NHS England Provider Trust Frequently asked questions: Excluded Devices Service Review

Transcription

1 NHS England Provider Trust Frequently asked questions: Excluded Devices Service Review V5.0 19/12/2016 Theme 1: Scope of the Arrangement Q1.1: Does the initiative include devices within the National Tariff or those commissioned by CCGs? A: No, this initiative only relates to tariff excluded devices commissioned by specialised commissioning. However, we understand that in some areas the commissioning responsibilities and funding flows for some of the devices covered by this initiative may be being picked up by CCGs. The intention is to clarify the Information Rules (IR) for 2017/18 and where required change the contractual and allocation arrangements to ensure that all the high cost devices covered by the centralised supply chain are commissioned by specialised commissioning and therefore under the commissioning responsibility of NHS England. For 2016/17 we are reviewing options to minimise bureaucracy whilst preparing for any required local changes in 2017/18 (see Q1.6 below). Q1.2: Do we know if ICDs will be within or excluded from the National Tariff in 2016/17? A: ICDs will remain in National Tariff exclusions in 2016/17, as per the recently published National Tariff. Furthermore, the 2017/18 National Tariff Consultation Document recommends that ICDs will remain on the excluded devices list for 2017/18/19. Q1.3: What happens if the devices my Trust uses are no longer procured through this new arrangement? A: The focus of the project from April 2017 is to maximise the benefits for the NHS from aggregating all its demand for the current range of high cost tariff excluded devices. Within this initial stage, we are not looking to reduce the current range of available devices, indeed one of the potential additional benefits from this project is the ability to facilitate the timely adoption of cost effective new device technology into the NHS. However, in the longer term when we have the data to gain a more granular national understanding of device usage it is reasonable to expect that we will, through industry, our clinical advisors and reference groups, review all potential options to deliver greater benefits for the NHS. Q1.4: Are bespoke devices included in the new arrangement? A: Yes. However, we understand the complexity of the production, procurement and supply chain for bespoke orthopaedic and maxillofacial orthopaedic prostheses, and endovascular aneurysm repair devices (EVAR). Correspondingly it is our intention to work strategically with industry, clinical reference groups and Trusts to ensure these

2 devices are effectively transitioned into the new arrangement. This will clearly take longer than off-the-shelf devices and is expected to complete by spring Q1.5: Will we be able to order new products as they come to market? A: Yes. The electronic catalogue, which is currently being validated by suppliers to ensure completeness, will be updated with new products on an on-going basis, where the new product introductions are in line with procurement process. Q1.6: Does this arrangement cover non-specialised patients such as private patients or overseas patients? (Updated) A: This is a specialised commissioning initiative and there are no requirements under the National Tariff or NHS Standard Contract for Trusts to use the new arrangement for patients, other than specialised commissioning patients. However, we understand that many Trusts do not have separate arrangements for NHS and private patients in terms of procurement and stock management and that it would reduce bureaucracy if Trusts were able to order their entire excluded device requirement through a single process. Correspondingly and as a priority we are developing a recharging mechanism to accommodate this working with Provider Trusts. This is being piloted with a number of Trusts and should be available shortly. The current proposal includes Trusts reporting which devices have been used on non-nhs England patients. This in turn will trigger an invoice being sent to the Trust. This process will cover NHS Wales, NHS Scotland, Channel Islands patients, private providers and insurance companies for overseas patients. The process will also be used in the interim for NHS England to reclaim costs which have been paid by CCGs. Q1.7: Does this arrangement include all the products associated with a device that I currently purchase and recharge through the pass-through process? A: We are working with suppliers and Trusts to ensure that the electronic catalogue covers the current range of products ordered by Trusts. The excerpt below is an illustrative example to demonstrate the approach we have taken however; we will continue to work with Trusts to ensure that appropriate requirements are met:

