A Trust's perspective on the transition to HCTED

Wednesday 30 August 2017

We caught up with Mark Stevens, Head of P2P, Procurement and eCommerce Department at Central Manchester University Hospitals NHS Foundation Trust to chat to him about how their transition to HCTED has been going. Before hearing from Mark take a closer look at the system.

HCTED Background

Wide variations in the prices hospital trusts pay for the same products, in the rates of adoption and usage of devices across the country saw NHS England spend around £500 million a year on High-Cost Tariff-Excluded devices such as implantable cardioverter defibrillators for people with abnormal heart rhythms and bone conducting hearing implants.

In April 2016 NHS England introduced a new nationwide system for purchasing High-Cost Tariff-Excluded Devices (HCTED) used in specialised services. By taking a more rigorous commercial approach, the advantage of economies of scale and reducing price variations, it is estimated that tens of millions of pounds can be saved from the annual cost of devices.

How it works

The new system for hospital trusts to order devices for specialist services will be operated by NHS Supply Chain. The approach involves a transactional model involving zero cost to healthcare providers.

Rather than separate hospital trusts paying for the devices and being reimbursed by NHS England as previously happened, providers will place orders for devices with NHS Supply Chain at zero cost to them. NHS Supply Chain will then place the order with suppliers and invoice NHS England.

The system in action

Over 50% of all Provider Trusts within scope of the programme have now migrated across to the new model across 11 device categories.

NHS Supply Chain is continuing to work closely with Provider Trusts to ensure the continuation of the programme for the remaining categories. Provider Trusts who have migrated have reported that once one category has transitioned the remaining categories are more easily implemented.

Thanks for talking to us today Mark Can you tell us when your trust migrated over to the Zero Cost Model (ZCM) and how many categories you have implemented using the HCTED system?

1. Audiology Bone Conducting Hearing Implants (BCHI)

2. Cardiology Occluder, Vascular, Appendage and Septal devices

3. Heart Valves Percutaneous valve repair and replacement devices – mitral/pulmonary valve

4. Neuromodulation Deep brain, vagal, sacral, spinal cord and occipital nerve stimulator.

Has it made a big difference to your trust and how you order HCTEDs? No, it hasn’t made a big difference to how we order HCTEDs, as we use a third party inventory service it was just a case of uploading the supply route on the agreed day. How easy has the transition been? We met with Darren Machen [NHS Supply Chain’s Implementation Manager] to discuss usage and suitable categories and then followed the process on each area which made implementation easier.

Mark Stevens CMFT

HCTED Implementation process with CMFT

1. Shared HCTED usage figures and departments - The trust provided HCTED baseline data which was then cleansed by NHS Supply Chain and the clinical lead from the trust. Baseline data and pricing information is critical to ensure that, during migration to the Zero Cost Model (ZCM), no additional cost is accepted by the NHS and to ensure that all existing products required to deliver services are available.
2. Product match - Their bulk baseline data was matched against the ZCM catalogues. Any products in scope from the bulk download that were not in the catalogues were added following a check that the devices were NHS England funded excluded devices.
3. Inform - All internal parties are informed at least a month in advance of migration.
4. Availability - Ensure all items in the range are available, to maintain full clinical choice.
5. Make global change - The trust replaced their old catalogues with the new ZCM catalogue in their purchasing systems, removing any chance of the incorrect codes been ordered and confirming the total switch to the ZCM.
6. Mask/delete old products - To ensure that moving forward all HCTEDs are now only purchased via the new centralised system.

  Did you encounter any complications during the transition and if so how did you overcome these? We had to factor in different lead times and also the eDirect route. What have been the immediate benefits to your trust and how do you see this benefitting the NHS in the long term? Transparency, I think it’s a great initiative and will allow a fair price for all. Have you had much support from your Implementation Manager at NHS Supply Chain to implement the process? We couldn’t have managed this process as fluently as we have without the input of Darren Machen. He has helped us manage the process at each stage and met with stakeholders within the trust to help provide the bigger picture view of the NHS. Do you think it’s important for all trusts to work together on this? Yes. We are working alongside the Shelford Group and have also successfully implemented four stages of the programme by ourselves. There should be no barriers to making this move. If you were speaking to a trust that is yet to migrate over to the ZCM, what advice would you give them? Involve all interested parties at the start and keep them updated, make sure your data is accurate and all the products are covered. Interested parties include key stakeholders within a trust – Procurement, Finance, IT, Clinical Teams (Departmental Leads), End Users (who place orders). Plus any Contracting Teams that work with their regional NHS England Supplier Manager as these are often engaged afterwards once we obtain NHS England support. What are your recommendations for migrating over to this system? Make sure you have all communication out in advance to insure that internal stakeholders are aware of the changes, keep finance and clinical colleagues informed, ensure your systems have the correct up to date information; this makes any change a lot simpler.

For general enquiries, updates and a copy of the latest NHS England Provider Trust FAQs contact: England.Speccomcommercial@nhs.net

Unsure if your trust is in or out of scope of the HCTED programme; or you have some implementation or technical queries? Please email: implementation@supplychain.nhs.uk

For more information on the new system, including detail of the devices it covers click here

For more information on how NHS Supply Chain is supporting the programme click here