National supply system for High-Cost Tariff-Excluded Devices

In April 2016, NHS England Specialised Commissioning introduced a new nationwide purchase and supply system for specific categories of High-Cost Tariff-Excluded Devices (HCTEDs).

Which devices are in scope?

The new system covers named ‘high-cost tariff excluded devices’ as set out in the List of High Cost Devices in the 2017/19 National Tariff Payment System (Annex A, Tab 13a HC Devices). These are 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 PbR tariff, it would skew the average costs of the Health Resource Group (HRG) used to pay for the procedure.

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.

The following 15 HCTED categories are currently within scope of the programme:

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. ICD (Implantable Cardioverter-Defibrillator)
5. ICD with CRT (Cardiac Resynchronisation Therapy) capability
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
13a. Aneurysm coils
13b. Flow diverters for intracranial aneurysms
14. Intracranial stents
15. Lengthening nails for limb reconstruction and circular external fixator frames

Two further categories that include bespoke prostheses used in orthopaedic and maxillofacial practice are currently outside the scope of the programme.

What it will deliver

Seen as a companion of the Lord Carter reforms with NHS trusts, 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 HCTED 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 trusts to support migration to the new model 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

The Specialised Commissioning HCTED programme has two stages. The first is to migrate all NHS trusts commissioned to deliver specialised services in England to a national supply system for the identified HCTED categories (see above list). This system will become the mandated method by which NHS England will fund HCTEDs within the programme for use by trusts. This implementation phase is being 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.

NHS England Specialised Commissioning and NHS Supply Chain are working with NHS trusts to support migration to the new model 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.

Contacts

For general enquiries, contact: ENGLAND.speccomm-HCTED@nhs.net

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