Working with the NHS

At Bristol-Myers Squibb, we recognise the significant challenges facing the NHS. The public rightly want fast access to high quality care at a time and place that is convenient to them.

At the same time, the global recession means budgets are increasingly constrained. The challenge for the NHS, therefore, is to meet these public expectations with tighter resources.

We believe our portfolio of existing and pipeline medicines can be part of the solution to these challenges. These new medicines will offer opportunities for the NHS to provide patients with better outcomes and better quality of life. Yet we also recognise that new treatments will present challenges to the NHS.

New medicines often increase the upfront cost of healthcare. They may also require staff training, new capacity or changes to patient pathways. At a time when resources are stretched it is ever more important that the NHS gets the most out of the new medicines it invests in, in terms of both clinical outcomes and patient experience.

In recognition of this, our approach at Bristol-Myers Squibb is to work in partnership with the NHS to make sure it gets maximum value from our medicines.

Our teams are becoming more flexible when it comes to meeting customer needs rather than trying to apply a one-size-fits-all solution. In fact, we are now regularly having conversations with payers about providing a whole service and not just medicines.

Partnerships that bring value to the NHS

In order to meet its chosen strategy, every partnership entered into by Bristol-Myers Squibb with the NHS must be underpinned by four key undertakings:

  • Bristol-Myers Squibb endeavours to continually develop medicines to meet true unmet medical need across a range of disease areas
  • We are committed to enhancing clinical excellence through clinical research activities
  • We will provide robust evidence on our medicines to support NHS decision makers
  • Bristol-Myers Squibb is striving to improve its service delivery so that its medicines reach the right patients at the right time.

NHS Joint Working

Chelsea and Westminster Hospital Foundation Trust
Dean Street at Home, Postal HIV testing
The aim of this project is to target sexually active ‘men who have sex with men’ (MSM) in London through a revised website site ‘Dean Street @home’, and invite them to take a postal HIV test via a 3rd party provider which has existing governance links to Chelsea and Westminster sexual health services. Innovative technology is used to target and interact with MSMs The project is designed to complement existing HIV screening services by leveraging innovative channels such as social networks. It is funded by Chelsea and Westminster Health Charity and Bristol-Myers Squibb contributed £30,000.

Imperial College Healthcare NHS Trust
Imperial College Healthcare NHS Rapid testing Service
This project aimed to make HIV testing more accessible to people at high risk of infection, who may not be currently accessing services. Additionally, it aimed to reduce undiagnosed HIV to reduce morbidity, mortality and onward transmission as early diagnosis and treatment has been shown to be more cost effective. To identify undiagnosed HIV in London targeting those at high risk of infection who do not currently use clinical services via a rapid test offering. Bristol-Myers Squibb contributed £9,600, which was matched by Imperial College Healthcare NHS Trust.

St Stephen’s AIDS Trust at the St Stephen’s Centre, Chelsea and Westminster Hospital 
Development of an annual review clinic
The aim of the Joint Working Agreement is to develop an annual review Clinic in partnership with the St Stephen’s AIDS Trust at the St Stephen’s centre, Chelsea and Westminster Hospital. The unit will provide optimal care to the aging HIV population, introducing novel screening procedures. Bristol-Myers Squibb contributed £250,000.

University Hospitals of Leicester NHS Trust
 The aim of the joint working agreement is to produce a DVD "HIV Testing – Talking our languages Leicester", which will be an Educational resource for patients. This will help drive patient awareness and understanding of HIV and encourage an increase in HIV Testing for patients whose first language is not English. Bristol-Myers Squibb contributed £7,500, which was matched by University Hospitals of Leicester NHS Trust.

Royal London Hospital 
Implementation of sustainable Opt-out HIV testing within ACCU and HDU
 Implementation of a sustainable Opt-out HIV testing within ACCU and HDU at the Royal London to reduce late diagnosis of HIV and improve patient outcomes. Bristol-Myers Squibb has invested £20,000 into this joint working project and further to this will provide project management support and secretariat. £20,000 was also contributed to this project from Royal London Hospital to fund HIV testing facilitator band 6 nurse for one year.

North Middlesex University NHS Trust
Improving patient outcomes through: funding a full time Hepatitis Nurse Specialist role at the NMUH NHS trust for a 12 month period
 The project funded a Specialist Nurses role, to assist with Hepatitis services, enhance education within Primary Care, and to identify and treat HBV patients by increasing clinics held at the hospital. The Nurses role will be pivotal in early detection, and to help reduce patients waiting times which are currently more than 6 weeks. BMS have agreed to part fund the role for 12 months, and will work with NMUH on providing a better quality of service to patients and to support nurse training. Bristol-Myers Squibb contributed £25,000, support around resources and materials e.g. patient information leaflets in different languages, Hep B info website, Hepatitis B Posters. North Middlesex University NHS Trust contributed £25,000.

