A Case Study: How England Implemented Its First Population Health Agreement
Author(s)
Diego Civitelli, BSc, MSc1, Panos Kanavos, BSc, MSc, PhD2.
1Research Officer, The London School of Economics and Political Science, London, United Kingdom, 2London School of Economics and Political Science, London, United Kingdom.
1Research Officer, The London School of Economics and Political Science, London, United Kingdom, 2London School of Economics and Political Science, London, United Kingdom.
OBJECTIVES: A first-of-its-kind Population Health Agreement (PHA) between the National Health Service (NHS) and Novartis aimed to improve the management of cardiovascular disease by supplying Inclisiran to 300,000 patients in primary care. The drug is recommended for the prevention of secondary heart disease in patients who are unresponsive to statins. We investigate the agreement's effectiveness by analyzing dispensed doses and exploring the key implementation challenges and successes.
METHODS: We collected monthly Inclisiran dispensing data, broken down by Integrated Care Board (ICB), from OpenPrescribing.net, covering November 2021 to February 2025. To supplement this, we performed a rapid review of existing evidence on Inclisiran, which included clinical trial data, the National Institute for Health and Care Excellence (NICE) recommendation, and relevant media releases and editorials. Finally, we conducted semi-structured interviews with stakeholders directly involved in the implementation of the agreement.
RESULTS: The analysis reveals a significant shortfall in the PHA’s objective, with only 64,163 Inclisiran doses administered in its first three years, far below the 300,000 patient target. Semi-structured interviews revealed several key barriers. Firstly, as a first-in-class product subject to additional safety monitoring, medical practitioners were hesitant to prescribe it in primary care. Secondly, physicians were not mandated to prescribe the drug, as it was not included in the General Medical Services contract. Thirdly, some stakeholders believed that the NICE's decision-making process was influenced by political pressure. Finally, NHS England was perceived to have pressured GPs to prescribed Inclisiran.
CONCLUSIONS: The initial PHA fell short of the ambitious targets set by NHS England and Novartis. To secure better outcomes in the future, we recommend that similar agreements account for doctors' willingness to prescribe new medications and offer appropriate financial incentives within primary care. The low uptake achieved by NHS England might make manufacturers hesitant to enter into similar deals.
METHODS: We collected monthly Inclisiran dispensing data, broken down by Integrated Care Board (ICB), from OpenPrescribing.net, covering November 2021 to February 2025. To supplement this, we performed a rapid review of existing evidence on Inclisiran, which included clinical trial data, the National Institute for Health and Care Excellence (NICE) recommendation, and relevant media releases and editorials. Finally, we conducted semi-structured interviews with stakeholders directly involved in the implementation of the agreement.
RESULTS: The analysis reveals a significant shortfall in the PHA’s objective, with only 64,163 Inclisiran doses administered in its first three years, far below the 300,000 patient target. Semi-structured interviews revealed several key barriers. Firstly, as a first-in-class product subject to additional safety monitoring, medical practitioners were hesitant to prescribe it in primary care. Secondly, physicians were not mandated to prescribe the drug, as it was not included in the General Medical Services contract. Thirdly, some stakeholders believed that the NICE's decision-making process was influenced by political pressure. Finally, NHS England was perceived to have pressured GPs to prescribed Inclisiran.
CONCLUSIONS: The initial PHA fell short of the ambitious targets set by NHS England and Novartis. To secure better outcomes in the future, we recommend that similar agreements account for doctors' willingness to prescribe new medications and offer appropriate financial incentives within primary care. The low uptake achieved by NHS England might make manufacturers hesitant to enter into similar deals.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HPR2
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Health Service Delivery & Process of Care
Topic Subcategory
Insurance Systems & National Health Care, Reimbursement & Access Policy
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)