3 Bone Anchored Hearing Aids Processor Baha 5 sound processor brown Bone Anchored Hearing Aids Processor Baha 5 sound processor black Bone Anchored Hearing Aids Processor Baha 5 sound processor silver Bone Anchored Hearing Aids Processor Baha 5 sound processor blonde Bone Anchored Hearing Aids Processor Baha4 sound processor in chestnut brown Bone Anchored Hearing Aids Processor Baha4 sound processor in champagne blonde Bone Anchored Hearing Aids Processor Baha4 sound processor in soft black Bone Anchored Hearing Aids Processor Baha3 power sound processor BP110 in slate grey Bone Anchored Hearing Aids Processor Baha4 sound processor in slate grey Bone Anchored Hearing Aids Accessories BIM400 Implant Magnet Bone Anchored Hearing Aids Processor Baha3 power sound processor BP110 in chestnut brown Bone Anchored Hearing Aids Processor Baha3 power sound processor BP110 in soft black Bone Anchored Hearing Aids Processor Baha3 power sound processor BP110 in champagne blo Bone Anchored Hearing Aids Processor Baha 5 sound processor copper Bone Anchored Hearing Aids Implant + Abutment BIA400 Implant 4mm W Abutment 10mm Bone Anchored Hearing Aids Implant + Abutment BIA400 Implant 4mm W Abutment 8mm Bone Anchored Hearing Aids Processor Baha cordelle II body worn with black transducer Bone Anchored Hearing Aids Implant + Abutment BIA400 Implant 4mm W Abutment 12mm Bone Anchored Hearing Aids Implant BI300 Implant 4mm Bone Anchored Hearing Aids Processor Baha cordelle II body worn with beige transducer Bone Anchored Hearing Aids Processor Baha4 sound processor in ocean blue Bone Anchored Hearing Aids Accessories Baha 5 Demo, Black Bone Anchored Hearing Aids Implant + Abutment BIA300 Implant 4mm With Abutment 9mm Bone Anchored Hearing Aids Processor Baha cordelle II body worn with grey transducer Bone Anchored Hearing Aids Accessories Prescription only- Abutment Snap Coupling 8.5 mm Bone Anchored Hearing Aids Abutment BA210 Abutment 8.5mm For Flange Fixture Bone Anchored Hearing Aids Accessories SP Magnet 3 Black Bone Anchored Hearing Aids Accessories Flange Fixture ST 4mm Bone Anchored Hearing Aids Abutment BA400 Abutment 12mm Bone Anchored Hearing Aids Accessories Irrigation Tubing Set Bone Anchored Hearing Aids Accessories Headband Bone Anchored Hearing Aids Accessories Cochlear Baha Telecoil Bone Anchored Hearing Aids Accessories Baha 4 Demo Brown Bone Anchored Hearing Aids Abutment BA400 Abutment 10mm Bone Anchored Hearing Aids Accessories SP Magnet 4 Black Bone Anchored Hearing Aids Accessories Testband Bone Anchored Hearing Aids Abutment BA400 Abutment 14mm Bone Anchored Hearing Aids Abutment Cochlear Vistafix VXA300 Abutment 3.5mm Bone Anchored Hearing Aids Accessories SP Magnet 2 Black Bone Anchored Hearing Aids Accessories Conical Guide Drill 3+4 mm Q1.8: Does the new arrangement cover the stock already paid for by Trusts and if so will NHS England be buying this stock? A: No. Existing stock purchased by Trusts should be charged to commissioners as it is used through the pass-through system following the existing reimbursement process. Once migrated over to the new system Provider Trusts should run this stock down and will continue to receive reimbursement by NHS England using this existing method. Provider Trusts should continue to record the value of stock on their balance sheet as it reduces and until it has fully depleted. At this point, stock held in the Trust will have been replenished by the new transactional model and paid for at point of order by NHS England. The levels of stock held and products used will be understood through the new financial reconciliation process as referenced in Q1.6. Again, clarity of this process will be shared with you as soon as it is available. Q1.9: Is this scheme mandatory? A: Yes. All high cost devices covered by this initiative will be sourced through the centralised supply chain arrangement. The National Tariff and NHS Standard Contract guidance were changed in 2016/17 to provide the regulatory framework to facilitate this change. Non-compliance with the requirements of this initiative would ultimately result in a breach of contract and non-payment. However, this is a transformational initiative with system-wide support and following dialogue with advisors and Trust colleagues, NHS England is implementing a phased process of collaborative transition.

