Introduction

NHS England has identified a requirement to set out a clear policy position on which providers or organisations should be categorised as purchasing points, and therefore be able to access medicine prices on Medicines procurement and supply chain (MPSC; formerly known as Commercial Medicines Unit) frameworks (secondary care procurement).

Background

The MPSC was established to put in place medicine framework agreements to support NHS secondary care trusts in England. At its conception, MPSC frameworks provided medicine prices for use in secondary care, for the treatment of NHS patients.

Every tender issued by the MPSC to a pharmaceutical supplier includes a list of purchasing points. Purchasing points are those providers or organisations that can access MPSC framework medicine prices. Initially, purchasing points were secondary care providers, but over time, the list has grown to include more organisations with a role in the care and treatment of NHS patients.

To become a purchasing point and therefore be able to access MPSC framework prices, providers or organisations must meet the following criteria:

• medicines are for NHS patients only
• prices remain confidential
• medicines purchasing data must be supplied monthly to the MPSC (via its preferred route)
• any medicines purchased must be from a MPSC framework (where one exists) for an agreed list of medicines, except where there is a strong clinical reason for purchasing ‘off framework’.

Context

Enquiries regarding access to MPSC frameworks have, to date, been handled on a case-by-case basis. However, with the establishment of integrated care systems (ICSs) and following consultation with stakeholders, we believe that it is now necessary to provide a policy position that clarifies which providers or organisations can access MPSC framework prices.

No stakeholder supported general access to MPSC framework prices in primary care, and therefore primary care organisations are excluded from having access to MPSC framework prices – the exceptions being the specific NHS England commissioned services as detailed below.

Policy position

The following providers or organisations will be given access to MPSC frameworks as purchasing points (as stated):

• secondary care trusts and mental health trusts – full access to MPSC framework medicine prices and homecare service prices
• hospices – full access to all MPSC framework medicine prices and homecare service prices
• organisations contracted to support NHS England commissioned services:
  • prison services – full access to MPSC framework medicine prices and homecare services.
  • ambulance services – full access to MPSC framework medicine prices
  • HIV/PrEP services – access to a restricted list of framework medicine prices to support service provision.

Authority

The NHS England MPSC has drawn up this policy statement; it is responsible for ensuring the operational implementation and oversight of access arrangements.

The access arrangements set out in this policy statement will be reviewed on a regular basis.

For any enquiries about the contents of this statement, please email: cmupharmacyteam@nhs.net 

Access to MPSC frameworks – Question and answers

This section provides background information on the MPSC and purchasing points, and sets out the underpinning rationale for how the NHS England policy position was developed.

MPSC (formerly the CMU) background

What is the MPSC?

The MPSC was established to put in place medicine framework agreements to support secondary care trusts in England. Over time, access has been broadened to other providers or organisations treating NHS patients.

The MPSC is part of the NHS England Medicines Value and Access Directorate.

Its core purpose is to:

• deliver efficiencies for the NHS in the procurement of medicines
• initiate procurement and support the Department of Health and Social Care (DHSC) ‘purchasing for safety’ agenda for those medicines
• ensure an efficient and effective supply chain for medicines to the patient.

What is a MPSC framework?

A MPSC framework is an agreement that offers confidential prices on several different frameworks (medicines/products), which are available to providers or organisations (either as a purchasing point or via third-party arrangements) that treat NHS patients.

What medicines/products are available on a MPSC framework?

MPSC manages several framework agreements for:

• generic medicines including newly available generic medicines used in hospitals
• branded medicines, biosimilar medicines and intravenous (IV) fluids
• blood products, dose-banded chemotherapy and flu vaccines for hospitals
• homecare.

Can any provider or organisation access MPSC framework prices?

No. Any provider or organisation that wants to access MPSC framework prices must be registered as a purchasing point or via third-party access arrangements enacted in accordance with the National Pharmaceutical Supply Group (NPSG) guidance. 

Purchasing points

Can any provider or organisation be granted purchasing point status?

No. There are key conditions of access. Most notably products bought at MPSC framework prices must be used to treat NHS patients only and prices should remain confidential.

What are the requirements of a purchasing point?

Any provider or organisation that is granted purchasing point status must meet the following ‘key conditions of access’, and therefore be able to access MPSC framework prices:

• medicines are for NHS patients only
• prices remain confidential
• monthly purchasing data must be supplied to the MPSC (via its preferred route)
• any medicines purchased must be from a MPSC framework (where one exists) for an agreed list of medicines, except where there is a strong clinical reason for purchasing ‘off framework’.

How were previous requests for organisations that wanted to become a purchasing point managed?

