The market access hire you think you need. And the one you actually need.

A device company I spoke with last year had done everything right. Three years of development. Clinical evidence package built to NICE dossier standard. UKCA clearance. They appointed a Head of Market Access who had fifteen years of NHS payer experience, a strong NICE network, and a track record in pharmaceutical market access that read exactly as it should.

Fourteen months later, they called me. The NICE submission was on track. ICBs that would actually commission the device had never been engaged. The health economic model supporting the commissioning case didn't exist. Nobody had built the clinical evidence package NICE would require at the point of guidance, because nobody had been briefed to.

That candidate wasn't incompetent. The brief was.

The brief problem nobody talks about

Most senior market access searches fail before they start, because the brief is written by people who know what they need the function to achieve but not yet what the role actually requires to achieve it.

There are two failure modes. The brief is too broad: "someone to handle NICE and get us into the NHS." That describes a function. It doesn't describe a role, a talent pool, or a candidate. The brief is too narrow: "direct NICE technology appraisal experience required," when what the company needs at its actual stage is ICB commissioning relationships and an NHS network (a different pool of people, built over different careers, doing different work day to day).

These aren't equivalent skill sets that can be developed on the job. A health economist with deep NICE appraisal experience, trained through a large pharmaceutical company or health economics consultancy, brings specific and valuable expertise. If your device needs ICB engagement before the NICE process completes, that expertise is misaligned. Spending the first twelve months of a tenure discovering that distinction is how companies add a year to their NHS adoption timeline.

The dimension question

VP Market Access sits at the intersection of four things: health economics, clinical evidence strategy, payer relationships, and commercial planning. No senior hire is equally strong across all four. So which dimension matters most right now? The brief that ignores this question produces a shortlist from the wrong talent pool.

The profile depends entirely on stage. At UKCA clearance with no NHS commissioner relationships, the brief needs to prioritise payer network and ICB relationships above all else. Positive NICE guidance with adoption challenges shifts the priority to health economics and local market engagement. A US build is a different search entirely. And searching for someone who "ticks all four" is how a search runs long, costs more than it should, and ends with someone either too junior to lead the function or too senior to stay once it's built.

Name the dimension. Build the brief from there.

What the right candidate looks like

Strong VP Market Access candidates for UK device companies aren't on job boards. They're inside existing organisations, managing active NICE submissions, running ICB engagement programmes, or building health economic evidence packages. Looking happens only when the opportunity is specific enough to make it worthwhile.

The pharma crossover is the most common trap in these searches. Pharmaceutical market access experience isn't directly transferable to device market access. The coding pathway is different. Procedural evidence requirements differ in structure and timing. And the clinical adoption dynamics that determine whether your device gets routinely used, or sits in a positive NICE guidance document that nobody acts on, operate through mechanisms pharmaceutical market access professionals rarely encounter. A candidate with twelve years navigating NICE for pharmaceutical products understands the appraisal mechanics. They haven't built the device-specific payer relationships, and they haven't operated in the NHS commissioning environment that decides routine use.

What good looks like: NICE process familiarity from the inside, active ICB relationships in the relevant therapy area, clinical credibility that holds up in a room with clinicians and payers, and the commercial acumen to connect the reimbursement timeline to the company's funding position. That combination is rare. The search has to be designed to find it, not hope it applies.

The question that precedes the brief

Before opening the search, one question resolves most of the ambiguity: what does commercial success look like in eighteen months, and what has to be true about the market access landscape for that to happen?

That answer tells you which dimension of the role matters most. The dimension tells you which talent pool. Which pool tells you how to run the search, who to approach, and what the appointment timeline looks like.

Companies that get this right find the right person in three to four months. The ones who start with the job description and work backwards from there are still searching at month seven, or they've made an appointment that costs them a year to recognise and another six months to correct.

The brief comes first. Everything that follows is a product of how well it was written.