HPR2 A case study: how England implemented its first Population Health Agreement

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.