Presentations by Mike Kenny, Acting Co-Director of Enterprise and Growth, Innovation Agency and Dr Neil Paul, a GP and Board Member with Cheshire East ICP at the Excel in Health: Understanding the NHS Landscape webinar on Wednesday 11 May 2022.

1. May 2022
Mike Kenny – Enterprise and Growth
NHS Structure and Accessing the NHS Market – What
Suppliers need to know

2. The Academic Health Science Network – Role & Purpose
(The ever changing) NHS Structure (from July 2022)
How the NHS Buys things
What Suppliers Need to know
Opportunities for Innovators & Suppliers

3. AHSN overview How we support
Businesses:
• Navigating the NHS
• Market research
• Developing a value
proposition
• Evaluating real-world
impact
• Health economic reports,
business cases
• Implementation
• Product development &
regulatory
• Signposting to resources
• Securing Funding
NHSE & BEIS-OLS commission to drive
Economic growth via development and
uptake of proven innovation into NHS
AHSN
Network
Core
&
Enhanced
offer

5. Department of Health and Social Care
Commissioners
Now
From July 2022 (parliament pending)
NHS England
Clinical
Commissioning
Groups (CCGs)
Plan and “buy” care from…
PROVIDERS
Primary Care Secondary Care
Mental Health Care Community Health Care
£
Department of Health and Social Care
NHS England
Integrated Care System (ICS)
Integrated Care System
Integrated
Care Board
(ICB)
Integrated Care
Partnership
(ICB)
Delegates to & contracts with…
Secondary Care
Community Health Care
Mental Health Care
Primary Care
Provider “Collaboratives”
Integrated Care
Partnerships (ICP)
or “Place’s”
Integrated Care
Partnerships (ICP)
or “Place’s”
Primary Care Network
or Neighbourhood
Primary Care Network
or Neighbourhood
Primary Care Network
or Neighbourhood
Primary Care Network
or Neighbourhood
£

7. It’s a big market (£170bill in 22/23), but not a quick market to access
• The NHS is a monopoly in Healthcare (but doesn’t think or act like one)
• 1000’s of organisations, not “One NHS”
• Highly regulated = risk averse (slow decisions)
• Pilots rather than purchase
• Paid for activity not outcomes
• Over managed and under led
• Staff don’t think like a patient or act like a tax payer

8. • The NHS uses products from over 80,000 suppliers (medical equipment, medicines,
food, business and office goods)
• Spending Approx. £70bill
• Generally, your company and product(s) have to be on a Procurement Framework or
Dynamic Purchasing System
• Or ride on the coat-tails of someone who is
• The NHS is not a “typical” purchaser – long decision making chains and lead times
• Getting on a procurement framework is not the end of the process – companies still
need to continue business development activity
• More on procurement in a later Excel workshop

9. Commissioners or Procurement Teams will ask:
• Is it on a procurement framework?
• Is it actually in the market or are they looking at a pilot to complete product development
• Is it TRULY ready?
• Has anyone else bought it already?
• And can I contact them?
• And what do they think of it?
• What is the evidence base like?
• Is there any real world evidence?
• Are there any Case Studies of use?
• Is there a business case for the product I can see?
• What else exists in this space and how does it compare?
• What “Horizon Scans” or “Innovation Insights” exist?
e.g. Transformation of services, Reset/Recovery

10. Commissioners or Procurement Teams
will ask:
• Is it supporting clinical decision making?
• Does it have AI?
• Is it for clinicians?
• Is it for patients?
• Does it access or share patient data?
• Does it have open API’s
• Is it modular?
• Does it fit into our existing platforms?
Digital Products
Answers to those questions:
• NICE (Digital) Evidence standards Framework
• Medical Device Regulations
• DCB0129 Compliance
• NHSx AI Lab
• ODS Code
• NHS Spine Compliancy
• GP IT Futures
• Developer.nhs.uk
• Digital Technology Assessment Criteria
• NHS Login
• PHR Toolkit
• etc

11. Sustainability – Is Carbon the new currency / basis for a value proposition?

12. Sustainability – Is Carbon the new currency / basis for a value proposition?
Commissioners or Procurement Teams will ask:
• How does this product deliver social value?
• Fighting Climate change
• Covid-19 Recovery
• Tackling Economic Inequality
• Equal Opportunity
• Wellbeing
• What is the impact of this product on my
organisations Carbon footprint?

