This document provides an overview of a three day programme on understanding the NHS. Day one focuses on understanding the structure and system of the NHS. Day two covers relevant knowledge and skills for success working with the NHS. Day three is about applying the learning and pitching innovations. The document discusses the NHS landscape including its history, structures, priorities and statistics. It also covers integrated care systems, clinical commissioning groups, primary care networks and their roles. Opportunities for procurement within the NHS are discussed including frameworks and portals.

1. Excel in Health
Understanding the NHS

2. Three day programme overview
1. Understanding the NHS
2. Relevant knowledge and skills
for success
3. Applying your learning and
pitching your innovation

3. Find someone you’ve never met:
● Spend TWO MINUTES (each) sharing:
o What challenges do you bring with you today?
o What are you hoping to get from this experience?
● Repeat with another new contact…

4. By the end of our session today, you will be able to:
● Identify characteristics of NHS structure and system
● Recognise processes for working with the procurement
system
● Identify relevant elements of NHS culture that may
impact your work
Respond to Reflection #1 in your workbook

5. NHS Landscape

6. ● NHS history overview
● NHS structures
● National context
● STP/ICS priorities

7. ● Created in 1948
● Free at point of care to all
● £125bn = 7% of GDP
● 1m patients every 36 hours
● 1.7m staff (5th largest employer in world & 2/3 of £)
● 135 acute non-specialist trusts
● 17 acute specialists trusts
● 54 mental health trusts
● 35 community providers
● 9,200 GP practices (ave. list size 7,800)
● 14,000 Community Pharmacies
● 211 CCGs / 1,300 Primary Care Networks
● 44 STPs / ICSs

8. ● The NHS provides a comprehensive service, available to all
● Access to NHS services is based on clinical need, not an individual’s ability to
pay
● The NHS aspires to the highest standards of excellence and professionalism &
quality of care is highest when staff are valued, empowered and supported.
● The patient will be at the heart of everything the NHS does
● The NHS works across organisational boundaries and in partnership with other
organisations in the interest of patients, local communities and the wider
population
● The NHS is committed to providing best value for taxpayers’
money and the most effective, fair and sustainable use of
finite resources
● The NHS is accountable to the public, communities and
patients that it serves

10. www.kingsfund.org.uk/audio-video/how-does-nhs-in-england-work

11. ● An ambitious approach linked to the NHS Long Term Plan
● Seeks to:
o Support the first 5 years and provide evidence for the next 5 years
funding
o Support the ‘Triple Aims and Integration’
● and… ‘dissolve the historic divide between primary and
community health services’

12. ● PCNs are not about commissioning, they are about provision as
‘investment and delivery vehicles’
● Essential Contribution’ to be defined for PCNs, as ‘…part of the
wider service that ICSs will be organising’ - and to play its part in
partnership with community services
● Increased funding from NHSE for Primary Care (Additional
Staffing / Indemnity etc.)
● 100% coverage / membership expected of PCNs
● Additional roles (with PCNs having capitated budgets and
flexibility of staff provision from 2020)
● 7 national service specifications

13. ● Anticipatory Care - Structured care and targeted MDT support
for physical / mental health needs / multi morbidities
● ‘...can only be delivered by fully integrated primary &
community health teams...input from community providers, GP,
social care & hospitals’
● Full requirements developed by ICSs, and commissioned by
CCGs
● Personalised Care - ‘What matters to you?’ Rather than ‘what’s
the matter with you?’
● Social prescribing link workers fully funded to support the NHS
Comprehensive Model, e.g. choice, care planning, self
management & personal health budgets
● Care Homes - PCNs ... ‘will be responsible for working with
emergency services to provide emergency support, including
where advice or support is needed out-of-hours’

