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Procurement

Procurement is an essential part to implementing insulin pump therapy into routine clinical practice. The purchasing of pump technology however can be daunting, complex and time consuming - but it does not need to be. In this section, we have provided information on what procurement means, what the various options are for purchasing the technology (and any associated consumables), who provides this technology and what current models are available and other factors that Trusts need to think about before, during and after implementation.

To explore this section please click on the headings below:

Procurement Options - provides an overview of the two options that are now available to the NHS for purchasing this technology.
Supplier Details - lists the current pump suppliers and provides individual information sheets on the pumps currently available from each of these suppliers.
Utalising the new insulin pump therapy code - provides information surrounding a new code that has been created for insulin pump therapy through collaboration with the NHS Information Centre for Health and Social Care.
Training programme - details the training options that are available to clinical staff surrounding insulin pump therapy management.
NHS Service Specification - provides a succinct overview of what service changes are required in order to ensure the successful embracement of the procurement process.
Department of Health guidance for PCTs - gives an overview of procurement guidance for PCTs that has recently been issued by the Department of Health.

Procurement Options

Procurement of insulin pumps must comply with Trusts "Standing Financial Instructions" (SFIs) and current Public Procurement Legislation. Trusts should always ensure they engage with their local procurement department when considering the development of services in this way. Until recently, a formal "tender" process has been required in order to purchase insulin pumps; however there is now an additional option that Trusts may want to consider. Both options are described below:

Complete a local procurement process. An example procurement project plan for this was developed by one of the CNTAC project implementation sites. This highlights a (typical) indicative procurement process and approximate time scales for completion.
Access and make full use of a new Purchasing Framework, which has been developed through Healthcare Purchasing Consortium. This option provides Trusts with an alternative to running a local tender process for the provision of insulin pump therapy whilst still complying with SFIs and UK legislation.

A Clinical focussed information sheet sheet (for clinical champions / clinical implementation leads) on the National Purchasing Framework has been developed for teams to review.
A procurement information sheet (for local supplies teams), which will explain the detail of the new set up and how you can access it in more detail is also available.

The Office of Goverment Commerce has produced a procurement summary paper which highlights the details of procuring within the public sector which Trusts may find useful.

NOTE: Each Trust is responsible for its own contractual arrangements and must choose one or other of the above routes ensuring appropriate advice is sought through its local procurement or supplies department.

Supplier Details

There are currently four providers of the insulin pump. Whilst it is not NTAC's role to recommend specific manufacturers, the technology currently available at the point of publication (June 2010) is available from UK suppliers listed below. An information sheet on the most current insulin pump that is available from each supplier can be downloaded by clicking on the links below:

Each technology provider will have different models of the pump technology, each of which will have its own unique feature(s) and as time progresses and the variety of pumps increase; however the concepts that underpin adoption of the technology remain the same for Trusts moving forward with implementation.

Utilising the new insulin pump therapy code

It is hoped that in the future there will be specific tariffs under the Payment by Results regime to enable Trusts to cover the costs of an insulin pump therapy service in a more accurate way than the current tariff structure enables. However work is ongoing with the NHS Information Centre for Health and Social Care to develop coding structures that will underpin the potential new tariff in the future.

Whilst the above work is being progressed, Trusts must ensure that they to use an existing Office of Population Censuses and Surveys Classification (OPCS) code when fitting a pump for the first time. The insulin pump coding document explains the OPCS code in more detail and when and how it should be used in clinical practice.

Training Programme

At present there is a lack of education and structured training programmes to develop local competence in insulin pump therapy management across the country. Local experience and resources available is equally varied and as a result some people with diabetes who have access to an insulin pump have to travel long distances to receive the support they require.

There are different options available to clinicians who want to be trained in insulin pump therapy management, which include:

Enrolling on tailored training package that is currently available within the NHS.
Share knowledge and expertise with established centres locally.
Gaining access to training packages which are offered from pump suppliers (this should be agreed as part of the procurement process).

The section provides useful resources on how CNTAC project implementation sites approached this, with the project data supporting the notion that training varies across the diabetes specialist teams. More nurses in the NTAC implementation sites for example were trained by industry over any other healthcare professional and collectively, consultants, nurses and dietitians all received training from colleagues within their respective areas.

NHS Service Specification

An operational service specification has been developed to complement the , which guides Trusts through all of the service requirements that must be met in order to ensure that the benefits of procurement can be realised. This document clearly maps out how to measure the impact of following each requirement and gives a description of what a Trust needs to do in order to reach a successful output. Operational requirements surrounding the quality and level of service, clinical governance, implementation, financial demand and procurement requirements are all touched upon.

Department of Health Guidance for PCTs

The Department of Health has recently published a Click here, which provides a framework for decisions regarding this essential component of service delivery. Its aim is to "support PCT boards, their delegated authorities and providers (where applicable) in making appropriate and effective decisions about procurement, and ensuring consistency with the overarching principles for public services procurements. These principles include transparency, proportionality, non-discrimination and equality of treatment" - Source: Department of Health: PCT procurement guide for health services.

The purpose of the guide is to enable PCTs to:

Decide when to use procurement for a clinical service.
Determine what procurement approach to use if they are running a procurement exercise.
Outline some key aspects of procurement including the scope of a service specification, financial and risk issues.