Framework contracts have been used for a number of years in the commissioning of services for the NHS. The framework agreement establishes the terms governing contracts to be awarded during a given period, in particular with regard to price and quality, and where appropriate, the quantity. Framework agreements for the NHS normally run for a period of four years (48 months). The competition for companies to be included on the framework contract is sometimes periodically 'opened-up' and further companies that fulfil the criteria are added to the framework contract.
The major issue with framework contracts is the decrease in transparency, with the use of framework contracts masking to a certain extent, how much NHS work is being given to non-NHS organisations.
The contracts list a number of companies that are considered to have the abilities to fulfil the services the contract asks for. Once the companies are signed up then the participating commissioners (trusts, ICS etc.) can award these companies contracts through a shortened procedure. However, unlike with other tendering opportunities that are advertised and awards published in the public domain, awards made via framework contracts are rarely published. This means that it is difficult to gauge how much money companies are being paid for their work. It is also unclear how much of the money allocated to the framework contract does actually get paid out. For example, does all of a four year £100 million framework contract actually get paid to companies or other organisations?
Details of some very high-value framework contracts 2014-2023
November 2014: £780 million clinical services
In November 2014, NHS Supply Chain awarded places on a four year "Surgical hospital services" to 11 private companies. The contract had a maximum value of £780 million over four years. The companies listed could be contracted to supply surgery and diagnostic services, both mobile and strategic. Imaging services include bone densitometry, cardiac angiography, CT, mammography, MRI, PET CT, X-ray, ultrasound, and theatre services, including theatre services for cardiology, dental, endoscopy, ENT, General Surgery, and gynaecology. The companies are Alliance Healthcare, Care UK, Circle Health, Cobalt Unit, Diagnostic World Ltd, Inhealth Ltd, Medical Imaging Partnership, Nuffield Health, Ramsay Health, Regents Park Cardiovascular Solutions, and Vanguard Healthcare.
August 2017: £200 million medicine at-home services
Southend University Hospital NHS Foundation Trust awarded places on a framework contract to over 13 companies for mid-tech homecare medicines services, with the award published in August 2017. The contract had a maximum contract of £200 million. The initial period of the contract was two years, but two lots of one year extensions could potentially be awarded.
This includes, but was not limited to, provision of homecare services for the following areas: Hepatitis, Oral Chemotherapy, Self-injectable Methotrexate, Erythropoetin Stimulating Agents (ESAs), and Self-Injectable Biologic Products for Rheumatology, Dermatology, Gastroenterology and Neurology Indications.
The companies awarded places included Healthcare at Home (now Sciensus), Baxter Healthcare, Fresenius Medical Care, Lloyds Pharmacy, One Stop Pharmacy, and Healthnet Homecare.
November 2017: £56 million National Framework Agreement for On-site Surgical and Medical Capacity Solutions
The Countess of Chester Hospital NHS Foundation Trust put in place a new commercial Framework Agreement to procure on-site surgical and medical capacity solutions. The framework contract was worth £56 million over four years. In November 2017 two companies were awarded places on it - Healthcare Business Solutions (UK) Ltd and SHS Partners Surgical Ltd.
The contract award states that the overall aims of contract is to provide "NHS Organisations with fully compliant solutions which supplement the delivery of patient care by NHS Organisations in line with the NHS' core Key Performance Indicators including but not limited to: A&E 4 hour wait targets, elective 18 week Referral to Treatment targets, cancelled procedures targets, bed availability and utilisation targets, timely and appropriate diagnostic testing targets and urgent 2 week GP referral rules for suspected cancer."
January 2019: £105 million NHS Diabetes Prevention Programme (NDPP)
As part of the NDPP, NHS England awarded places to five providers on a Framework Agreement in January 2019. The five providers have to provide, anywhere in England, up to 100,000 behavioural interventions aimed at preventing or delaying the onset of Type 2 diabetes in people with non-diabetic hyperglycaemia (or pre-diabetes) per year for the initial period of the three year Framework Agreement. The Framework Agreement include an option for it to be extended for a further 12 months in addition to the initial 3 year term upon review. The companies will be paid a share of the £105 million allocated to the framework contract.
The companies are Ingeus UK Ltd, Living Well Taking Control LLP, Pulse Healthcare, Reed Momenta, and WW GBR ltd.