13.  Protect the most vulnerable from COVID-19
 Help Restore NHS services inclusively
 Develop digitally enabled care pathways in ways which
increase inclusion
 Accelerate preventative programmes which proactively
engage those at risk of poor health outcomes
 Particularly support those who suffer mental ill-health
 Support Collaboration in planning and delivering action
Does your product:

14. How to “speak” to NHS purchasers, How to frame your value proposition.
Clarity Have a clear focus, know what your “ask” is
Understand
The Needs & Priorities of the NHS around your innovation.
Your product is a point solution that needs to fit into
complex pathways. Understanding collateral impact is key
Avoid the Hard sell
Understand and communicate what is in it for the NHS,
Patients, Citizens (populations)
Long Game
The NHS is a complex system of 1.5 million employees and
60 million clients
AHSNs can catalyse adoption by removing barriers
Co-create Engage and Partner rather than Tell or Sell
Value
Multi-dimensional – Social Value, Carbon Reduction,
Reducing inequality, increasing inclusion, Return on
Investment, Cost of Implementation, Cash Releasing

15. • The Pandemic changed behaviours of patients and NHS & Social
care staff due to necessity
• Covid created the “use case” for greater digital provision of care…
virtually overnight
• Digital and Remote is not for everyone - it can and has driven
health inequalities
• Carbon reduction will become as valuable as unit cost to NHS
organisations. Lots of opportunity for innovation, new product
development, redefining existing value propositions

16. • The NHS is a large but complex market for suppliers to
navigate
• There are new and expanding expectations of product
features, benefits and impacts that suppliers need to
understand
• Real World Validation / Real World Evidence can help avoid
pilots without purchase
• AHSNs are uniquely positioned and able to help you access
the NHS, Health and Care Market

18. Mike Kenny – Enterprise and Growth
Mike.Kenny@innovationagencynwc.nhs.uk
@innovation_mike
07825331521
NHS Structure and Accessing the NHS Market – What
Suppliers need to know

19. Introduction to NHS landscape - Excel in Health Event
Primary Care – Dr Neil Paul GP and PCN Clinical Director

20. About me – Dr Neil Paul
• GP Partner for 22 years*
• IT and CVD lead for PCG
• PEC member for PCT – IT primary
care and urgent care roles
• Helped setup CCG – and was board
member then switched to provider
• Helped setup GP Federation –
current GP lead role*
• PCN Clinical Director*
• Board member of CCICP and
Cheshire East ICP (place)*
• *current roles
• Written Apps for iPhone on sale on
Apple App store
• Run a GP education company
• Run a medicals business
• Provide services (consultancy,
turnaround, FTSU DPO etc) through
Howbeck Healthcare
• Helped create Apex from Edenbridge
which has recently sold to EMIS
• Sit on several clinical advisory groups
and provide consultancy services to IT
companies and health tech start-ups

21. A lot of what Mike told you is wrong!
• About primary care…
• 8000 GP practices – number getting smaller 30000 GPs
• Most are partnerships – other models exist – VIM gaining popularity
• Partnership model has issues.. Discourages investment – group
decision making – power of the veto – however no procurement rules
focused on costs and which pot
• Approx. 1250 PCNs – not official entities – MOUs between practices.
• Neither Practices nor PCNs have any procurement rules
• Some pots of money have stipulations…others don’t

22. Emerging C&M Architecture – April 22
PCNs - Neighbourhood (Care Communities) inc General
Practice
Providers
(Collaboratives)
Commissioners
(Collaboratives)
“Place Plus” – A wider Partnership, Planning & delivery across a wider
geographical area.
Place (Cheshire East) - Place Partnership, Leadership, Planning &
delivery with aligned Resources and Functions
Integrated Care Board (ICB)
(NHS)
Integrated Care Partnership (ICP)
(all other ICS partners)
Cheshire and Merseyside
Integrated Care System (ICS)
Health and
Wellbeing Board

23. Supporting Integration
Integrated Care Systems
establish statutory ICS in each ICS area made up of an ICS NHS Body and a separate ICS Health & Care Partnership (NHS, local
government and partners)
Duty to Collaborate
Place a duty to collaborate on NHS organisations (both ICSs and providers) and local authorities.
Triple Aim
A shared duty to have regard to the ‘Triple Aim’ of better health and wellbeing for everyone, better quality of health services
for all individuals, and sustainable use of NHS resources.
Joint committees
allow ICSs and NHS providers to create joint committees
Collaborative Commissioning
remove barriers and streamline and strengthen the governance for collaborative and aligned decisions
Joint Appointments
introduce a specific power to issue guidance on joint appointments between NHS Bodies; NHS Bodies and local authorities; and
NHS Bodies and Combined Authorities to support the development and delivery of integrated care

24. Primacy of Place
• What can be done at Place, should be done at Place where it makes sense and subject
to statutory and contractual limitations
• Focus on local need and local priorities (inequalities)
• Task and Finish Groups established to review CCG functions (Inc Primary Care)
• Commitment to ensure that local resource remains local
• Importance of relationships and corporate memory
• Place Plus – local concept that Cheshire East and West could work together

25. So what?
• No longer a traditional commissioner/provider split -> Collaborative
working?
• PBR is gone - Block contracts – less profit making more outcomes
• More questions about overall value for money
• More direct control from SecState
• Possible reduction in GP involvement – resurgence of hospitals?
• Classical mistakes of ACOs..
• Lots of new people in new roles
• Lots of bun fighting and lack of clarity on governance and decision making
• Lots of people wanting to make a mark and to be seen to be successful
• Perhaps an attraction to a new way of doing things