University Hospital Birmingham Foundation NHS Trust (UHBFT)
Community-based assessment of liver disease severity
 This project will generate real word data in the field of chronic hepatitis B and C with a view of further understanding:

  • Cost effectiveness of an outreach hepatology services provided by nurse in an urban general practise
  • Quality of care provided in both scenarios
  • Burden of chronic viral hepatitis in Birmingham
  • Demographics of such populations
  • Differences between populations seen in primary care and hospital settings
  • Potential for the early therapeutic and diagnostic interventions with family members and close relatives
  • Impact of clinical management in the community on long term disease outcomes

Bristol-Myers Squibb provided £20,000 to the overall cost of this outreach project and University Hospital Birmingham Foundation NHS Trust contributed dedicated nurse and consultant time.

King’s Hospital NHS Foundation Trust
The aim is to provide part funding for a full time Hepatitis B data manager at Kings Hospital NHS Foundation Trust to enable the following:

  • To support earlier identification of liver disease including Hep B
  • To provide managed care in community
  • To improve data management systems
  • To assist in the implementation in the hepatitis service of the hospital-wide integrated mental and physical health evaluation project (IMPARTS).

Bristol-Myers Squibb contributed £15,228 in two payments and the NHS are contributing £12,000.

"Greater Glasgow and Clyde Hepatitis C" Joint Working Project 
Between Greater Glasgow Health Board and Bristol-Myers Squibb

Greater Glasgow Health Board have entered into a joint working agreement, as outlined in the ABPI /DH joint working template with Bristol-Myers Squibb for a period of twelve months with a review at 3 months and 6 months. Both parties have committed to equal funding as detailed in the ABPI / DH joint working template.

  • NHS Greater Glasgow and Clyde (NHS GG&C) has a very high prevalence of blood borne virus infection, in particular with the Hepatitis C virus (HCV) 1.2 % (compared to an estimated prevalence of 0.3 % in the UK and 0.7 % in Scotland). 
  • In view of the significant problem of liver morbidity and mortality in the population of GG&C from HCV, the Health Board and its Public Health Department are embracing and leading in the Scottish Sexual Health and Blood Borne Virus Framework which followed the Scottish Action Plan. The Board is committed to find people with previously undiagnosed Hepatitis C and those identified and subsequently lost to follow up, to prevent further transmission and future morbidity and mortality from HCV.

Project Outline

  • Part 1 of the project will identify groups of people higher than average prevalence of hepatitis C infection through anonymised testing for HCV.
  • Data will be collected on the patient
    • Age group
    • Gender
    • GP Deprivation score
    • GP practice location
    • ALT group
    • Laboratory based Fibrosis-4 score (FIB-4)
    • AST to Platelet Ratio Index (APRI)
    • HCV positivity & Genotype 
  • Part 2 of this project will be to develop and perform a computerised search in GP practices for high risk patient populations to be targeted in future screening HCV strategies.

Primary Outcomes

  • The results of Part 1 of the project, which will link the results of different levels of transaminases (ALT levels) to HCV infection and identify GP practices, gender, deprivation and transaminase levels with high prevalence of Hepatitis C. 
  • The results will be presented at a future scientific meeting (e.g. EASL / BASL).
  • Sample size calculations have been performed by Professor Sharon Hutchinson in order to give validity to the final results and the Stakeholders for this overall project will ensure that the results are recognised nationally and internationally. 
  • Primary outcome for part 2 will be the pilot (and eventually roll out) of a screening strategy within GG&C.

Secondary Outcomes

  • The success of Part 2 of the project will be evaluated by how many actual patients with Hepatitis C are identified in the
  • NHS GG&C Health Board area. This will inform and refine a HCV screening strategy across Scotland and beyond.
  • Analysis of the data produced in both projects will be published for wide dissemination. 

    Date of Prep: December 2015 1392UK1501170-01

All Wales Diabetes Forum
Newly Diagnosed Type 2 Diabetes Pathway for Wales
Project supported an uptake of a new handbook to increase self awareness of importance of managing type 2 diabetes. The project aimed to increase uptake and attendance at newly diagnosed education events and reductions in referrals to dieticians. Bristol-Myers Squibb contributed £15,000. The All Wales Diabetes Forum invested time in designing booklets and packs, alongside coordination of roll-out meetings.

East Midlands Cardio-Vascular Network AF Programme 
The aim of this project is to increase the appropriate detection, diagnosis and treatment of patients with AF in primary care and reduce the numbers of AF related strokes and associated emergency admissions into secondary care. The project also aimed to improve shared knowledge amongst health professionals across the health economy and within localities building relationships between primary and secondary care, and between cardiac and stroke clinicians. Additionally, the project aimed to improve the commissioning of AF services to incentivise good clinical practice and support ongoing delivery of value for money services and improve the patient pathway and speed up access to specialist services as well as providing equity for patients with AF.
Bristol-Myers Squibb/Pfizer contributed £5,000 and £25,000 was contributed from East Midlands Cardio-Vascular Network.

