Selling to the NHS Naidex Talk April 2013

I recently spoke at the Independent/assisted living conference Naidex National in Birmingham about ‘Selling into the NHS’ how can small businesses successfully win contracts and sell into the NHS. 

This article summarises this topic.

I have been involved with selling to the NHS for over 20 years, initially 9 years with Becton Dickinson the global US single use device manufacturer then 3 years with Smiths medical where my last role was Global VP for their hospital infusion business. Since leaving Smiths I have pursued a number of business interests all mainly focussed on the commercialising and promoting of new medical technologies. The NHS has been going through change ever since I was a young salesman in 1990 and as a supplier it is vital to keep abreast of these ongoing changes. 

The customer is busy with more patients, more forms to complete and less staff to do the work. We are all living longer and our health needs, as we age, get more complex and require greater levels of intervention. The customer is as much concerned about what their job will be or if they’ll have one in the midst of all the changes as they are about your great new product.

Thus as a supplier it is not enough to simply have a great product the real challenge is gaining acceptance and adoption. To do this we need to understand the following;

• Who is the customer of today?
• What are they trying to achieve?
• How can my product/service help with this?
• What is the jargon?
• What is the contracting landscape?

Andy Burnham Shadow Secretary of state for health speaking in September 2012 ‘Moderngov’ magazine about the coalition changes to the NHS said;

“They’ve basically removed the ability to plan and control the service.’

‘That part of the service has been broken and the genie is out of the bottle. I don’t shy away from the fact that it does mark a fundamental departure in NHS history, it is the end of the NHS as we have known it.’

Customer Need

One of the critical success factors to selling to the NHS is in understanding what the customer wants. I was surprised when I asked the audience at the conference that no-one had read the government reports ‘Innovation Health and Wealth Accelerating Adoption and Diffusion in the NHS’ December 2011 or ‘Investing in UK Health and Life sciences’ December 2011.

Both of these free reports highlight key programmes and metrics by which organisations delivering healthcare will be monitored. From an assisted living viewpoint the first report states;

“We will launch a ‘Child in a chair in a day’ programme to transform the delivery of wheelchair services throughout the NHS’. If I was in this business I would wish to understand;

• Who is managing this programme?
• What does each local authority or healthcare provider have to do to meet the programme metrics?
• What is the funding behind the programme?
• And most importantly -how can my products hep the customer achieve their targets for this programme?

I still have a copy of a written memo "those were the days" that I wrote in September 2000 when I was Sales and Marketing Director at Smiths Medical. The labour Government launched the NHS plan In July 2000. We bought 100 copies of this report and the memo went to all senior staff within the business explaining the key areas of the plan and how it might affect our business. This included our sales and service offer, our product mix, how we could improve our product quality and what product changes maybe required to meet the future market need. This was the start of what is now termed Public Policy Research.

Key Tip

If you can align your product to a key metric your customer needs to achieve then this is a great starting point to get your products adopted.

Clinical need

Imagine your customer posed a clinical need and then paid you to develop a solution for this need. “Does it sound too good to be true? Well it isn’t.”

The government has a programme whereby it sets out some future healthcare challenges then invites R&D proposals to meet these and will ‘buy’ the R&D. In effect the customer is paying you to develop and idea to solve their problem. The programme is the Small Business Research Initiative (SBRI). www.innovateuk.org/deliveringinnovation/smallbusinessresearchinitiative.ashx funded by the Technology Strategy Board (TSB).  

A clinical challenge is posed. Initial bids of up to £100k are invited to develop a solution to the challenge and then up to 10 x £100k awards are made. Follow on funding of up to £1m is available for some of the competitions.

Recent competitions in the Independent/assisted living space include one in 2011 for ‘Improving the Health of People with long-term Conditions ‘Personalisation and Empowerment. In 2012 there was also a competition and here is a quote from the briefing document

‘The Doh and NHS Midlands and East are running an SBRI competition in the health sector to help industry bring new technologies to support the achievement of regional health priorities and increase the possibility of adoption in the NHS.  The competition is open to all companies, including those not currently engaged in the health sector. The focus of this new competition will be to find ways of improving patient compliance via medicines management, a key challenge in the independent/assisted living space.’

Key Tip

If you can align your product to a publicly declared clinical need then once again this goes someway to aiding its adoption

Clinical Appraisal

The National Institute for Health and Clinical excellence (NICE) is traditionally associated with the appraisal and recommending of drug therapies. What is not so well known is that they have a free technology appraisal process for medical products.

http://www.nice.org.uk/aboutnice/whatwedo/aboutmedicaltechnologies. This is for launched products that have a CE mark and some sales in the marketplace. The free review is conducted by an independent panel and assesses product performance evidence submitted by the company and well as assessing other reference sources. The usage advice for devices is advisory unlike the more mandatory drug advice.

Know the Jargon and keep up to date

The following are all bodies one hears mentioned in talks or reads about in articles on the NHS. It is critical to have an understanding of what these organisations do, what they are trying to achieve and what impact they may have on your product being bought and adopted.