26. When is a PCN not a PCN?
When it’s a care community

27. Care Communities/neighbourhoods
• Are the sub units of place
• Have PCNs in them but include all health, social and third sector
services in them
• Teams are being aligned to this boundaries
• Are being encouraged to work collaboratively
• Are being asked to look at data and ID needs and create plans
• Ideally need new contractual mechanisms

28. Primary Care Networks
• Collection of practices in an area – in theory one area…
• Working together to deliver PCN contract
• Direction of Travel is area based contracts
• Peer Pressure to reduce variation
• Area based services?
• Some practices are merging – PCN as Practice is quite powerful

29. GP Practices
• Partnership model
• Income – Expenses = Profits
• Profits divided by partners in predetermined shares usually based on
sessions worked but some other factors.
• Most incomes are fixed – apart from some incentive schemes – QOF IIF etc
• Biggest Expense is staff – don’t have to follow AFC – so constant pressure
to be lean and mean… reluctance to take on new work esp that considered
to have little or no value – up side is can be ruthlessly efficient – My
Vaccine site has vaccinated >100K pts 80% of all vaccines in the end were
given by GPs..

30. Show me the Money
Tip think– Is it real money in a real bank account?
Inside a practice (some have rules)
• GMS
• QOF
• IIF
• Prescribing incentives scheme
• PPA income
• Vaccs and imms fees
• LES/DES/ES monies
• Fees to patients
• Other contracts
• Arroles money
Virtual – outside a practice
• Referrals budget
• Prescribing budget
• Diagnostics budget
• IT budget
• NHS infrastructure – Inc. community
services, Mental Health

31. GP Pressures
• Workforce crisis – less GPs
• Increasing population numbers
• Increasing elderly
• Increasing expectations
• Increasing capabilities of medicine – new drugs new treatments all
complicated and time consuming
• Poor state of the hospitals – waiting lists and over specialisation
• Press / government – are we being setup to fail?

32. System Pressures
• A&E activity
• Ambulance issues
• RTT targets – longest waiting lists ever
• Mental health explosion
• Bed blockers
• High Frequency attenders
• Health / Social overlap

33. What incentivises primary care?
• Profit
• Reduced workload – more services please
• Helping hit targets
• Good clinical care – but usually only if above not affected..
• Issues are PMs and practices are busy and often aren’t IT literate and
have no Project Mgmt capacity – too many people want practices to
trial stuff for ?what benefit (POCT example)
• Practices worry about IG/data security/wasting their time/clinical risk
from unproven etc…

34. What incentivises the system?
• Reducing health inequalities
• Anything that reduces admissions/readmissions/attendance esp. in
year
• Anything that has demonstratable efficiencies to the system – beware
the poorly thought out cost saving example - there is a mantra you
only save money when you shut a ward or operating theatre.
• Push for Risk Strat and Risk Segmentation – See UCL Partners work

35. Examples with my thoughts on
why some innovations succeed
and others don’t.

36. AccuRx
• Spotted a gap – 1-1 messaging from the
desktop
• Had enough funding to give it away free
and build a user base – so no purchasing
to begin with
• Deeply understood – EMIS API – and
desktop security (could be installed
without admin rights)
• Didn’t need practice manager
engagement -The IT literate could install it
by themselves and use it without needing
whole practice adoption
• Listened to users & rapidly added new
features
• Covid helped – photos and video
• Held NHS over a barrel – has generated
some bad feelings
• Some of their latest features aren’t
amazing…are they having to listen to
NHS…
• Appear to have slowed down a little
• Held up by the API and its abilities

37. Examples of Kit
Macroview Otoscopes
• Clear benefit to end users
• Simple capital purchase by end
users
• Ability for single clinicians to
purchase or group deals
• However expensive and marketing
not amazing in the UK – so some
use and love but some don’t know
about them
• Also Institutions often buy cheaper
Alivecor devices
• Clear use for end users
• Capital purchase - Simple 1 off price
• App not great and no one has thought
of how to integrate to clinical systems
• Not marketed well to NHS - However
some NHS body did find out about it
and as it ticked the AF screening box –
they bought loads – also may soon
have NICE tech appraisal guidance

38. EPS
• National Programme with tons of project management – delivered in
a centralised standardised way
• Clear benefits to clinicians and to patients and to practices though no
payments
• Software seemed to work well from day one..
• Lot of training supplied
• Managed to get practices and practice managers engaged in
delivering it
• Some updates/added functionality – but could do with a lot more

39. POCT
• It seems to be a great idea..
• Local labs feel threatened and complain about QI/price/undermining them
• Diagnostics budget is complex and central and not particularly under local
control to easily vary
• Mix of capital/revenue complicates things
• Not enough data on usage and costs
• Concern over accuracy
• Training requirements large
• Kit not that portable where some of use cases are at home etc..

40. Final Advice
• Be able to explain your product/service in a couple of sentences so
that people get it – and understand the benefits
• Understand who pays, who uses, how its installed/introduced, who
benefits