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 use and reliance on framework contracts in the NHS has increased in recent years, driven by a strategic push from NHS England to centralise procurement, reduce costs, and improve efficiency through the Central Commercial Function (CCF) and the Framework Accreditation Programme. Over 2,200 organizations now use NHS Shared Business Services (SBS) framework agreements. NHS England introduced a Framework Accreditation Programme in August 2023 to force the use of nationally accredited frameworks, reducing duplication.
Issues
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 recent very high-value framework contracts
November 2025: Framework for Insourcing and Outsourcing of Clinical Services
NHS Shared Business Services Limited (NHS SBS) published a notice of its intention to put in place a Framework Agreement for the provision of Insourcing and Outsourcing of Clinical Services to be used by NHS SBS Approved Organisations. The estimated value of the framework is £1.5 billion.
September 2025: Mental Health and Wellbeing Services
In September 2025, The Countess of Chester Hospital Commercial Procurement Services awarded a multi supplier national framework agreement for the provision of Mental Health and Wellbeing Services under the Provider Selection Regime. The framework runs from September 2025 to September 2029.
The services provided under this framework will be Mental Health and Wellbeing services for young people, adults or both. The Framework intends to cover a range of services that fall within the scope of Mental Health and Wellbeing services, delivered either virtually or in person.
August 2025: Provision of Insourced and Outsourced Clinical Services Framework
The Countess of Chester Hospital NHS Foundation Trust awarded places on the framework 'Provision of Insourced and Outsourced Clinical Services Framework' to over 40 organisations in August 2025. The framework runs from September 2025 to August 2029. The total value of the procurement framework is £100 million.
May 2025: National Framework Agreement for Radiology Capacity Solutions (PSR)
The Countess of Chester Hospital NHS Foundation Trust awarded places on the framework 'National Framework Agreement for Radiology Capacity Solutions (PSR)' to six suppliers. The framework is valued at £25 million and runs until June 2029.
October 2024: £600 million insourcing of clinical support services
In October 2024, 38 suppliers were awarded places on the framework agreement insourcing of clinical support services. The framework's total value is £600 million and ends July 2027. This was a re-opening of competition for the pre-existing Framework Agreement SBS10203 Insourcing of Clinical Support Services which was conducted under the Light Touch Regime ('LTR'). Suppliers currently awarded to the pre-existing Framework Agreement did not need to re-apply. Companies awarded places include AM Diagnostic Imaging Ltd, Atlas Diagnostics Ltd, Connect Health Ltd, Healthshare Ltd, Modality LLP, and Ultrasonix Ltd.
July 2024: £250 million radiology reporting and associated services
In July 2024, 17 suppliers were awarded places on this Radiology Reporting & Associated Services Framework Agreement. The Framework Agreement is awarded for an initial period of 2 years with the option to extend for a further 2X12 months period and is worth £250 million. This framework agreement replaces one for the same service which came to end on 2nd December 2023. Companies listed include 4Ways Healthcare, AXON Medical, DMC Healthcare, InHealth Limited, Medica Reporting Ltd, and Radiology Reporting Online.
January 2024: £725 million clinical managed services, including managed maintenance services
In January 2024, 41 suppliers were awarded places on a framework contract for clinical managed services, including managed maintenance services. The four year contract was valued at £725 million. The framework includes: Clinical Managed Services and Managed Maintenance Services.
January 2024: National Framework Agreement for Radiology Capacity Management Solutions
The Countess of Chester Hospital NHS Foundation Trust awarded places on the framework 'National Framework Agreement for Radiology Capacity Management Solutions' to six suppliers. The framework is valued at £30 million and runs to January 2027.
January 2024 (re-opened) and 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.
The framework was re-opened in January 2024 with a further eight suppliers awarded places on the contract.
August 2023: £640 million reporting services - teleradiology
In August 2023, 10 suppliers were awarded places on the framework contract Reporting Services - Teleradiology. The framework is valued at £640 million and ends in August 2027.
July 2023: £800 million insourcing of clinical support services
In July 2023, 40 suppliers were awarded places on the insourcing of clinical support services. The total value of the framework is £800 million from July 2023 to July 2027. This procurement was conducted under the Light Touch Regime ('LTR'). The framework may be re-opened under the light touch regime at specific points during the term of the framework.
