The Other Side 16:

Interview with a Clinical Procurement Specialist

Ian Poxon is a Clinical Procurement Specialist at Nottingham University Hospitals NHS Trust, and is Chair of the National Network of Clinical Procurement Specialists. On Target talked to him about the new landscape of NHS purchasing for secondary care.

1. How would you define ‘procurement’?

The obtaining of products and services for an institution, attempting to get value for money.

2. How does your role bring together clinical and financial priorities?

The two don’t always go together. There are a lot of pressures coming through from central government: initiatives on infection control etc. And we have to be mindful of clinical need: it’s not just about buying the cheapest option. As with purchasing a company car, you don’t want the Trabant and can’t afford the Rolls Royce, so you go for a Rover or a BMW. You try to get a balance, to get the best deal possible for the organisation.

To support clinicians, we need to get an understanding of the financial processes and implications, as well as clinical needs and the product. Many people think purchasing in the NHS is a bit like going to Sainsbury’s and they can pick what they want off the shelves, but it’s not like that. More and more Trusts are saying “We need a corporate way of doing this,” rather than letting it devolve to individual budgets or deciding earlier which products to use.

3. What are the key features of the new NHS procurement structure where medical technologies are concerned?

We’re not totally joined up on this at the moment. The Hubs that have been formed are working in slightly different ways. We are targeted by the DH to work with companies developing technologies and help them get through to the marketplace. It’s not very straightforward at times.

A lot of companies don’t understand the way the NHS and procurement work, and don’t understand the needs of clinicians and how to take their innovation to the end user. Then we have the silo budget mentality of the NHS, where money is put into certain pots and then can’t be moved. From a Trust perspective we are targeted on moving new technology forward, but we are mindful of the financial constraints that NHS Trusts operate under.

As for the new Collaborative Procurement Hubs – we’re paying for them to help us purchase in a better way by aggregating volumes and getting better prices, but again it’s about making sure that the links are there down to the customer and the patient. The Hubs are targeted on innovation and being progressive, but if we don’t have the communication channels in place it’s difficult to move forward.

4. What positive opportunities does the new purchasing landscape offer to medtech companies?

It gives them a contact point. One problem they’ve had in the past has been not having enough points of contact to bring new products to. They’re getting nearer to the end user than before: we’re still not close to the end user, but we’re trying to give them the opportunity.

The DH has set up new bodies, like the Innovation Hub at Warwick University, to look at development. The work of HITF supposedly helps us to do that: it gives us a channel to bring new technologies to the fore. The Innovation Hubs will be working with CP Hubs, who in turn work with individual Trusts, aiming for change and communication to help move products forward.

Tied in with that, the Centre for Evidence- Based Purchasing has moved from working alone to working within NHS PASA. It can look at products across various routes, trying to see whether they should be moved forward into the NHS faster, and to provide the evidence to do that.

5. What are the potential pitfalls of trying to sell medical technologies to the new purchasers?

Communication again – getting the information to the right people. The new purchasers are still distant from the end users, because they are covering such a large geographical area. Companies should never miss out the Trust procurement department: the interface between the hospital patients and the purchasing side is there, not ten miles up the road at the CP Hub. You can sell the idea to a CP Hub, but will individual Trusts follow what it says? Each Trust, though paying for the Hub’s services, has its own budgets to manage and its own problems to face on a daily basis. You do need to see the Hub, but also people at individual Trust levels.

A lot of medtech companies think once they have designed a product it’s just going to be snapped out of their hands. They don’t understand the beast of the NHS! The days of targeting individual consultants are going. Now the Hubs get information out to the Trusts, where it is evaluated again and passed on to the clinicians.

Companies should never miss out the Trust procurement department: the interface between the hospital patients and the purchasing side is there, not ten miles up the road at the CP Hub. Each Trust, though paying for the Hub’s services, has its own budgets to manage and its own problems to face on a daily basis.

6. If you had to condense your advice to the medtech industry into a single message, what would that be?

Let’s all work together. We all have a part to play in this. We need these medical technologies, but we need to know they ‘do what it says on the tin’. We need independent research, clearly presented as such. We don’t like the American way of thrusting things down our throats. We also want companies engaged in innovation to talk to Trusts about what they are doing in their locality, as we are targeted by the DH to support local businesses.

We want to work with companies to use products to the best effect. They have to bring not just the product, but the training and support to go with it. It’s no use just coming as a company with the MD as salesman and saying “Yes, I can sell you this, it’s dirt cheap.” Because of the legal implications of using medical technology, we need to ensure that staff are fully on board and fully educated in using any new product.