January 2019: £100 million remote radiology reporting
NHS England awarded places on a framework for remote teleradiology reporting and auditing services to nine companies in January 2019. The companies are 4Ways Healthcare, Alliance Health, Diagnostic Healthcare, DMC Imaging, Inhealth Ltd, Medica Reporting, Everlight Radiology, Telemedicine Clinics, and Vital Radiology Services. The companies will receive a share of the £100 million allocated to the contract over two years, although the agreement includes an option to be extended for a further 12 months plus 12 months.
March 2019: £600 million contract for the provision of patient discharge services
Places on this £600 million Framework Agreement were awarded to a large number of companies, not-for-profit organisations, and some NHS trusts in March 2019 to supply patient discharge services to adults aged 18 and over. The aim is to support hospital discharges for adults and to improve the patient pathway from hospital acute care to an appropriate care setting and therefore reduce delayed transfers of care and unavoidable re-admissions to hospital.
The framework was divided into 3 service lots: Discharge to Assess Services, where people are assessed for longer term care and support in the right place; Third Party Brokerage, where services work personally with families and beyond the traditional care hours model to support people to move to a care home of their choice, step-down care or back into their own homes; and Medical Care at Home, also known as secondary care at home or a virtual ward.
Companies awarded places include Healthcare at Home (now Sciensus), Interserve Healthcare Ltd, Provide CIC, Cera Care, Emergency Personnel Ltd, and the British Red Cross.
April 2019: £600 million Mobile and Strategic Clinical Solutions
NHS Supply Chain awarded places on the framework contract for the supply of Mobile and Strategic Clinical Solutions in early 2019, with the award published in April 2019. It was anticipated that in the first 24 months of the framework agreement the value of purchases would be in the region of £250 million and for the full 48 month term (if extended) the anticipated value is £600 million. The framework was divided into eight lots.
Several lots of the framework cover the production and evaluation of diagnostic images and patient care within a mobile or modular unit. The service can include the provision of at least one member of staff who must be skilled and fully qualified in the operation of the (imaging) equipment, equipment including any consumables, a booking service; and an imaging reporting service to facilitate clinical patient diagnosis. The types of imaging services included Bone Densitometry, Cardiac Angiography, CT, Mammography, MRI, PET CT, and X-ray.
Other lots cover various surgical procedures and the provision of patient care within a sterile mobile or modular unit, which could include staff, theatre equipment and consumables. The types of mobile/modular theatre services that may be required in this lot include cardiology, dental, endoscopy, ENT, general surgery, gynaecology, lithotripsy, and minors/A & E.
Thirty-four companies were awarded places on the framework including BMI Healthcare, Care UK, EMS Healthcare, Inhealth Ltd, Everlight Radiology, and Vanguard Health.
October 2020: the £10 billion NHS increasing capacity framework
NHS England awarded the first places on the NHS Increasing Capacity Framework in early 2021. The framework includes: NHS inpatient and day case services (including full supporting pathology and imaging) and urgent elective care and cancer treatment in line with nationally set criteria; NHS Diagnostic Services; and Clinical facilities and related services. In fact, the framework covers all hospital-related services. Set up to cope with the backlog due to the cessation of elective surgery during the worst months of the Covid-19 pandemic in 2020/21, the framework signed up a large number of private companies, including the country's largest private hospital companies. The framework was to replace the system of block-booking of private hospital beds that took place during several months of the pandemic in 2020/21. The maximum funding for the four year term of the framework is £10 billion. The framework contract also set in motion the awarding of contracts for Community Diagnostic Centres (CDC).
The contract award notice 2021/S 028-070725 includes the details of 61 suppliers that entered into frameworks agreements in February 2021, then Contract Award Notice 2021/S 028-070725 in April 2021 includes an additional 24 suppliers that have entered framework agreements, making a total of 85 suppliers. A further award notice in June 2021 included more suppliers.
November 2021: £2 billion NHS Workforce Alliance Framework Agreement
This framework contract's full title is for NHS Workforce Alliance Framework Agreement Insourced Services to Support the Provision of Healthcare Services by NHS and other public bodies (including Clinical Services) and covers a four year time frame to October 2025. The contract is described a part of the recovery from the COVID pandemic and is needed to supplement, support and expand the NHS's "in-house capacity through use of insourced service provision".
The framework covers a broad range of clinical and medically related insourcing services, including; diagnostics, diagnostic imaging, cardiology, endoscopy, ENT, general surgery, gynaecology, ophthalmology, orthopaedics, physiotherapy, urology, dermatology and all other specialities and functions.
In November 2021, places on the contract were awarded to 37 suppliers, including Healthharmonie Ltd, ID Medical Group, Medacs Healthcare, Omnes Healthcare, and Totally Healthcare. The framework is opened every six months for further companies that fulfill the criteria to be added to the contract.
Selected high value framework contracts 2014 to 2023
|Date award published and link||Details||Maximum amount||Contracting body||Length of contract (months)||Companies|
|20/12/2014||Mobile and Strategic clinical Solutions and Associated Goods to be provided within various environments including a range of clinical and imaging applications.||£780,000,000||NHS Supply Chain||48||Alliance Medical Ltd, Care UK, Circle Health, Cobalt Unit, Diagnostic World Ltd, InHealth Ltd, Medical Imaging Partnership, Nuffield Health, Ramsay, Regents Park Healthcare, Vanguard Healthcare|
|29/01/2015||Community musculoskeletal physiotherapy framework||£24,000,000||North East Lincolnshire CCG||36||Abacus Physiotherapy Ltd plus 8 other companies|
|16/01/2016||Children and Young People's Emotional Wellbeing and Mental Health Early Intervention Services||£10,000,000||West Sussex County Council||60||Twenty providers mainly charities and not-for-profit companies, plus an NHS trust|
|20/02/2016||Supply of A&E, Intermediate Tier Vehicle, and Private Transport Services and Extra Contractual Journey's all on a when required basis by the South East Coast Ambulance Service NHS Foundation Trust.||£10,500,000||South East Coast Ambulance Service||48||UK Specialist Ambulance Services; Sites Ambulance|
|16/05/2016||National Diabetes Prevention Programme||£35,000,000||NHS England||36||Ingeus UK Limited;Living Well Taking Control;Pulse Healthcare Limited trading as ICS Health and Wellbeing;Reed Momenta Limited|
|21/11/2016||Framework agreement for the Provision of a Pharmaceutical Wholesaler service||£66,000,000||Derby Hospitals NHS Foundation Trust||24||Alliance Healthcare Distribution Ltd and 3 other companies|
|21/12/2016||Orthotics Products and Services.||£350,000,000||NHS Shared Business Services Ltd||84||Over sixteen companies listed on the award contract|
|19/08/2017||Homecare medicine services||£200,000,000||East of England NHS Collaborative Hub for Southend University Hospital Foundation Trust||48||Healthcare at Home Ltd, Lloyds Pharmacy, and 19 other companies|
|10/11/2017||National Framework Agreement for On-Site Surgical and Medical Capacity Solutions||£56,000,000||Countess of Chester Hospital NHS Foundation Trust||48||Healthcare Business Solutions Ltd and SHS Partners Surgical Ltd|
|22/1/2019||NHS Diabetes Prevention Programme - Re-Procurement||£105,000,000||NHS England||48||Ingeus UK Ltd; Living Well Take Control LLP; Pulse Healthcare Ltd; Reed Momenta Ltd; WW GBR Ltd|
|23/1/2019||Remote Teleradiology Reporting Services||£100,000,000||North of England Commercial Procurement Collaborative (NOE CPC)||48||4ways Healthcare Ltd; Alliance Medical Ltd; Diagnostic Healthcare Ltd; DMC Imaging Ltd; InHealth Limited; MEDICA Reporting Ltd; Radiology Reporting Online LLP trading as Everlight Radiology; Telemedicine Clinic Ltd; Vital Radiology Services Ltd|
|14/3/2019||The Provision of Patient Discharge Services||£600,000,000||NHS Shared Business Services||48||NHS, charity and private companies, including British Red Cross; Carebridge Staffing Ltd; Central and North West London NHS Foundation Trust; Cera Care; Emergency Personnel; and Healthcare at Home Ltd|
|4/04/2019||NHS Framework Agreement - Homecare Treatment of Lysomal Storage Disorders||£32,000,000||NHS England||24||Healthcare at Home Ltd|
|31/05/2019||Provision of Teleradiology Reporting Services||£10,000,000||East of England NHS Collaborative Hub||48||4ways Healthcare Ltd and 6 other companies|
|18/04/2019||Mobile and Strategic Clinical Solutions||£600,000,000||NHS Supply Chain||48||4Ways Healthcare Ltd, Alliance Medical Ltd, BMI Healthcare Ltd and 31 other companies|
|22/08/2019||Provision of Supplementary Healthcare Services||£10,000,000||North of England Commercial Procurement Collaborative||48||Eden Clinical Services & 9 others (Lot 1). Alliance Medical Ltd, BMI Healthcare, Care UK, Warrington and Halton Hospitals NHS Foundation Trust & 2 others|
|22/08/2019||NHS England 2019/21 Specialised Commissioning Contract Procurement Region North||£215,539,000||NHS Arden and Greater East Midlands CSU||48||Three NHS trusts, plus The Ace Centre, & Hyperbaric Treatment and Training Services Ltd|
|6/09/2019||Supplementary Mental Health Placements to Support NHS Capacity Requirements (only six lots awarded out of 8)||£60,000,000||North of England Commercial Procurement Collaborative||48||Camden and Islington NHS Foundation Trust, St Andrew's Healthcare,, Whitepost Healthcare Ltd|
|3/01/2020||Procurement for the provision of Gender Dysphoria Surgical Services to NHS England, NHS Scotland and NHS Wales||£107,100,000||NHS South West SCU||84||Aspen Healthcare, Nuffield Health, Hull University Teaching Hospitals NHS Trust & 5 other companies|
|8/01/2020||Framework Agreement for Outsourced Radiology (Remote Teleradiology) Reporting Services||£32,000,000||Surrey and Borders Partnership NHS Foundation Trust,||48||4Ways Healthcare Ltd,DMC Imagind, Medica Reporting,Everlight Radiology,S24 Ltd, Telemedicine Clinic|
|19/02/2020||Essex Urgent Primary Medical Care Pseudo Dynamic Purchasing System||£57,456,000||NHS Castle Point and Rochford, NHS Basildon and Brentwood, NHS Southend, NHS Mid Essex, NHS Thurrock, NHS North East Essex, NHS West Essex CCGs||72||College Health Ltd, Omnes Healthcare & 4 other companies|
|30/06/2020||Homecare Medicine Services for Immunogobulin Therapies||£100,000,000||East of England NHS Collaborative Hub||48||Lloyds Pharmacy Ltd & 5 others|
|10/02/2021 (first award notice)||NHS Increasing Capacity Framework||£10,000,000,000||NHS England||48||Over 60 companies listed|
|16/4/2021 (second award notice)||NHS Increasing Capacity Framework||Additional 24 companies added|
|28/06/2021 (third award notice)||NHS Increasing Capacity Framework||Further companies added|
|15/08/2022 (fourth award notice)||NHS Increasing Capacity Framework - Refresh||Further companies added|
|10/06/2021||Framework EOECPH Maxillofacial & Oral Surgery Surplus Demand Services LTR||£10,000,000||East of England Collaborative Procurement Hub||36||Eight private companies|
|14/10/2021||DHSC Assisted Testing Framework||£386,584,484||DHSC||48||IQVIA Ltd,Sodexo,Reed Specialist Recruitment,Abbott Toxicology|
|17/11/2021||Framework agreement for the provision of homecare medicines services||£200,000,000||East of England Collaborative Procurement Hub||48||Healthcare at Home, Alcura plus 13 other private companies|
|13/11/2021 (first award notice)||NHS Workforce Alliance Framework Agreement for Insourced Services to Support the Provision of Healthcare Services by NHS and other public bodies (including Clinical Services)||£2,000,000,000||NHS England||60||37 private companies|
|12/09/2022 (second award notice)||NHS Workforce Alliance Framework Agreement for Insourced Services to Support the Provision of Healthcare Services by NHS and other public bodies (including Clinical Services)||18 more private companies added|
|21/02/2023 (third notice award)||NHS Workforce Alliance Framework Agreement for Insourced Services to Support the Provision of Healthcare Services by NHS and other public bodies (including Clinical Services)||Six more companies added|
|6/07/2022||Framework for the provision of Dermatology Services||£48,000,000||East Of England NHS Collaborative Hub||20||My Skin Doctor,Portland Clinical Ltd,Shakespeare Clinic,Vita Health Solutions Ltd|
|20/01/2023||NHS Diabetes Prevention Programme||£142,640,000||NHS England||36||Living Well Taking Control LLP (but framework was meant to appoint 5)|
|2/02/2023||Hybrid Outpatient Pharmacy Dispensing Framework||£100,000,000||East of England NHS Collaborative Procurement Hub||36||AAH Pharmaceuticals plus three other companies|
|27/03/2023||Community Mental Health Framework Supporting Services||£15,809,220||Bristol, North Somerset and South Gloucestershire Integrated Care Board||36||A total of 24 charities, not-for-profit companies and companies awarded places|