4 Trusts should expect to be contacted in advance of implementation by NHS Supply Chain. Trusts will be requested to nominate a lead contact point (Trust Champion) and arrange an introductory meeting with NHS Supply Chain. Through collaborative dialogue a bespoke implementation plan is then developed for each Trust based on existing contractual commitments and systems. Q1.10: What are the implications of the changes to the high cost device list proposed in the 2017/18 Tariff Engagement Document (TED)? A: The TED considers the removal of 11 high cost device categories from the excluded list. However, the Further Policy Development Document states that: We will look to ensure that changes to the high cost devices list are appropriately aligned with NHS England procurement policy The final published consultation document recommends that the 9 categories outlined below that are covered by the centralised supply chain will remain on the high cost device list for 2017/18/19: 3D mapping and linear ablation catheters used for complex cardiac ablation procedures Aneurism coils Carotid, Iliac and renal stents Deep brain, vagal, sacral, spinal cord and occipital nerve stimulators Endovascular stent grafts Flow Diverters for intracranial aneurisms Intracranial stents Percutaneous valve repair and replacement devices Peripheral vascular stents Follow up note on bifurcated stents We introduced a new category of bifurcated stents onto the list for the TED, as we wanted this type of stent to remain on the high cost list, whilst removing others into the scope of tariff. As we are no longer moving stents into tariff, we do not need to separately identify bifurcated stents. Although the category will not appear, they will remain on the high cost list under stents. Q1.11: Why do I need to provide my Trust baseline data? A: Trusts baseline data has 2 important uses. Firstly, the provision of your Trust baseline usage and pricing data in a consistent, transparent and coordinated way will provide the visibility and understanding required to benchmark NHS national pricing, inform our procurements and develop an informed national savings road map. Secondly it will help us ensure that we do not pay higher prices during the transition period prior to the completion of new national procurements. Q1.12: Can we have access to the list of products that will be available by supplier and device type under the new system? (New) A: Yes. Please contact your Implementation Manager or implementation@supplychain.nhs.uk for the latest copy. However, it should be noted that the catalogue is constantly evolving as new products become available. It should also be noted that the latest catalogue is signed off with each Trust prior to them going live as part of the implementation process to ensure service continuity.

5 Theme 2: Timing of the Arrangement Q2.1: The commissioning intentions were published on 30 September 2015 and state that Provider liabilities for contractual volume commitments entered into prior to 1st October 2015 would be honoured as part of transition plans. This only appears to be 1 days notice, is that correct? A: The commissioning intentions have given 6 months notice from 1 April Therefore from 1 October 2015 providers shouldn t have entered into new contractual arrangements or extend existing arrangements that have implications beyond 31 March There were no restrictions on a provider agreeing new arrangements that only run up to 31 March Q2.2: What happens with contracts that were put in place before 30 September 2015 that run beyond 31 March 2016? A: In line with the commissioning intentions and the NHS Standard Contract 2016/17, NHS England will be honouring the terms of existing supply agreements entered into prior to 1 October 2015 pursuant to a lawful procurement process*. However, we understand that there may be some arrangements that do not fully meet all of the expected requirements but are based on what could be considered a legally binding agreement with a supplier. These should be discussed with the Implementation Team to ensure that we fully understand all future volume commitments that have been made. We also recognise the potential commercial sensitivity regarding the sharing of contractual arrangements. If a Trust has any issues with sharing this information with NHS Supply Chain then NHS England will liaise directly with the Trust to facilitate the required level of disclosure to enable the dispensing clauses in the National Tariff and NHS Standard Contract regarding existing contracts to be enacted. * The tender process should have followed relevant EU procurement legislation and show fair, transparent and equal treatment towards all suppliers. Depending on the value of the tender it should be searchable on Tenders Electronic Daily and/or Tenders Direct and have an OJEU reference number. Q2.3: Are all Trusts being transitioned to the new arrangement at the same time? (Updated) A: The initial plan was to migrate a first wave of 57 Trusts. These Trusts have the highest annual expenditure plans for high cost devices and account for 91% of total expenditure. However, we have been approached by a number of wave 2 Trusts wanting to migrate quickly, and where this has been possible we have done this. The expectation is that all wave 1 Trusts will have started ordering and all wave 2 Trusts will have been contacted about implementation plans by the end of the financial year. We are also working closely with the South Region to accelerate the process across all relevant Trusts. The initial focus is on ICDs and CRT-Ds.

