Beyond Unplanned Activity – Why Pharma Must Redesign Its Engagement
I have always argued that if your product, service, or pathway doesn’t show an Integrated Care Board how it helps with today’s workload, then don’t expect airtime. That position still stands — the NHS remains consumed by unplanned activity. But if we stop there, we miss the bigger point: unplanned activity isn’t just a pressure point, it’s the organising principle shaping local priorities.
Commissioners, transformation leads, even clinical directors, now filter every proposal through a single question: will this reduce unplanned demand on our system?
The reality is that traditional ABN/NPN activities don’t even begin to answer that. They describe a product. They highlight an evidence base. But they rarely connect the dots across an ICS business case — one that balances reduced demand with pathway redesign, workforce strain, and financial sustainability.
Why this matters now
Every new therapy, device, or service carries ripple effects. It doesn’t just help patients; it shifts where patients turn up, who manages them, and how quickly. If you can’t show where in the pathway your product prevents referrals or admissions, cuts wait times, or unlocks capacity, you’ll struggle to get traction.
Take the example of specialist-initiated therapies. In many ICSs, the bottleneck isn’t funding but access. Patients can’t reach specialists quickly enough, or are being managed in community hubs instead. Without understanding those local flows, your product risks being clinically impressive but operationally irrelevant.
Moving from description to system value
To evolve beyond ABN/NPN, pharma needs to think like the ICS itself:
Map the population health challenge: where are the cohorts, how do they present, and what’s the impact of delayed or emergency-driven care?
Frame value through unplanned activity: show how earlier diagnosis, alternative management, or pathway redesign reduces acute admissions.
Build the business case before the TA: don’t wait for NICE publication. Work upstream to shape the infrastructure, capacity planning, and cross-service alignment that an ICS will need to implement.
Identify behavioural barriers: clinicians, commissioners, and managers are under relentless workload stress. Any friction — new forms, extra steps, or uncertain ROI — will kill momentum.
The bigger challenge
This is about more than selling a product. It’s about shaping the environment so that when your therapy is ready, the system is ready too. Without that groundwork, we repeat the cycle we saw with NOACs or Hepatitis C antivirals: ground-breaking science slowed to a crawl by unprepared infrastructure.
At Nzyme, we call this market shaping before market access. It means working with ICS networks, neighbourhood leaders, and system finance teams to co-create the business case, not just pitch it.
Final thought
So yes — if your product doesn’t ease capacity crisis within the system, you’re not getting through the door. But the smarter question is: how do we demonstrate that impact in a way that aligns with local priorities, reflects the behavioural realities of overstretched clinicians, and builds an investable case for an ICS?
That’s the conversation pharma needs to be having. Not another ABN. Not another product deck. But a genuine system story — one that makes unplanned activity the start of the discussion, not the end.