The NHS should not be viewed as a single organisation but rather a franchise with hundreds of outlets throughout the UK. Each country in the UK has different structures, processes regulatory bodies and priorities. In addition, each area has its own individual contracts.
The NHS can be divided into primary, secondary and tertiary care providers. Primary care usually refers to the care provided within the patients own community. As such it normally refers to GP services and health centres, District nursing services and community pharmacies. In some instances it will also refer to specialist clinics and community-based services such as artificial limb and wheelchairs services.
Secondary care refers to hospital based care however to confuse matters some healthcare trusts also classify a number of key patient-group based services within secondary care for instance children’s services, and alternatively psychiatry may be primary-care based regardless of whether that care is delivered in a hospital or the patients own home.
Tertiary care refers to specialist centres and recognised centres of excellence in specific disease management. Patients are referred to these services from their local district general hospital (secondary care).
All equipment used in pressure ulcer prevention and treatment within the UK has to meet a high standard. This is set not only by bodies such as the MHRA but also their Purchasing Authority.
In recent years the purchasing of equipment has become more formalised with the provision of national contracts (PaSA for England and Wales). Only approved manufacturers and products may be listed within the supply catalogue. These contracts are awarded through a national tender for a period of 1-3 years. Contracts include preferred suppliers of rental and lease equipment as well as purchase products.
Trusts are able to purchase from the approved list however local purchasing trends will be influenced by local equipment purchase and maintenance contracts (which may be arrived at by local tender) and the recommendations of local key opinion leaders. These could include:
- Ward clinicians
- Tissue viability nurses
- Occupational Therapists
- Manual Handling advisors
- Physiotherapy advisors
- Medical Equipment Maintenance engineers
- Buyers
Contracts and preferred suppliers are appointed on a matrix of interdependent issues. The exact make-up of these is determined at local level but invariably include: price, cost effectiveness, longevity, ease of decontamination and repair, service level agreements, educational support, ease of use, clinical efficacy evidence and reliability.
The clinical and equipment needs of the three types of care providers are very different. Generally, primary care will require equipment which is simple to use and easy to transport to the patients own home. