What’s the structure?

People speak about the NHS as if it’s one organisation but that simply not true. There are large acute hospitals, which provide care for the most unwell patients, community services which provide care mainly for people with long-term conditions or to avoid someone having to go into hospital or to provide care at home after a period of being in hospital. There are mental health trusts, which have both hospitals and community services. There are GPs which are small independently run businesses who are increasing working together and joining forces, particularly around back office functions such as IT or HR. There are clinical commissioning groups who purchase services on behalf of the whole population in a particularly geography. Public health functions such as health lifestyle services, sexual health or drug and alcohol services which have moved from the NHS and are now paid for by the local authority. These organisations all cover a specific geographical area and the mix of providers ranges significantly area to area.   

In order to combat some of the this complexity there has been a requirement for organisations to increasingly working together in partnerships called Sustainability and Transformation Partnerships, in some areas of the country this has worked well, in others not so much. In areas where this is working, organisations are looking to work even closer and are moving towards joint budgets and the introduction of Integrated Care Organisations, these will have the responsibility for looking after the whole population health in a particularly geographical area.

On top of all this there are national health bodies such as CQC (Care Quality Commission) who monitor the quality of care, NICE (National Institute for Clinical Excellence) who set out the quality standards and consider the cost effectiveness of different types of treatment and organisations such as NHS Digital.

How does the money flow?

So that’s the structure, but how does the money flow? The Department for Health, along with other government departments will negotiate a settlement for Health, remember, Social Care and Public Health aren’t covered in this that is negotiated separately as part of the Local Government settlement. A formula is applied and the money is then allocated to Clinical Commissioning Groups, who decide locally how best to spend the funding.  

Acute Trusts get paid based on the amount of activity they do (the number of patients who are treated in the hospital), community and mental health services get paid on a block contract (same amount regardless of the number of patients seen) and GPs are also paid on the number of patients registered with them, with some other smaller financial incentives for undertaking extra tasks over and above general GP services. There are also CSU (Commissioning Support Units) who are historically paid on block providing advice to Clinical Commissioning Groups, they often provide services such as IT help-desk functions, HR services, data analysis services, they are increasing moving into the consultancy space and will be paid by providers and commissioners for the work they delivery.

Where to start?

So where to start? IT as a function often sits under finance and isn’t its own department within the NHS, IT is definitely still seen as cost rather than an enabler, so the Directors of Finance ultimately hold the budget locally.

Most clinical commissioning groups have chief clinical information officers, so it may be helpful to track down who they are.  Both community services and acute trusts will also have Head of IT and will normally have one or two clinicians who sits on their IT group, to ensure systems meet the needs of users.

At a national level NHS Digital has responsibility for the digital channel to the public but locally there isn’t one person who leads on this. Each STP area has been required to write a digital road map document. It can be helpful to read this to get a better understanding of local priorities and how your product might be helpful in delivering against their strategic priorities. 

As part of the STP, IT leads from across all the organisations will come together to talk through the delivery of projects on the digital road map. There will also often be a primary care (GP) IT group where people from across GP practices come together to share ideas and in some cases work collaboratively together.

Another good starting place can be the Academic Health Science Networks who have a role of connecting the NHS with research, academics, industry, patients and the public. It can also be interesting to see who is involved in the Q network, as this will help you identify who is interested in driving change locally. You should also investigate if it could be helpful to you to get onto a supplier framework agreement.

Summary

There is no easy way to sell into the NHS but it’s important to build relationships with in the influencers in your area, remember people buy from people.