First NHS Total Orthopaedic Solutions framework saves £6.5m

The first framework to cover the procurement of all orthopaedic products, to be open to the NHS across England and Wales, and to be designed to encourage the use of small and medium sized suppliers, has delivered more than £6m for LPP members in its first year – and clinical engagement has been fundamental to getting savings at that level.

First NHS Total Orthopaedic Solutions framework saves £6.5m

The four Hubs - NHS London Procurement Partnership, North of England Commercial Procurement Collaborative, NHS Commercial Solutions and East of England NHS Collaborative Procurement Hub (working together as NHS Collaborative Procurement Partnership – CPP) – delivered the NHS Total Orthopaedic Solutions Framework Agreement in January 2015.

As LPP’s senior lead for the Medical, Surgical and Supply Chain category, Tom Wynne, says, “We sought to award an agreement that for the first time included product areas not previously taken to market, and that was structured to apply nationally. We were keen to demonstrate best practice for the NHS, and give optimum value to patients and the taxpayer.”

Orthopaedics is one of the major spend areas in NHS medical and surgical procurement. 2011 figures show that spend on hips and knees alone was £504.5m across the NHS in England. Prior to the creation of the national framework, LPP members could procure orthopaedics through three separate frameworks, each a sub category of orthopaedics - Spinal, Trauma and Elective. Between them, these frameworks had saved members £5.6 million between 2012 and 2014. To ensure the continued delivery of savings, however, the team recognised the need for a fresh approach to the category.

The fresh approach

A significant number of suppliers provide products in more than one orthopaedics sub category. If managed professionally, this provides the opportunity to leverage cross-category deals to the benefit of both the NHS and suppliers. Suppliers covering more than one sub category will offer attractive commercial terms across a number of categories, if trusts bring together their different orthopaedics requirements into one order.

At the other end of the scale, smaller, niche suppliers of medical and surgical products are often highly innovative, but unable to meet the compliance requirements or compete in frameworks against major providers. To address this, and so encourage SME suppliers to apply for a place on the framework, CPP took a ‘multi lotted’ rather than ‘single lotted’ approach to the structure of the framework – effectively breaking possible trust requirements down into their component parts, where it was sensible to do so.

Following discussion and consultation with members about adopting this
approach, the framework was divided into 10 lots:
• Hips
• Knees
• Extremities
• Trauma
• Spinal
• Bone Preparation
• Regenerative Technology
• Arthroscopy and Sports Medicine
• Power Tools and Consumables
• General Instrumentation

Managing implementation: getting a step-change in approach

Creating a framework is one part of the process; encouraging its implementation among members is another matter. Whether and how a trust uses a framework will
determine just how successful it is for the NHS.

Trusts can (and often do) generate savings from a new framework by keeping things
‘as is’ - in simplistic terms, where the same suppliers are now on the new framework, providing the same products but at a more competitive price, the trust will see savings. It also keeps clinicians happy and requires little clinical input – clinicians can continue to use the products they have always used.

However, every trust is now under greater scrutiny to deliver bigger savings numbers than ever before. Trust boards should rightly question whether their approach to procuring orthopaedics products is delivering optimum savings. That requires a step change in orthopaedics procurement, but it is not only doable, it should be an imperative for every orthopaedics clinician and procurement manager.

The LPP team worked with members to get that step change. Once the framework was awarded an analysis of the benefits to be achieved from behaving ‘as is’ was released to relevant trusts. This analysis quickly showed that there was a disparity in approach by trusts across LPP, and that far greater savings could be achieved where trusts combined their areas of spend across their individual disciplines.

The LPP team proactively reviewed market opportunities and provided trusts with a variety of scenarios which clearly demonstrated the benefits of taking this combined approach to the market. As a result, total full year savings achieved in the framework’s first year are £6.18m across 28 trusts, an average saving of 12.6 per cent. ‘As is’ savings would have been just £3.32m.

The difference in the procurement approach which each trust needs to adopt is:

a) Look at all orthopaedics requirements in the round, instead of discipline by discipline (for example, Trauma reviewed in isolation)

b) Develop scenarios which show the art of the possible, and then ensure you get clinical engagement to agree what can realistically be progressed to give the optimum result

c) Make clinicians fundamental to a decision making process which ensures that sound decisions are made on both commercial and qualitative grounds. Without clinical involvement, the most likely outcome is status quo which will deliver minimal savings.

Dartford and Gravesham NHS Trust

David Brown, Head of Procurement at Dartford and Gravesham NHS Trust, explains how his trust implemented the new framework, and with what results.

“The NHS Total Orthopaedic Solutions Framework enabled us to be compliant in our
orthopaedics procurement and generate savings. To date we have accessed the Hips and Knees lots, and will also be accessing Trauma. The savings achieved are already £136,737 for 2015/16, and we anticipate £ 616,857 for 2016/17 with the additional benefit realised through the Trauma lot.

Getting to this stage has seen a great deal of clinical input into rationalising the orthopaedics products we use. The Chief Orthopaedic Consultant is chair of our Strategic Procurement Board, and was happy for us to engage directly with him. The procurement and clinical were looking for the same outcome, and so worked co-operatively with the LPP team to achieve the results we all were looking for.

The support from LPP was first class and professional. The team was able to engage directly with clinicians, and they were a great
support to the Procurement department here.”

David Brown
Head of Procurement
Dartford and Gravesham NHS Trust

22-04-16    Medical Surgical Supply Chain

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