6 Q2.4: Are all categories being transitioned to the new arrangement at the same time? A: This will depend on the categories of devices a Trust uses, when current contractual volume commitments end and the Trust specific implementation plan. However, in general terms it is expected that bespoke devices (see Q1.4) and outsourced arrangements (see Q3.7) will be transitioned later in the process. Theme 3: Operation of the Arrangement Q3.1: What guidance is there to support the implementation of the new arrangement? A: Six months formal notice of the new arrangement was given in the commissioning intentions published on 30 September Furthermore, this has been reflected in the 2016/17 National Tariff Payment System and the NHS Standard Contract 2016/17. The 2016/17 National Tariff Payment System sets the price payable for devices based on the new arrangement and the NHS Standard Contract 2016/17 contractually mandates the new arrangement. Q3.2: What happens during the transition period before the new model is implemented? A: Devices should be ordered under the current arrangements whilst providers are transitioned onto the new arrangement. The cost paid for these devices will be reimbursed under the pass-through process as per the 2016/17 National Tariff Payment System. If Providers experience any issues operating their current supply arrangements during the transition please contact us and we will support your discussions with suppliers if required. Q3.3: Will I still be reimbursed for devices used if I am out of contract and awaiting implementation to the new model? A: Yes. If you experience any issues in sourcing devices during the transition period please contact us and we will support your discussions with suppliers if required. Q3.4: What will NHS England do with the savings generated from this arrangement? A: The current and expected growth in expenditure on high cost tariff excluded devices far exceeds the growth in the NHS budget. This arrangement is an important part of the arrangements being put in place to sustainably meet the requirements of our patients within available resources. The expected savings from this arrangement have been incorporated into our financial plans to support the improvement of services in 2016/17. Q3.5: Will the new arrangement impact on supplier rebate schemes? A: No. All suppliers who operate rebate schemes within their prices will be incorporated into the new arrangement. Where rebate schemes are incorporated into contracts that run past 31 March 2016 Trusts should continue to invoice NHS England for reimbursement of the cost of the product, any rebates and / or discounts

7 received under the terms of that contract, and should be commercially neutral for suppliers and the NHS. Q3.6: Historically we have aggregated in-tariff and national tariff excluded devices spend from the same supplier and secured overarching financial benefits for our Trust. In some instances, these benefits are hard to then break down and attribute to specific device categories e.g. where a rebate applies to the Trusts total spend. Isn t there a risk that these benefits to the NHS will be lost? (New) A: NHS England is working closely with the NHS Business Services Authority (NHSBSA) to monitor all device prices including in-tariff devices that are not mandated to transfer over to the National NHS framework agreements (see Q3.13). However, we are aware that during the transition period until new frameworks are in place there may be difficulties in maintaining complex benefits schemes. We want to work with Trusts and suppliers to ensure that the full value from these incentives are achieved where appropriate. This is particularly relevant in device categories such as ICDs where contract arrangements are generally more complex. In response to this we have taken a hybrid approach. Clearly where we have available frameworks that can immediately offer improved value for the NHS we will migrate Trusts straight away. However, where a complex benefits scheme may offer better value we are working with Trusts, their suppliers and procurement partners to fully understand the options available. Where appropriate and possible we will look to migrate existing complex arrangements that add value into the Zero Cost Model when the new framework is implemented at the start of the 2017/18 financial year. Q3.7: Some suppliers have expressed concerns that NHS England will expect better prices for tariff excluded devices from aggregated demand whilst Trusts will expect to maintain the full range of benefits they received when they procured both in-tariff and tariff excluded devices. Is it possible for NHS England to clarify this situation? (New) A: The answer to this question should be read in conjunction with Q3.6. NHS England is looking to improve the value that the NHS achieves from its significant annual investment in high cost devices by aggregating demand and wherever possible reducing the cost to supply the NHS. We will actively work with the market to develop national volume commitment, improve clinical effectiveness and adopt new effective technologies. NHS England does not want to see price reductions in tariff excluded devices being driven by price increases in in-tariff devices. Moreover, NHS England understands that Trusts, procurement hubs and collaboratives will continue to drive value for the NHS from procurement activities for in-tariff devices. The expectation is that Trusts will continue to work with suppliers to balance commitment and value and this may include complex deals. However, going forward these complex local deals should just relate to commodities that the Trusts are procuring. Importantly, understanding the detail and breakdown of your agreements, enabling complete transparency, will allow us to help you work this through with your suppliers.

