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Bridging the gap between procurement and clinicians

In an interview with NHS Supply Chain, Emma Nuttall, the organisation’s clinical nurse advisor (CNA), speaks about the role she has in helping trusts meet Lord Carter’s efficiency challenge and why it needs to be done.

It’s at this time of the year when most of us take a look at our budgets and think about ways we can save money. Procurement in a trust is no different, and a CNA’s role is to get clinicians to think about their procurement budget and to help them find ways to save – all year round.

Of course, this is a very simplified way of looking at the role of a CNA, but the end result is the same: to help trusts save money through the procurement process, whilst maintaining safety and quality.

Back in 2015 Lord Carter identified the need to move towards standardisation, rationalisation and fair pricing purchase through a standard route. His reference to potential savings of £2bn from procurement underpins the work Emma Nuttall is undertaking.

“The process of looking at savings is complex, and the ethos of change is uncomfortable for a variety of reasons. But this needs to occur if the NHS is to be sustainable moving forwards, and it’s everyone’s responsibility to take this forward into the future,” said Nuttall, CNA for NHS Supply Chain.

To make savings possible requires a real partnership between procurement teams and clinicians, and this is where a CNA can play a key role.

Negotiating change

Nuttall is one of 12 CNAs currently working for NHS Supply Chain. A registered nurse, she looks after 15 trusts predominantly in the north of England. Working closely with account managers, her clinical experience and procurement knowledge provides her with the appropriate skills to talk to clinical staff about the choice of products they use and encourage them to try other products that could make savings for the trust.

“My role is about negotiating,” explained Nuttall. “I unpick why people don’t want to change products. It’s often because we are looking at something they’ve always used, they trust the brand and the product, or it can even be because they like the packaging and how it looks.

“It’s important for me to get people past that mentality and get them thinking about clinical acceptability and cost. Does the product do the job it’s meant to do? Is it fit for purpose? Those are the questions people should be asking.

“If the answer is yes, then I ask end users to at least try the different product. It’s not about taking away choice or losing control; it’s about getting over hurdles and getting staff involved. And there are huge savings that can be made. I often say to people, you budget at home when you shop. This is everyone’s money that’s being spent.

“Where we really miss a trick in procurement is in not educating our clinical staff earlier in their careers. We learn about people’s roles in the hospital, but procurement is never taught. It’s a bit of a mystery where products come from for many. As a junior member of staff we see things on the shelf, but we don’t know how it got there or its cost, we’re just used to it being there. Being procurement and budget savvy needs to be taught much earlier – and not just for nurses but for doctors, surgeons and all clinical colleagues too.”

Newcastle successes

Nuttall has built a particularly good relationship with The Newcastle Upon Tyne Hospitals NHS FT, which has taken many of her proposed product switches on-board. For just over a year the trust has had a Clinical Procurement Evaluation Group (CPEG), chaired by Chris Eddy, deputy director of nursing and patient services. The group meets monthly and Nuttall joins them to talk through numerous items identified through regular ordering, and to discuss the pros and cons of changing to alternative, lower-cost options. So far the CPEG has achieved an admirable £200,000 of savings, with £75,000 in progress, and has progressed into two additional focus groups.

“There’s still a significant amount of savings that can be made,” said Eddy. “If I take theatre shoes as an example, there are huge price differences, with products being ordered ranging from £15 to £90. We need to think of the rationale behind these differences. It can’t be because that’s what’s always happened. There are opportunities to make more savings by switching to alternative, clinically acceptable products.”

Jolene Grainger, procurement specialist at the foundation trust, has worked closely with Nuttall and was instrumental in setting up the CPEG. “By liaising closely with clinical colleagues, the procurement team has been able to identify and act upon opportunities to improve patient care and achieve cost savings,” she said.

“When I speak to clinicians I ask them to look at the products they have in their cupboards to see if they’re ordering a lot of the same product from different suppliers. I went into the radiology department recently and had a rake through the cupboards.

“We want clinicians to be part of this – it’s important we work together. It’s about product changes where we can make savings, but it’s not just about savings: we still have to have a product that is fit for purpose.”

Helen Lisle, director of procurement and supplies at the foundation trust, added: “I am delighted with the progress made within the trust over the past 12 months. We knew from the outset that there were many opportunities to review the products being used. In some instances the group has been able to ensure consistency of use across the trust, which of course has many benefits, including reduction of risk through misuse of product.

“Having an additional resource with a clear clinical background to support the programme has been extremely beneficial. It’s so important for the clinical staff to be able to have open and honest clinical conversations and for them to also see that the programme is very much about delivering clinically acceptable products to support the very best care to our patients. Nuttall provides the group with so much support and guidance that we see her as very much part of the team.

“I am very much looking forward to seeing the progress over the next 12 months and the implementation of another group to look specifically at opportunities in theatres.”

Harnessing clinical expertise

That’s where Nuttall’s clinical experience is so important. She bridges the gap between procurement and clinicians. “I’m not just sat at a desk asking them to use a different product because it’s cheaper. I come into the trust with the products so the clinical staff can see them, try them and make their own minds up. With my clinical training I can offer them the reassurance that the products I’m proposing are fit for purpose and will do the job they need them to do,” she explained.

“Of course, I’m open to and value feedback. Staff are often positive about switching once they have tested the product, but if they aren’t – and have clinical reasons for that – I’ll follow that up and have gone back to suppliers on some products and told them the products aren’t good enough. 

“Trusts should use CNAs as an asset, as a resource, even if it’s just to identify and help work through their challenges. They may have a huge area of spend that needs clinically unpicking and I can help with that. I can bring input about what has worked well elsewhere and put trusts in contact with one another, for peer-to-peer discussions.

“If someone says to me ‘I can’t use that for a procedure,’ I can ask why and say, ‘these 30 trusts do use this and, as a nurse, I think you can. But let me support you in working through this and finding a solution together.’”

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W: www.supplychain.nhs.uk