National supply system for high-cost tariff-excluded devices

Specialised Services Devices programme (formerly known as the High-Cost Tariff-Excluded Devices programme)

Following the programme’s restart in autumn 2020, migrations of high-cost tariff-excluded device categories to the national supply route have progressed well and delivery is now underway for phase II.  The current remit of the programme has grown to include links with wider innovations in the devices field and work on procurement processes for prosthetics centres. Recognising the work being undertaken across all programme workstreams, it is now often referred to as the Specialised Service Devices programme (SSDP).

Migrations to the central supply route: the programme has completed the majority of migrations planned to take place in phase I and ongoing support will continue for any legacy issues.

Clinical optimisation of devices: Clinical chairs and advisors in the device working groups (DWG) are continuing to refine the process for inclusion of new devices and range extensions within the existing national catalogue, as well as continuing work on device category specifications.

Financial reconciliation process (FRP): The FRP process for in scope devices is well established and we will continue to work with NHS Providers to adapt and refine this as arrangements change.

1a categories for migration: In addition to the current devices within the programme, several new categories are now to be included.  These are known as 1a migrations and work to move these additional categories to the central supply route will take place during the 2022/23 financial year.

Please read these frequently asked questions (FAQs) about our Specialised Services Devices programme (you will need to register for a FutureNHS account to access the FAQs).

Which devices are in scope?

In April 2016, NHS England Specialised Commissioning introduced a new nationwide purchase and supply system for specific categories of high-cost tariff-excluded devices.

The new system covers named ‘high-cost tariff excluded devices’ as set out in the National Tariff Payment System (Annex A: The national tariff workbook, tab 14a HC Devices). These are the devices that NHS Improvement with NHS England have agreed should be paid for separately from the national tariff, for the procedure in which they are used. This is because if they were included in the payment by results tariff, it would skew the average costs of the Health Resource Group (HRG) used to pay for the procedure.

Please note, the decision to define a device as excluded from tariff remains with NHS Improvement and NHS England pricing function and is not within the remit of Specialised Services and queries relating to the inclusion of items within the programme should be directed to the pricing function.

Following considerable work, it has been concluded that lengthening nails for limb reconstruction and circular external fixator frames should not be moved wholly onto the program due to the benefits of procuring them with the wider range of devices in this clinical area. However, they remain excluded from tariff at this stage. Two further categories that include bespoke prostheses used in orthopaedic and maxillofacial practice continue to sit outside the scope of the programme.

The 15 in scope categories include:

  1. bone anchored hearing aids – now referred to as bone conducting hearing implants (BCHIs)
  2. deep brain, vagal, sacral, spinal cord and occipital nerve stimulators
  3. intrathecal drug delivery pumps
  4. implantable cardioverter-defibrillator (ICD)
  5. ICD with cardiac resynchronisation therapy (CRT) capabilities
  6. three-dimensional mapping and linear ablation catheters used for complex cardiac ablation
  7. radiofrequency, cryotherapy and microwave ablation probes and catheters
  8. occluder, vascular, appendage and septal devices
  9. percutaneous valve repair and replacement devices (mitral/pulmonary valve)
  10. peripheral vascular stents
  11. carotid, iliac and renal stents
  12. endovascular stent graft
  13. aneurysm coils
  14. flow diverters for intracranial aneurysms
  15. intracranial stents

What it will deliver

Seen as a companion of the Lord Carter reforms with NHS Providers, Specialised Commissioning is using a similar methodology of centralised purchase and supply to deliver better quality and realise value for medical devices. This change is taking place in the context of a wider strategic change in NHS procurement for all hospital-used goods as set out in the Department of Health and Social Care’s Procurement Transformation programme (PTP) which articulates a similar national procurement approach in the new NHS Supply Chain operating model.

The Specialised Commissioning SSDP programme aims to reduce pricing variation and drive transparency, whilst providing value for money, accelerating the adoption of effective new technologies and delivering savings for the NHS from procurement opportunities via our NHS Supply Chain partners.

NHS England Specialised Commissioning and NHS Supply Chain are working with NHS Providers to support migration to the central supply route and to proactively resolve any issues during implementation. The system should see improved clinical practice and device optimisation, as clinicians will be able to choose the best device for the patient from a clinically evaluated, evidence-based catalogue.

How it will work

Delivery of the Specialised Service Devices programme has been planned in two phases. The first phase saw the migration of all NHS providers commissioned to deliver specialised services in England to a national supply system for the 15 categories in scope listed above. This system is now the mandated method by which NHS England will fund devices within the programme for use by providers. Implementation of remaining migrations and 1a categories continues to be led by two category tower service providers as part of the new NHS Supply Chain: Health Solutions team (HST) and Collaborative Procurement Partnership (CPP).

The second phase is designed to optimise device choice across the identified categories to enhance patient outcomes, improve value and deliver cash releasing and commissioner savings. To achieve this, device working groups (DWGs) will develop a clinical utilisation methodology to reduce unwarranted variation in the extensive range of available devices and NHS Supply Chain will deliver price reductions in devices purchased. The DWGs will have a role in horizon scanning to accelerate adoption of new devices demonstrated to add value.

Contacts

For general enquiries please email ENGLAND.speccomm-HCTED@nhs.net

For implementation and technical matters please email implementation@supplychain.nhs.uk

For finance related queries please email england.speccomm-hctedfinance@nhs.net