14. ● Setting national policy & developing best practice for NHS technology, digital & data, data-sharing &
transparency
● Setting standards – developing, agreeing & mandating clear standards for the use of technology in
the NHS
● Ensuring that NHS systems can talk to each other across the health & care system
● Helping to improve clinical care by delivering agile, user-focused projects
● Supporting the use of new technologies by the NHS, both by working with industry & via its own
prototyping & development capability
● Ensuring common technologies & services (e.g. NHS App) are designed so NHS orgs don’t reinvent
wheels
● Making sure that all source code is open by default
● Reforming procurement – helping the NHS buy the right technology through the application of
technology standards, streamlined spend controls & new procurement frameworks that support our
standards
● Setting national strategy & mandating cyber security standards so security is designed in from the
start
● Championing & developing digital training, skills & culture so our staff are digital-ready
● Develop AI capability via funding programmes & development of NHSx AI Lab
Respond to Reflection #2 in your workbook

15. ICS /
HCP/
ACO /
ACS
Geographic
area (not
CCG)
PCN

17. https://www.longtermplan.nhs.uk/wpcontent/uploads/2019/01/nhs-long-term-plan.pdf

18. •Early detection
•Breast, prostate, lung, bowelCancer
•Prevention
•Familial Hypercholesterolaemia; Cardiac Arrest; Stroke servicesCVD
•Prevention
•Monitors; self care; choices and consequencesDiabetes
•Prevention
•Rehab; Meds Opimisation; Risk ScoringRespiratory
•Children and young people (25% prevalence)
•Crisis; suicide prevention, eating disorders, learning disabilitiesMental Health

19. • Primary Care Networks
• To integrate teams and digital servicesPrimary Care
• Urgent treatment centres, NHS 111
• To reduce pressure on A&EUrgent Care
• Digital transformation
• To reduce wait times and delayed transfersAcute Care
• IAPT expansion
• Crisis; suicide preventionMental Health

20. • 75% of Trusts are in the red
• We pay for activity not outcomes
• Annual budgets
Finance
• More patients, less staff
• 100k workforce gap
• Retention and skill developmentWorkforce
• Digitalising the system for patients and clinicians
• Interoperability of digital systems
• Patient information and record sharingDigital

21. 30% of people in NWC
live with one or more
long term conditions
The difference in life
expectancy
between areas
across NWC can
vary by more than
10 years
By 2021 there will
be 9% (5700) MORE
people living beyond
65 years with the
biggest growth in
those aged 70-75
and 85+
Over half of
adults are
overweight or
obese

22. ● Shift the emphasis from disease and distress to
prevention and promotion (prevent the fires)
● Passive patient becomes more discerning and
responsible for their health and wellbeing – choices
and consequences
● Technology
● Resource optimisation
● Reducing duplication
● Greater standardisation and reliability

23. Integrated Care System
Currently a shadow integrated care
system called Healthier Lancashire and
South Cumbria:
● Five integrated care partnerships
● 1.7m population
● 8 CCGs
● 5 Trusts
● 4 upper tier Local Authorities
● NHS England and NHS Improvement
● Wider partners such as voluntary,
charity, hospices and education
Morecambe
Bay
Pennine
Lancashire
Central LancashireWest
Lancashire
Fylde Coast
Lancashire and South Cumbria

24. Healthier Lancashire
Out of Hospital Acute and
Specialised
Mental Health Prevention and
Population Health
• Regulated Care
• Primary Care
• Stroke
• Cancer Alliance
• Better Births
• Head and neck
• Vascular
• Diagnostics
• Pathology
• Children and
Young People
• Suicide Prevention
• Leaning
disabilities
• Preventing
Diabetes
• Public Health
• Population Health
• Personalised care
Commissioning Urgent and
Emergency
Workforce Digital
• Commissioning
development
• Clinical policy
reviews
• Respiratory
• Falls
• UTIs
Careers
Clinician Passport
It's Your Move
Well at Work
Our digital future

25. Cheshire and Merseyside
Healthcare Partnership
● 12 CCGs
● 9 Local Authorities
● 20 Provider Trusts
Focussed on:
● Collaboration and partnership
● Joined up care
● Targeting localised priorities
● Implementing a place based
care matrix