NHS England has not previously published a policy position on which providers or organisations can access MPSC framework prices, with requests historically handled on a case-by-case basis. Therefore, the MPSC has worked with stakeholders to inform the development of a policy position to provide clarity on the approach taken by NHS England.

What is the process for a provider or organisation that wants to become a purchasing point?

The first part of the process is to complete a pre-qualification questionnaire – this can be found in Annex A of the purchasing point factsheet.

As a final step before purchasing point status is granted, purchasing points need to sign a confidentiality access agreement as a commitment to the ‘key conditions of access’.

How do MPSC framework suppliers know which organisations are on the list of purchasing points?

MPSC provides all suppliers with a MPSC framework agreement in place with a list of purchasing points authorised by MPSC to access framework prices. 

Are any providers or organisations ineligible to become a purchasing point?

Yes. Private providers (for example, independent sector hospitals/clinics, homecare providers, outsourced pharmacies) are not permitted to be registered as purchasing points.

Please note: If you are a private provider, you cannot become a purchasing point and have access to MPSC frameworks, irrespective of the volume of NHS work you undertake.

Access to MPSC frameworks – policy position

Why has NHS England reviewed which providers and organisations can access MPSC frameworks?

With the establishment of ICSs and following consultation with stakeholders, we believe that it is now necessary to provide a policy position that clarifies which providers and organisations can access MPSC framework prices.

Therefore, the MPSC engaged stakeholders to consider the options and develop a policy position that sets out which organisations are eligible to access to MPSC framework prices and with which confidential information about prices can be shared.

Which stakeholders were consulted to inform the policy position?

Engagement with stakeholders focused on the issue of which providers or organisations treating NHS patients should be able to access MPSC framework prices. Stakeholder engagement was split into two phases:

When did the new policy come into effect?

The new arrangements came into effect from 1 January 2024.

When will the access arrangements be reviewed?

The access arrangements will be reviewed periodically to ensure they remain fit for purpose.

Why have independent sector providers (ISPs) not been granted purchasing point status?

As part of our research exercise we explored the feasibility of granting purchasing point status to those ISPs contracted by NHS England to support the recovery of elective activity. However, it became apparent while working with ISP and wholesaler representatives that ISPs face several operational barriers in complying with the key conditions of access to MPSC frameworks.

To ensure NHS England applies consistency in its approach to implementing the policy position, those ISPs that were registered as a purchasing point were informed of the new policy position and removed from the live list of purchasing points.

Could ISP access not be managed locally, for example via a third-party arrangement?

The feasibility of locally managed access was explored with hospital chief pharmacists, but discounted due to a lack of infrastructure and capacity to manage such complexities in hospital pharmacy departments.

Will access be extended to include primary care organisations?

No, not at the time of publishing the policy position. No stakeholder supported general primary care access. NHS England will keep the position under review.

Why did stakeholders not support primary care access to MPSC framework prices?

Stakeholders were concerned about sharing confidential information about prices through framework agreements with primary care commissioners, doctors and pharmacists.

In addition, the models of procurement for primary and secondary care are very different, and primary care access would create unintended consequences. For example, a GP practice may believe that for a primary care generic medicine, a secondary care framework price is more affordable, but this may be because the primary care price they can see is the Drug Tariff, which includes the margin to run community pharmacies, as well as the distribution margin. 

How will NHS England ensure purchasing points comply with the access criteria?

MPSC currently monitors and collects purchasing data. NHS England is considering other measures and mechanisms required to tackle issues of confidentiality and to ensure medicines bought at MPSC framework prices are for NHS patient use only.

Are any future changes to access proposed?

No, not at this stage. However, as ICSs develop and mature, and should some services move from a secondary care setting to a community care setting (care closer to home) – for example, a biologics clinic for rheumatology, consideration will be given to any further changes that may be required.

Other related questions

Does the policy position for access to MPSC frameworks apply to other access schemes?

No. However, by implementing policy on access to MPSC framework agreements, it may be appropriate for patient access schemes and other types of commercial arrangements to consider a similar policy for access.

Can a purchasing point outsource the supply of medicines at MPSC framework prices to a third-party provider?

Yes. Access to MPSC framework prices for third-party providers should be enacted in accordance with the National Pharmaceutical Supply Group Guidance for NHS trusts: outsourcing outpatient pharmacy services.

How will NHS England monitor misuse of MPSC frameworks?

NHS England has published an escalation process (see Annex C to the purchasing point factsheet) through which suppliers should report real-time concerns about the misuse of MPSC frameworks. These will be investigated.

Publication reference: PRN1221i