CQC- Care Quality Commission

QIPP - Quality Innovation Productivity Prevention

DOH - Dept of Health

CCG -Clinical Commissioning Groups that will replace PCT’s in 2013

NICE -National Institute for health and clinical excellence

TSB - Technology Strategy Board

SBRI - Small Business Research Initiative

HIEC - Health Innovation and Education Cluster - Industry/Academia/Clinical Partnerships

CPH - Collaborative Purchasing Hubs

HTA - Health Technology Appraisal

MHRA - Medicines and Healthcare Products Regulatory Agency

Quality Innovation Productivity Prevention

www.improvement.nhs.uk/Default.aspx?alias=www.improvement.nhs.uk/qipp

I am going to expand on one very important programme; QIPP and how to sell to the NHS you need to be using this language.

The DOH website states -

QIPP – Quality, Innovation, Productivity and Prevention – is a large scale transformational programme for the NHS, involving all NHS staff, clinicians, patients and the voluntary sector. It will improve the quality of care the NHS delivers while making up to £20billion of efficiency savings by 2014-15, which will be reinvested in frontline care.

This can be further expanded across the 4 elements.

• Quality – products, training, services, people.
• Innovation – services, patient and care pathways, products.
• Productivity – quicker, lighter, more efficient, easier to use, cheaper to use

(de-skilled member of staff) reduces or removes the need to attend hospital, reduces the dwell time in hospital, allows care/treatment that is traditionally hospital based to be non-hospital.

• Prevention of problems - safety, infection, reduce demand for services by making population healthier - increasing health and well being, lifestyle, exercise, diet, alcohol, smoking.

If you’re selling to the NHS you need to begin to sell and market your products using this language, sit back and consider your product in the following way;

• Who may use my product? – e.g. an elderly person at home
• Who may influence this product use? – their Adult children, carer, OT
• Who may purchase the product? – Local Authority, PCT, user or influencer themselves
• This is your decision making unit DMU.
• Whose daily working routine or clinical pathway or patient pathway will your product/service touch or have an impact on?
• What does each person in the unit want from the product?
• How will your sales and marketing message differ for each unit member?
• How can you align your product with the objectives of QIPP for each user type?
• This then informs your sales and marketing approach and moves you away from features and benefits selling, to a more sophisticated communicative sell.

Key Tip

If you can speak the language your customer understands, then this is a great starting point to get your products adopted.

Contracting and Purchasing Landscape

One you have got a good understanding of what your customer needs, the clinical need they have and the jargon they’re talking we can turn our attention to the contracting and purchasing landscape. This is an ever changing picture and not one that be explained fully in a brief article.

The key medical device/product purchasing body is NHS Supply chain www.supplychain.nhs.uk. This is managed by DHL on a 10 year contract. They have pledged to save the tax payer £1bn by introducing innovative new products and services. Hard evidence of this is hard to find and the website talks about increasing volumes, reducing suppliers and increasing compliance to tenders. Nevertheless they are an important organisation to work with.

They purchase over 620,000 products from baked beans to MRI machines. They have a range of purchasing categories and contracts including Rehabilitation, Pressure Area Care and Continence care. One contract awarded in February 2012 was for ‘Simple Aids for Daily Living and associated Products’. This included bathing aids, dressing aids, home aids and toilet aids. The contract statement said;

‘NHS Supply Chain is pleased to announce the launch of the Simple Aids for Daily Living Contract offering a comprehensive range of products from leading suppliers to meet a 'one stop shop' strategy. This contract has been compiled in line with the government initiative “Transforming Community Equipment” to meet the demands of the primary care market.’

These framework or national agreements very rarely give a volume commitment to a supplier. They are much more a licence to sell your product and a basic validation that your product meets the contract specification, e.g. is it CE marked? Does it meet the pre purchase criteria and that you have an agreed pricing mechanism for trusts to pay?

You still need good old fashioned boots on the ground sales people to then promote your product to the end user and ensure adoption.

Regional or local purchasing also takes place with local trusts forming Collaborative purchasing groups and individual hospitals awarding contracts. These arrangements in theory do not offer the business potential of the national awards, however they should give you a volume commitment, are likely to be built more on trust than the filling in of forms and will be easier to manage and defend.

Another way to approach the market place is to partner with an established supplier and use them as a distributor. They will have an experienced sales team; lots of contacts, an associated product portfolio and the market knowledge to gain you market entry.

These suppliers can be found in a couple of ways, the NHS supply chain website above lists not only awarded contracts and products but supplier names as well. The www.contractsfinder.businesslink.gov.uk website tells you the name and address of suppliers if you go to;

• Advanced search
• Select ‘details of what government has bought and is buying’ section
• Type in product type in search box and pending or awarded contracts can be seen along with the product details and supplier names.

In Summary

The NHS is an ever changing and complex organisation to deal with, there are

Multiple entry levels for new products and small suppliers need to focus their efforts.

My advice is to go for small to medium sized accounts first to gain some sales, build come confidence in the product, recruit some product champions and validate that the product meets the needs of the various customer types as you expected.

Then you can start to build your business case for the larger opportunities that will take longer, be more competitive, more complex but hopefully more rewarding.

Know your customer, know what they want, know how they are being measured, know who the DMU is and what their needs are. Align your product/service to these needs and wants with QIPP. Research the contracting landscape and happy selling.