26. Cheshire and Merseyside Healthcare
Partnership
Health Inequalities Focus
• Mental wellbeing
• Zero suicide
• Cardiovascular disease – zero strokes
• No harm from alcohol
• Every child immunised
• Reducing falls
• No violent crime

27. INDEPENDENCE & PREVENTION
Products & services that:
• Improve the physical, mental & emotional wellbeing of
individuals & carers
• Are targeted at healthy people to keep them well & prevent
illness
• Support early diagnosis by identifying people at risk of
developing disease
• Identify people with an existing diagnosis to who are at risk of
deterioration
PATIENT ACTIVATION & SELF CARE
Products & services that:
• Support people with an existing diagnosis to manage
their condition
• Use of support & education to increase patient activation
that will reduce likelihood of exacerbation
• Provide information & advice which helps people
maximise their wellbeing
GREATER SUPPORT & RESOURCE FOR
PRIMARY CARE
Products & services that:
• release GP capacity
• Make GP practices more effective & efficient places to work
WORKFORCE RESOURCE OPTIMISATION
Products & services that:
• Support the creation of new roles
• Increase productivity of the workforce
• Offer new technologies that plug gaps in workforce (eg AI in
diagnostics)
• help reduce/avoid duplication & variation in staffing
• Support integration of health & social care teams
DIGITISING THE SYSTEM
Products & services that:
• Trigger a shift from paper based working to digital working
• Introduce remote & assistive technology
• Enable record sharing & interoperability
• Population-based intelligence systems
• greater patient access to information & records
• reduce the burden of travel for staff & patients
IMPROVING SYSTEM FLOW
Products & services that:
• Reduce time spent in hospital
• Help the navigation of the urgent care system to prevent
admissions
• Reduce delayed transfers of care
• Identify bed availability across the system
• Reducing time lost waiting for access & discharge
OPERATIONAL EXCELLENCE
Products & services that:
• Improve effectiveness & efficiency of “back
office” non-clinical systems
• Reduce running costs of organisations
• “Carter” products
• Doing the basics really well, everywhere
• reduce variation & duplication in processes
• Help an organisations do things better, faster,
safer, cheaper
PATIENT SAFETY & QI
Products & services that:
• Increase the quality & safety of clinical services
• Reduce impact of human factors
• Reduce serious incidents & never events
• Improve patient experience
• Improves outcomes & reduce side effects
Develop – Matching Innovation Products to NHS “System Need” Making it relevant

28. Where does your innovation match system
needs?
Respond to Reflection #3 in your workbook

29. Commissioning and the need for
procurement

30. What is commissioning?
• What is procurement?
• Procurement towers
• Procurement frameworks
• Other portals
Commissioning and Procurement: Our
Topics

31. What is commissioning?
What is procurement?
Commissioning and Procurement
Respond to Reflection #4 in your workbook

33. C
https://www.kingsfund.org.uk/sites/default/files/2017-10/NHS_structure_2017.pdf
Commissioning
Clinical
Commissioning
Groups (CCGs)
NHSE/I
Local Authorities
Private providers
Commissioners Contract with Providers
Integrated Care
Systems
Voluntary sector
GPs and other
primary care
Primary Care
Networks (PCNs)
Primary Care
Networks (PCNs)

34. How the money flows
Public Health
England
Other arm’s length
bodies, including NHS
Improvement, Care
Quality Commission
and Health Education
England
Department
of Health
Parliament
NHS England
Clinical Commissioning
Groups
Better Care
Fund
Local
authorities
Public
health
Community
services
Mental
health
Hospital
services
Ambulance
services
Primary
care
Specialised
services
Primary
Care
Networks
£122.2 billion
£105.9 billion
£7.4 billion
£4.2 billion
£76.6 billion
£3.4 billion
£15.4 billion£12.8 billion
£2.1bn Sustainability
and Transformation
Fund

35. What does this mean for you?
● Providers procure products, Commissioners commission services
● Emerging Integrated Care Systems hold some funds but aren’t real
yet
● The organisation that uses a product may not be the organisation
that reaps the benefit
● Operational efficiencies vs cost savings
● 70% NHS costs are in staff. Incremental changes are not cash
releasing for commissioners
● What will your product replace or improve?
● The tariff for PbR is available publically. Use it.
https://improvement.nhs.uk/resources/national-tariff-1719/