8 Q3.8: What if prices go up? A: The intention of this initiative is to maximise the buying power of the NHS for high cost tariff excluded devices. Our analysis shows that savings can be made by moving onto prices currently available under existing frameworks. When we have robust data we will put in place new frameworks that realise the benefit of aggregated NHS demand. This should further reduce the average price paid by the NHS. There may be some localised instances where the NHS receives exceptional prices e.g. where a supplier has offered introductionary prices or a provider has taken advantage of spot purchasing offers. These may well be lost in the move to national purchasing; however, they will be more than offset by consistently lower average prices. Q3.9: What will happen to high cost tariff excluded devices that are included in outsourced arrangements, such as those in place for some Cath-labs? A: In our stocktake of current contractual arrangements we were not notified of any outsourced arrangements coming to an end by 31 March During the implementation phase we intend to identify all such arrangements and agree bespoke plans with each Trust going forward. We are aware that a number of Trusts are currently considering new managed service options that include services that use some of the high cost devices covered by the central supply chain arrangement. We are currently validating a proposed way forward with a number of managed services providers and should be able to distribute more information shortly. Q3.10: Will Trusts be able to maintain consignment stock or will this be held by NHS Supply Chain and how will it be processed? A: Trusts will be able to order devices to maintain the level of consignment stock required to operate their emergency and elective services. This initiative should not impact the good work carried out by both Trusts and suppliers to effectively manage inventory and reduce unnecessary stock holdings. This will include stocktakes to enable NHS England to appropriately account for consignment stock ordered through the new arrangement. When a product is ordered to replenish consignment stock, the details of which patient the implanted product has been used in will be recorded and invoiced as part of the new financial reconciliation process currently being explored as referenced in Q1.6. Both Trusts and suppliers have asked if NHS Supply Chain could be utilised to further reduce the burden of consignment stock within the NHS. Although this is being looked at it is unlikely to be a factor in the short term and devices will be delivered directly to Trusts from suppliers as per the current arrangements. Q3.11: Will there be deterioration in delivery lead times? A: No, there should be no change in delivery arrangements and service standards. Q3.12: Will suppliers still be able to loan equipment to Trusts? A: This has been raised by a number of Trusts and suppliers. Current NHS Supply Chain frameworks do not include loan equipment and from our research it does not appear that the provision of loan equipment has been routinely evaluated in other NHS procurements. However, this will be reviewed for future NHS Supply Chain

9 procurements, and during the transition period Trusts should operate their existing governance arrangements with regards to equipment loans. Q3.13: Should Trusts expect to see an increase in the cost of in-tariff items from suppliers who also produce high cost tariff excluded devices? A: No. NHS England and NHS Supply Chain have consistently made it clear to industry and Trusts that the intention of this initiative is to reduce costs for the NHS and not merely to shift the balance of cost and benefit between different elements of the NHS. Q3.14: Will Trusts be able to see the price of the devices they order? A: The online NHS Supply Chain catalogue will have a zero-price for all devices. However, we have been approached by a number of Trusts and clinicians who have said some visibility of price differentials will support front-line initiatives to improve the cost effectiveness of services. Some Trusts who wish to utilise the new arrangement for private services have also requested advanced pricing information. In support of this a product price list will be issued to Trusts so that it can be used for owned stock valuation for balance sheets, insurance purposes and to quote and recharge non-nhs England funded procedures. Further information and clarity on this will be provided to Trusts as soon as it is available. Q3.15: Will Trusts be able to make bulk purchases to maintain effective operational stock levels? A: Under the new system Trusts will retain the right to bulk order and hold levels of NHS owned stock to meet operational requirements. Clearly Trusts will no longer need to place bulk orders to get volume related price discounts as this is being delivered at the national level by aggregating total NHS demand. This should work to the benefit of both Trusts and suppliers. Although the expectation is that overall stock levels will reduce across the country lowering the risk, costs and disadvantages associated with bulk purchasing for Trusts, it is recognised there will be a continued need for Trusts to hold adequate levels of stock to assure continuity of service. Q3.16: Can I still swap expiring stock? A: Stock management is expected to be undertaken by the Provider Trusts, with a focus to avoid stock expiration. As Trusts are responsible for the relationship with their supplier representatives, they are encouraged to continue to manage the swapping out of stock close to expiration with them, in order to mitigate waste and cost to the NHS. NHS England will monitor stock expiry incidents through the new financial reconciliation process as referenced in Q1.6. Q3.17: Will I still have access to the free of charge items which I currently receive? A: Products and associated kit required to use a device, which under the current system are described as free of charge will be included in the device price and be part of the new excluded devices operating model. Training required to ensure correct and safe use of a product will also be included and will continue to be provided. Any products or capital equipment being provided free of charge should be intrinsically linked to the consumables and devices being purchased.