Leeds Teaching Hospitals NHS Trust
Joint Working between: 
Leeds Teaching Hospitals NHS Trust, Bayer plc, Boehringer Ingelheim Ltd and BMS Pfizer Alliance

Project Title: 
‘Improving the safety and effectiveness of anti-coagulation for patients across Leeds’

Across Leeds, there are currently over 9,800 patients under active monitoring to manage their level of anticoagulation, predominantly through the use of Warfarin. Estimated prevalence suggests that there is a high level of unmet need across Leeds and that the proportion of adults aged 18 years or older needing anticoagulation therapy is up to 2.4% of the adult population. Within Leeds this would equate to approximately 15,400 patients. Based on these figures, Leeds has approximately 5,500 patients who would benefit from anticoagulation but are not currently receiving it. Approximately two thirds of these patients will have Atrial Fibrillation and non-valvular Atrial Fibrillation and require anticoagulation to reduce the risk of avoidable stroke.

The aim of the project is that through the provision of anticoagulation services the incidence of stroke and thrombo-embolic events in the Leeds population will be reduced and all patients requiring anticoagulation for any indication will receive a timely, high quality service in accordance with national quality standards

The objectives of the project are to:

  • design and deliver the new service for the provision of an anticoagulation service across Leeds with the three Clinical Service and Support Units (CSUs): Leeds Cancer Centre, Pathology and Pharmacy at LTHT 
  • pilot the newly designed service and feedback outputs to the Project Board – get approval to amend and proceed
  • have a detailed engagement and communication plan to ensure all service users, carers and HCPs are fully aware of the redesigned service
  • engage with primary care to ensure the safe and effective care of patients requiring anticoagulation across Leeds
  • implement the redesigned anticoagulation service across Leeds
  • measure the impact of the redesigned service

Benefits for patients:

  • To improve care of patients requiring anticoagulation through real-time access to results and treatments.
  • Patients with out-of-range results will be triaged and managed within 8 hours of testing when Point of Care Testing (PoCT) has been utilised to obtain an INR result
  • Patients with out-of-range INR results will have immediate access Vitamin K or Low Molecular Weight Heparins (LMWH) reducing risks of bleeding and thromboembolic events
  • All patients requiring anticoagulation will have quicker access to the anticoagulation service in a clinically appropriate timescale (which may be 24-48 hours for new patients with VTE or hospital discharges and no greater than two weeks for elective indications such as AF therefore reducing the clinical risk for all patients requiring anticoagulation.)
  • Where appropriate patients referred into the service will be offered a choice of anticoagulation therapy.
  • Patients will experience a more streamlined anti-coagulation service – improving patient experience
  • Patients will receive care according to national guidelines.

Benefits for the NHS:

  • Meeting quality standards for anticoagulation and adherence to national and international guidelines for patients requiring anticoagulation
  • To increase the proportion of patients receiving appropriate anticoagulant therapy through clear guidelines on initiation and discontinuation of therapies as clinically appropriate. 
  • To offer anticoagulation therapy to patients who are suitable in line with national NICE and local guidelines.
  • Public awareness campaign across all Leeds Clinical Commissioning Groups (CCGs) to promote anticoagulation for patients with NVAF.
  • Patients’ therapy is optimised with treatment options including, warfarin, LMWHs and Novel Oral Anticoagulants (NOACs) in accordance with the protocols approved by the CCGs 
  • Patients will choose to be anti-coagulated following advice and support from a HCP
  • Improve the discharge process of patients requiring anticoagulation through improvement of the interface between the anticoagulation service and other secondary care departments

Benefits for Pharmaceutical partners:

  • By the service provider offering a clinically effective range and choice of anti-coagulants in line with NICE technology appraisals and clinical guidelines and in keeping with the aspirations described in Innovation, Health and Wealth and the principles of Medicines Optimisation, it is anticipated that this will result in approximately 20% of patients requiring anti-coagulation being prescribed a NOAC
  • Collaboration will benefit all partners through improved reputation as a result of working in partnership to benefit patient outcomes and experience
  • Develop a deeper insight and understanding of the NHS

The BMS Pfizer alliance contributed £28,079.

