not surprising, considering the pressures of running a busy hospital. It can be a challenge to balance the demand to provide the highest quality of care, with diminishing resources, and then administer significant numbers of commercial visitors (managing who is where and when, whether they are trained, insured and immunised).
However, with commercial representatives visiting multiple hospitals a week, and often accessing high risk areas such as theatres and wards, they can pose an increased risk to patient safety. One German study (Schiffers, H. et al, 2016) found that healthcare industry representatives requesting access to hygiene sensitive areas showed the lowest scores in hygiene training and a significantly lower Hepatitis B vaccination status, i.e. 37.5% compared to 70.7% for physicians and 53.1% for nurses.
Having easily accessible information on who is visiting a facility – including where, when, who they have visited, how long, how often – has many benefits. Procurement and finance teams can monitor and address activity from unapproved suppliers, take action to prevent unsanctioned products and bills, and verify service contracts are being delivered. Clinicians can protect patients and staff by ensuring that high risk areas receive only essential visits, and that those commercial visitors are trained, insured and immunised.
So, although the survey findings might not be a surprise, tackling the issue could seem like a daunting project. However, some simple steps can contribute to addressing a significant part of the challenge. For two examples of how hospitals have effectively managed commercial visitors, read about Chelsea and Westminster Hospital, who reduced commercial visits by 60%, and listen to University Hospitals of Leicester who “no longer lose sleep over it at night”.
Azadar Shah, Managing Director, IntelliCentrics
*About the survey
The survey was undertaken amongst delegates at the following three key conferences and the responses compiled.
- NHS Procurement Conference, 19th April 2017. Typical respondents Head and Deputy Head of Procurement and Procurement Leads.
- HFMA (Healthcare Financial Management Association) Annual Conference, 7-9th December 2016. The respondents were Directors, Heads and Deputies of Finance and senior financial project management
- HCSA (Health Care Supply Association) Annual Conference in November 2016. The survey respondents were mostly senior procurement professionals of UK Trusts. Job roles included: Head of Procurement, Procurement Business Manager, Senior Category Manager and Business Support Manager.
References
‘Potential infection control risks associated with roaming healthcare industry representatives’. Journal of Infection Prevention 2016, Vol. 17(1) 22– 28. H Schiffers, S Zaatreh, W Mittelmeier and R Bader.