Procurement

Procurement can feel complex and opaque in the NHS, particularly for innovators and suppliers who want to understand how decisions are made and how to access the system. This page explains how NHS procurement works in practice, the different routes to market, and what you need to consider when planning to sell to the NHS.

This page aims to help you understand:

• How does procurement in the NHS work, and who is actually responsible for buying goods and services?
• What types of goods and services does the NHS procure, and at what scale?
• What routes to market are available for innovators and suppliers selling to the NHS?
• What are the benefits and challenges of different NHS procurement routes, such as direct sales, frameworks, and tenders?
• Who are the key decision‑makers involved in NHS purchasing and adoption decisions?
• How do contract values, thresholds, and regulations affect procurement timelines and processes?
• What innovation‑focused funding and non‑traditional routes exist to support early‑stage solutions before formal procurement?

How does procurement in the NHS actually work?

According to The King’s Fund, the NHS is expected to have spent £204.9 billion in 2024/25 on goods and services. These goods and services are generally classified into the following main categories according to NHS England:

The NHS does not procure goods and services as a single national body. Instead, procurement happens at multiple levels across the system, including individual NHS trusts and Integrated Care Boards (ICBs), which are typically responsible for their own buying decisions. This decentralised structure means that routes to market, decision‑makers, and timelines can differ significantly depending on what you are selling and who the buyer is.

The NHS also expects potential suppliers to demonstrate their financial, commercial, and technical capability to meet their contractual requirements, as well as looking for demonstrable commitment to sustainability and social value as part of their Greener NHS, where suppliers must commit to achieving net zero carbon, and allocate a minimum of 10% weighting for net zero and social value in our tenders.

All procurement in the NHS is governed by public sector procurement regulations, most recently the Procurement Act 2023 and, for healthcare services, the Provider Selection Regime (PSR). These frameworks are designed to ensure non-discrimination, transparency, fairness, competition where appropriate, and demonstrable quality and value for money for taxpayers.

What are the different procurement routes to market for innovators?

There are several routes to market for companies interested in supplying the NHS. These are:

Selling direct to NHS trusts or primary care organisations in England

If a contract is valued below £118,133, innovators typically engage directly with an NHS provider, each of which operates its own processes. This involves identifying the right contacts, including clinical and procurement teams. Decisions are usually made collectively, based on a detailed business case and a comparison of available products at an approval committee.

Selling through the NHS Supply Chain

The NHS Supply Chain was implemented to re-structure and simplify the procurement and supply chain delivery model in order to reduce spending and consolidate purchasing power. As a result, the NHS Supply Chain supports NHS organisations and suppliers across several product categories, denoted as ‘towers’. These towers oversee medical products, capital expenditure, and non-medical spending.

Selling through collaborative purchasing agreements

Some NHS organisations choose to procure collectively through regional or collaborative purchasing arrangements. There are several regional procurement hubs (such as NHS London Procurement Partnership) as well as other alliances, confederations, and partnerships.

National framework collaborations and contracts

National frameworks are pre-approved supplier agreements that allow NHS organisations to purchase goods and services without running a full procurement each time. Suppliers and innovators apply through competitive tenders (often led by bodies such as the Government Commercial Agency (formerly Crown Commercial Service), and, if successful, are listed as approved vendors at agreed prices.

Government tenders and contracts

For contracts above £118,133, NHS organisations must run a formal tender process and advertise opportunities publicly. These are typically listed on platforms such as Find a Tender and other eTendering portals, and may also include routes like open competitions. For innovators, this is a key route to access larger contracts.

Who are the procurement decision-makers in the NHS?

If you’re implementing a health or care innovation, one of the hardest things to work out is who in the NHS can say “yes”. The short answer is – it depends. The NHS doesn’t have a single buyer, and decisions change depending on scale, value, service type, and maturity of the solution.

The key thing to note is that NHS decisions are rarely made by one person or one organisation. Most decisions involve various stakeholders with different interests:

• Clinical leaders – does it work and is it safe?
• Operational managers – can we run it day‑to‑day?
• Finance teams – can we afford it and is there value for money?
• Formal governance committees – is this defensible and compliant?

As mentioned, decision‑making is based on various elements, but typically take place at the following levels:

	Who this is:	What they typically decide:	Who you’ll talk to:
Local NHS providers:	NHS trusts (acute, community, and mental health), GP practices and Primary Care Networks (PCNs), and community and voluntary providers delivering NHS services.	Pilots and proofs of concept, local service changes, smaller contracts or short-term agreements.	Service or pathway managers, clinical champions, digital or transformation leads, finance or procurement managers.
Integrated Care Boards (ICBs):	ICBs are the NHS organisations responsible for planning and funding services for a local population. Their statutory commissioning role is defined in the Health and Care Act 2022.	Whether something should be adopted and scaled beyond a single provider, system-wide contracts, longer-term funding decisions.   ICBs must follow the Provider Selection Regime (PSR) when buying healthcare services (prioritises patient benefit, continuity, and collaboration rather than competition alone).	Decisions are made through formal committees with a heavier focus on evidence, outcomes, and affordability.
NHS England:	This is explained in the Strategic Commissioning Framework which sets out how ICBs are expected to make decisions over the long-term. Also important is the Direct Commissioning Update (2026) which outlines how commissioning responsibility are shifting from NHS England to OCBs over the next few years.	Sets national priorities and policy direction, directly commissions specialised services, national frameworks and programmes, sets standards, and oversees commissioning to ICBs. Similar to ICBs, NHS England must follow the Provider Selection Regime (PSR)	National programme leads, clinical and professional leads, strategic or policy teams, and commercial and commissioning teams.