10 Q3.18: How will Trusts need to process and reconcile purchases made under the new model and how will this work alongside the processing of stock purchased prior to migration i.e. Trust-owned stock? A: As referenced in Q1.6 this will be addressed as part of the new financial reconciliation process update. Q3.19: Once my Trust has migrated over to the new system what happens if we order an excluded device direct from a supplier? A: The Trust will not be able to recharge NHS England for that device. However, there is no restriction on Trusts directly purchasing excluded devices for non-nhs England patients such as private patients. Q3.20: How will potential finance issues, such as balance sheet transfers and stock returns, be handled? (New) A: The stock that Trusts currently purchase is owned by the Trust and will appear on their balance sheet. Eventually that stock will be used and the balance sheet value will go down to zero. Because NHS England is paying for the new devices, it will have the new stock on its balance sheet. So, there shouldn t be any requirement for balance sheet transfers. This is being reviewed as part of our pilot of the financial reconciliation process. For Trusts continuing to hold supplier owned consignment stock, there will be no change in process. The supplier will retain the value on their balance sheet and commercial agreements for the provision and management that exist now will continue between supplier and Trust. Q3.21: Will Trusts have to do stock returns to NHS England under the new system? (New) A: The intention is that the monthly financial reconciliation process will negate the need to undertake separate stock returns for NHS England-owned stock. This will be confirmed as part of the financial reconciliation process. Q3.22: Who will be liable for damaged or stolen devices? (New) A: The liability for damaged or stolen devices is dependent on who owns the stock. Stock that Trusts currently own and will use until depleted, when they will then order from the new Zero Cost Model is the responsibility of the Trust. Ownership of the supplier-owned stock e.g. consignment, will be the responsibility of either the supplier or the Trust, dependent on the consignment agreement. Effective stock management is an important element of Trust operations and this will not change with the new arrangement. Q3.23: Could NHS England provide a shared audit view of the change in process plus clarification of how these changes feed into other finance returns e.g. reference cost? (New) A: This is currently in progress. We are currently in contact with NHS Improvement around reporting and how it impacts on tariff, and we plan to do the same around reference costs.

11 Q3.24: What is the plan for duplication of procurement functions? Are we being asked to reduce headcount in our procurement team? (New) A: No. The expectation is that any freed up procurement resource will be redeployed to implement the Carter recommendations. Q3.25: How is migration to the national procurement and supply chain for excluded devices impacted by GS1 compliance? (New) A: GS1 compliance has a number of aspects, however, in terms of this initiative the key elements relate to GTINs (Global Trade Item Number) and GLNs (Global Location Numbers) linked to Requisition Points. NHS Supply Chain is currently working with suppliers to obtain the GTIN information where available so that this can be linked to the corresponding NHS Supply Chain NPC code in our systems. The GTIN will then be transmitted to NHS Trusts in the standard electronic and manual catalogue feeds. It is anticipated that GTINs will be populated in our systems from the NHS GDSN (Global Data Synchronisation Network) when available rather than from suppliers directly. The DH target date for GS1 compliance in class 3 devices is September GLNs from the 6 GS1 demonstrator sites are being mapped to NHS Supply Chain Requisition Points and will be completed by April Q3.26: Currently a number of products included in the excluded devices list are co-commissioned - so they may be reimbursed by NHS England on some occasions and then CCGs on other occasions. Is NHS England aware that if all excluded devices are purchased via the new system then this may result in increased costs for NHS England and decreased costs for the CCGs? (New) A: These anomalies should be addressed in the new information rules from 2017/18 onwards. Please see Q1.6 for information on the arrangements during 2016/17. Q3.27: Previously, Trusts were informed they would have full choice of products from the excluded devices list and that there would no longer be a requirement to commit to usage on excluded devices with suppliers or undertake local level procurements. We are now being told that this approach has changed and Trusts will now have to provide commitment to usage for some areas in order to facilitate migration to the centralised supply chain. Can you confirm this is the case? (New) A: Trusts will have full clinical choice of devices and are not obliged to provide volume commitments going forward under the centralised supply chain. However, during the migration period a number of opportunities have arisen to extend existing commitment arrangements that are beneficial to Trusts and the NHS as a whole. This approach will be dependent on the agreement of Trusts and of course the relevant suppliers and full data transparency. We are also developing our national approach to volume commitment. Understanding Trusts historical baseline data and usage forecasts will provide useful insight in that process. Other than in the specific transition arrangements mentioned in the paragraph above the provision of this data will only be used to develop NHS England commitment arrangements.

12 However, from the dialogue we have had with industry we are aware that a number of suppliers are keen to maintain Trust and Trust collaborative levels of volume commitment if possible. We will closely review all supplier submissions to national tenders and assess the available options and benefits available to the NHS, and discuss this with Trusts as appropriate. Version Control Version: 5.0 Author: <Michael Whitworth / Mark Kilner> Status: Official