July 2023: £300 million patient discharge and mental health step down care services
In July 2023, 12 suppliers were awarded places on the framework contract patient discharge and mental health step down care services. The contract is valued at £300 million and ends July 2026. The framework includes: Discharge to assess services; Third Party Brokerage Services; Virtual Ward Support Services; and Mental Health Step Down Care Beds Services. Companies listed include British Red Cross, Direct Heathcare 24 Ltd, Sciensus Pharma, and Pulse Healthcare Ltd.
September 2022: National Framework Agreement for Teleradiology, Telepathology and Telemedicine Services
In September 2022 the Countess of Chester Hospital NHS Foundation Trust awarded places on the framework National Framework Agreement for Teleradiology, Telepathology and Telemedicine Services to 14 suppliers. The framework is worth £100 million and runs until September 2026.
October 2020, February 2021, April 2021 and June 2021: 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.
Selected high value framework contracts 2014 to 2026
| 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 |
| 25/4/2023 | Reporting services: teleradiology | up to £100,000,000 | Shared Business Services | 36 + 12 | A total of 14 companies, including Everlight Radiology and DMC Imaging |
| 22/6/2023 | NHS Type 2 Diabetes Path to Remission Programme | £20,000,000 | NHS England | 24 | Five companies awarded places, including Momenta and Oviva. |
| 11/8/2023 | Patient discharge and mental health step down care services | £300,000,000 | NHS Shared Business Services | 36 | Twelve suppliers awarded places on the contract. |
| 15/8/2023 | Insourcing of Clinical Support Services SBS10203 | £800,000,000 | NHS Shared Business Services | 48 | Forty companies listed on the award, including 18 Week Support Ltd, Alliance Health, DMC Healthcare, Medacs Healthcare and Omnes. |
| 11/8/2023 | Reporting Services: Teleradiology | £640,000,000 | NHS Shared Business Services | 48 | Ten suppliers awarded a place, including 4Ways Healthcare, DMC Healthcare, Everlight Radiology and Telemedicine Clinic Ltd. |
| 29/1/2024 | Re-opening of the NHS Workforce Alliance Framework Agreement for Insourced Services to Support the Provision of Healthcare Services (see above) | £2,000,000,000 | North of England Commercial Procurement Collaborative | 22 months left on framework to October 2025 | Eight additional suppliers added to the framework. This framework was first opened in November 2021. |
| 9/2/2024 | Clinical managed services, including managed maintenance services | £725,000,000 | NHS Shared Business Services | 48 | A place was awarded to 41 suppliers. |
| 3/7/2024 | Radiology Reporting and Associated Services Framework Agreement | £250,000,000 | NHS Commercial Solutions | 24 | A place was awarded to 17 suppliers. |
| 8/10/2024 | Re-opening of Insourcing of Clinical Support Services (see above) SBS10203 | £800,000,000 | NHS Shared Business Services | 33 months left on framework to July 2027 | An additional 38 suppliers were awarded places on this framework. By September 2026, 69 companies were listed on the framework. |
| 3/3/2025 | Mental Health, Learning Disability and Autism: Assessment and Diagnosis, NHS Talking Therapies and Crisis Services (SBS10239) | £70,000,000 | NHS Shared Business Services | 48 | 30 organisations have been awarded places |
| 1/4/2025 | Radiology capacity solutions | £25,000,000 | Countess of Chester Hospital | From April 2025 to March 2029 | Six organisations awarded places in April 2025 |
| 1/9/2025 | Provision of insourced and outsourced clinical services | £100,000,000 | Countess of Chester Hospital | Runs from September 2025 to August 2029 | 40 organisations awarded places in August 2025 |
| 1/9/2025 | Online sexual health services SBS10255 | £95,000,000 | NHS Shared Business Services | October 2025 to October 2029 | Six organisations awarded places |
| 1/9/2025 | Mental Health and Wellbeing Services | Countess of Chester Hospital | Runs from September 2025 to September 2029 | Over 40 organisations are listed on the framework |