What are the different procurement thresholds and timelines?

Procurement timelines in the NHS vary widely. How long a decision takes is shaped less by willingness or enthusiasm for an innovation, and more by governance rules linked to contract value, risk, route to market, and approval status. For innovators, understanding these rules early is essential for realistic commercial planning and cashflow management.

Every NHS organisation operates under Standing Financial Instructions (SFIs), which set out what level of competition, approval and publication is required at different spend thresholds. While the exact numbers vary slightly by organisation, the underlying principles are consistent across trusts, ICBs and NHS England.

Lower value purchases (up to £15k)

For very small pieces of work, often below or around £5,000, NHS organisations can usually make a direct purchase or request a single quote. These are typically used for discovery work, short‑term pilots, or limited testing. Even at this level there must be a clear rationale and budget holder approval, but timelines are relatively short – often days to a few weeks under local governance rules.

As spend increases into the £5,000 to £15,000 range, this introduces light‑touch procurement involvement, but decisions can still often be completed within a few weeks to a couple of months if the scope is clear and funding is agreed. Importantly, NHS rules assess total contract value over its full life, not just annual cost, so a £5,000‑per‑year contract over three years is treated as £15,000 for procurement purposes.

Medium‑value contracts and structured procurement (£15k-£50k)

Once spend moves beyond around £15,000, governance requirements increase significantly. Many NHS trusts require multiple quotations or a small competitive process for contracts up to around £50,000. Procurement teams will usually become more actively involved, and formal approval will be needed from finance or divisional leadership. At this level, timelines of one to six months are common, depending on organisational capacity and risk profile. These contracts must be demonstrably fair, transparent and value‑for‑money, which adds planning, evaluation and sign‑off steps that cannot be skipped.

Higher‑value contracts and open tenders

Above roughly £50,000, most NHS organisations require a formal competitive tender, unless a valid exemption applies. These processes involve structured documentation, evaluation panels, and multiple governance checkpoints. Where required, opportunities and contract awards must also be published to Contracts Finder once they reach £12,000 (inclusive of VAT), even if they are still below full regulatory thresholds. To apply for high value contracts in the UK, usually above £139,688 (including VAT),  the Find a Tender service should be used instead.

Open tenders typically take six to twelve months from early planning to contract award. This includes time for internal approval to go out to market, bidder response periods, evaluation, moderation, financial sign‑off and mobilisation. For innovators, these timelines can feel challenging, but they are driven by statutory and audit requirements.

Innovation-focused procurement routes and funding

For early-stage solutions, the NHS often uses innovation focused mechanisms that sit outside of routine procurement. These are designed to test innovations in real-world settings, generate evidence (clinical, economic, and operational) for adoption, and minimise the risk of adoption. Many of these mechanisms also provide funding to support development and evaluation, helping innovators build a business case for adoption, but do not guarantee procurement.

Many funding routes exist, some include:

UK Research and Innovation (UKRI):	Invests in research and innovation across the UK, with nine councils focusing on sector-specific priorities and communities. Notably, one of the councils, Innovate UK, is the UK’s national innovation agency supporting business-led innovation in all sectors, technologies. and UK regions, with opportunities promoted on the UK Government website via the Innovation Funding Service. Competitions are also held, which run regularly throughout the year.
Small Business Research Initiative (SBRI) Healthcare:	A programme of competitions, funded by the Accelerated Access Collaborative (AAC), which aims to support the NHS Long Term Plan and accelerate innovative technologies in the NHS and wider healthcare system. SBRI Healthcare provides funding and support to early-stage products, enabling testing for business feasibility and technology development. More mature products are also supported through funding for real-world implementation studies. Competitions are based on defined themes and are launched periodically.
Health Innovation Networks (HINs):	England’s 15 Health Innovation Networks (formerly Academic Health Science Networks) act as the NHS’s regional innovation arm. They do not usually provide large‑scale funding, but they play a critical role in supporting health and social care teams to find, test and implement new solutions.
National Institute for Health and Care Research (NIHR):	Facilitates a range of research programmes to improve health, care, and wellbeing as well as promoting economic growth. Funding calls for programmes run on a rolling or scheduled basis depending on the programme.
Charities and mission-led funders:	Health charities are an important and often overlooked source of early funding. Organisations such as Cancer Research UK, Wellcome Trust, and disease‑specific charities frequently fund feasibility studies, pilots and validation work aligned to their missions. While these routes are usually disease‑specific, they can play a crucial role in generating clinical credibility and early evidence, especially for innovations addressing unmet need or health inequalities.
Private investment and venture capital:	Private investment (including angel investors, venture capital funds and corporate venture arms) plays a major role in early and mid-stage health innovation. While this funding is not NHS-specific, it is often essential to bridge the gap between grant funded pilots and scalable solutions.

Overall, procurement in the NHS is complex, decentralised, and highly governed, but it is also navigable if you understand how the system works. Ultimately, the NHS rewards innovations that are credible, evidence‑driven, and system‑ready. Those that succeed are typically the ones that align with patient need, fit into existing pathways, demonstrate clear value to the wider system, and engage the right stakeholders early. Procurement is rarely quick, but with the right preparation and expectations, it can be a powerful route to sustainable adoption at scale.