36. The NHS mantra
Procurement seen as
key solution to these
problems
● More with less
● Reduce variation
● Increase efficiency
● Reduce cost without clinical compromise
Repeat…

37. NHS Supply Chain
The new NHS Supply Chain was designed to help the NHS deliver clinically assured,
quality products at the best value, through a range of specialist buying functions.
● Aims to deliver savings of £2.4bn back into NHS frontline services by 2023.
● The new model consists of eleven specialist buying functions, known as Category
Towers
● Three enabling services for logistics, supporting technology and transactional services
underpin the model.
Key benefits:
Suppliers
• Lowering sales and marketing costs
• Single route into the national market
• A joined-up approach across the NHS
• Clear route for innovative products
NHS Trusts
• Savings channelled back to frontline services
• Releasing more time for core clinical activities
• Greater NHS clinical involvement in
purchasing decision
• More effective introduction of new products

38. Procurement Towers
There are 11 specialist buying functions knowns as category towers….
Non Medical
Tower 11
NHS Hotel Services
Tower 4
Orthopaedics, Trauma &
Spine, Ophthalmology
Medical
Tower 3
Infection Control
And Wound Care
Tower 5
Rehabilitation, Disable
Services, Women’s
Health & Associated
Consumables
Tower 2
Sterile Intervention
Equipment And
Associated
Consumables Tower 10
Food
Tower 9
Office Environment
Capital
Tower 7
Large Diagnostic
Capital Devices incl.
Mobile &
Consumables
Tower 8
Diagnostic
Equipment and
Associated
Consumables
Tower 1
Ward Based
Consumables
Tower 6
Cardio-Vascular,
Radiology, Audiology &
Pain Management

39. Talk at your table:
Respond to Reflection #5 in your workbook
Where do you fit within the Procurement Towers and why?

40. Opportunities:
If yes…
● Register on procurement towers
framework - suppliers@supplychain.nhs.uk
● Consider partnering with a larger supplier
● Consider forming a consortia
● Use your AHSN as conduit

41. Health system support framework
What is is?: a quick and easy route to access support services from
innovative third party suppliers at the leading edge of health and care system
reform.
● Can be used by any NHS organisation, including NHS Trusts, Clinical Commissioning
Groups (CCGs), national Arm’s-Length Bodies and local authorities
● Integrated Care Systems (ICSs) and Sustainability and Transformation
Partnerships (STPs) can use the HSS to access innovative technologies and digital
vendors to drive forward system reform
● The Framework focuses particularly on services that can support the move to
integrated models of care based on intelligence-led population health management

42. Framework areas
● Infrastructure:
o Electronic Patient Records and place-based digitalisation
o local health and care records across different care settings
o primary care IT support and cyber security
● Intelligence:
o targeted population health analytics
o digital tools for system modelling, actuarial assessment, planning, research, risk
stratification and impactability modelling
o clinical decision support tools
● Impact and Intervention:
o transformation and change support
o patient empowerment and activation (including self-care support, personalisation, assistive
technologies and remote consultations)
o demand management and capacity planning support solutions
o system assurance and provider modernisation
o medicines management support

43. G-Cloud
What is it?: G-Cloud (RM1557ix) is a framework where supplier cloud-based
solutions are made available through a front-end catalogue called the Digital
Marketplace.
o G-Cloud framework is THE place to be, for companies who are
thinking about selling their cloud-based solutions to the UK
government.
o The Digital Marketplace is an online service for public sector
organisations to find people and technology for digital projects.
 Any public sector organisation, including agencies and arm's
length bodies, can buy using the Digital Marketplace.