Adverse Event Pathway Project (AEPP): Early recognition and rapid treatment of immune-related adverse events (IrAE) Joint Working Project; HEY NHS Trust and Bristol-Myers Squibb (2017)
Reducing Time to Treatment Administration (RTTA) Joint Working Project: Newcastle (NuTH) and Bristol-Myers Squibb (2017)
Immuno-Oncology (I-O) pathway configuration project (IPC project): Velindre NHS Trust (VCC) & Bristol-Myers Squibb (2017) 
Adverse Event Pathway Project (AEPP): Early recognition and rapid treatment of immune-related adverse events: UCLH (on behalf of the Cancer Vanguard) and Bristol-Myers Squibb (2017)

East Midlands Office of the clustered Midlands and East Specialised Commissioning Group 

IFR (Individual Funding Request) Database Development
To support the development of a technical solution to help minimise unexplained variations and promote equity in decision making in relation to IFR’s. This also includes continued support for IFR database development project. The project was previously supported in 2010 and 2011 and covered by previous joint working agreements. Bristol-Myers Squibb contributed £3,000 plus training venue and skill provision, if required during the rollout, and training for the data capture and input personnel. £6,000 was contributed from the Specialised Commissioning Group, plus secretariat and coordination support.

Nottingham University Hospitals NHS Trust (NUH NHS Trust)
Melanoma & Renal Cancer Clinical Nurse Specialist
 To provide clinical nurse specialist support for patients at Nottingham University Hospitals NHS trust with metastatic renal cancer and malignant melanoma undergoing treatment with systemic therapy. Also included delivery of a safe service, improved cross speciality working, more appropriate use of resources, address peer review compliance with regards to a CNS for melanoma, better patient experience. Direct Costs to Bristol-Myers Squibb: £32,743, or £16,371 p.a. Nottingham University Hospitals NHS Trust contributed £32,743 or £16,371 p.a.

University Hospital Southampton NHS Foundation Trust (UHS)
Advanced Melanoma Clinical Nurse Specialist in University Hospital Southampton NHS Foundation Trust
 A three year project to develop a clinical nurse specialist service for patients with advanced melanoma (AM). The CNS will help develop the care pathway to ensure patients are supported by the extensive expertise offered by existing services. This will improve the care they and their families receive, enabling them to better adapt and cope with their disease so improving their overall experience and quality of life. In addition, it will help the Trust develop as a supra-regional centre of excellence for the diagnosis and treatment of patients with AM.
Bristol-Myers Squibb contributed £129,351 (£43,117 p.a.). University Hospital Southampton NHS Foundation Trust contributed indirect costs of £59,355 (£19,785 p.a.).

The Royal Marsden Hospital, NHS Foundation Trust
The development of supportive care pathways for people living with and beyond treatment for metastatic melanoma
 This project aims to provide funding for clinical specialist support for one day a week for two years to enable the CNS's in post to complete a work programme which will show the supportive care needs of patients who have had systemic therapy for metastatic melanoma. This will help define and develop the interventions required to meet these needs. 
Bristol-Myers Squibb contributed a direct cost of £26,141 total for two years. The Royal Marsden Hospital, NHS Foundation Trust contributed a direct cost of £1050 for transcription of interviews: indirect cost of £9,479 total for two years.

Mental health
Surrey and Borders NHS Partnership Trust
The project aims to assist with the collaboration of primary care and mental health services in Surrey, utilising medicines management and medicines choice website, delivering patient management solutions. 
Bristol-Myers Squibb/Otsuka contributed £12,000 for this project and £12,400 was contributed by Surrey and Borders NHS Partnership Trust.

Tees Esk and Wear Valleys NHS Foundation Trust
Mental Health Primary & Secondary Care Prescribing and Physical Health Audit within Tees Esk and Wear Valleys NHS Foundation Trust and local CCG’s
 This project aimed to increase understanding, as to current practice of side effect monitoring and patient engagement in medication regimes by undertaking a cross care, retrospective case note, audit of Severe Mental Illness patients IN NHS TEWV and local CCG’s. Bristol-Myers Squibb/Otsuka contributed £6,000, which was matched by Tees Esk and Wear Valleys NHS Foundation Trust.

South Staffordshire & Shropshire
This project aimed to improve patient outcomes by assisting collaboration of primary care and mental health service in South Staffordshire & Shropshire through a series of workshops to develop a consensus pathway for adult patients with bipolar 1 disorder. Bristol-Myers Squibb/Otsuka contributed £7575, which was matched by South Staffordshire and Shropshire. Sussex Partnership NHS Foundation Trust.

Sussex Partnership
 A training programme to improve patient outcomes by improving adherence to medication in Early Intervention Services within the Sussex Partnership NHS Foundation Trust. Bristol-Myers Squibb and Otsuka contributed £6,000. Sussex Partnership NHS Foundation Trust contributed £5,000.

South West Essex Primary Care Trust
This project delivered the development and roll out of a dynamic care pathway to support improved treatment and management of service users with Severe Mental Illness (with an emphasis on Bipolar Disorder). Bristol-Myers Squibb/Otsuka contributed £18,000. South West Essex Primary Care Trust contributed £15,000.

Date of preparation: May 2018; MLTUK1701479-06