44. What is a Framework Agreement?
 Definition: an agreement between a Contracting Authority (e.g. NHS SBS,
an NHS Trust, or a local council) and one or more suppliers, the purpose of
which is to establish the terms governing contracts to be awarded during a
given period, in particular with regard to price and, where appropriate, the
quantity.
● 6-9 month procurement process
● Awarded following a fully OJEU compliant process under the 2015 Public Contracts
Regulations
● Usually awarded for a period of 4 years
● *Legal requirement for public sector procurements over the value
of £118K
● Approx. cost of £25,000 per tender process for a Contracting Authority

45. Where to look for NHS opportunities
NHS Opportunities MUST be published online - you need to put the work in, you
have to search!
Essential Sites:
Above OJEU >£118k DoH, NHS Trusts / £181k NHS England, CCGs & NHS
Foundation Trusts
o TED Europa http://www.ted-Europa.eu
Below OJEU >£10k to £118k / £181k
o Contracts Finder http://online.contractsfinder.businesslink.gov.uk
Contracts Finder pulls from all sites where possible (One Place – Full
Transparency)
Other Useful Sites:
o Public Contracts Scotland – www.publiccontractsscotland.gov.uk
o Sell2Wales – www.sell2wales.gov.uk
o eSourcing Northern Ireland – www.e-sourcingni.bravosolutions.co.uk

46. How to look for NHS opportunities
● Registering is essential
● Register for all or as many as possible
● Searching for Opportunities is critical
● CPV Codes, NUTS codes and / or Key Words
o CPV Codes – define what is being sourced (e.g. 3314000 Medical
Consumables)
o NUTS codes define the location (e.g. Essex – UKH3)
● Use Alerts
● Regularly review sites and evaluate opportunities

47. Exploring NHS Culture

48. What do we mean when we talk about
culture?
Culture describes the rich
pattern of social behaviour
present in an organisation over
time, including all spoken and
unspoken rules, symbols,
routines and stories. Culture
binds together an organisation’s
different parts, giving identity to
the whole.’
This includes:
● Values
● Assumptions
● Artefacts

49. Considering stakeholder systems

51. VALUES: old and new power
Old power values New power values
Formal (representative) governance,
managerialism, institutionalism
Informal (networked) governance,
opt-in decision-making, self-
organisation
Competition, exclusivity, resource
consolidation
Collaboration, crowd wisdom,
sharing, open-sourcing
Confidentiality, discretion, separation
between private and public spheres
Radical transparency
Expertise, professionalism,
specialisation
Maker-culture, “do it ourselves” ethic
Long-term affiliation and loyalty, less
overall participation
Short-terms conditional affiliation,
more overall participation

53. NHS culture improvement themes
•Learning culture
•Listening culture
•Open and transparent culture
•Just culture

54. Principles of NHS culture
• Vision and values
• Goals and performance
• Support and compassion
• Learning and innovation
• Teamwork

55. Vision and values
Value The way we do things
Constant commitment to
quality of care
Everyone taking
responsibility in their work for
living a shared vision and
embodying shared values

56. Goals and performance
Value The way we do things
Effective, efficient, high
quality performance
Everyone ensuring that there
are clear priorities and
objectives at every level and
intelligent data constantly
informing all about
performance.

57. Support and compassion
Value The way we do things
Support, compassion, and
inclusion for all patients and
staff
Everyone making sure all
interactions involve careful
attention, empathy, and
intent to take intelligent
helping action.

58. Learning and innovation
Value The way we do things
Continuous learning, quality
improvement, and
innovation
Everyone taking
responsibility for improving
quality, learning, and
developing better ways of
doing things.

59. Teamwork
Value The way we do things
Enthusiastic cooperation,
team working, and support
within and across
organisations
Everyone taking
responsibility for effective
team-based working,
interconnectedness with
and across organisations,
systems thinking and
acting.

60. Your work and NHS culture principles
Vision and
Values
Goals and
Performance
Support and
Compassion
Learning and
Innovation
Teamwork

61. Resistance to change
Shock
Frustration
Resistance Exploration
Commitment
Integration
Valley of Despair

62. Overcoming fixed mindsets

63. Respond to Reflection #6 in your workbook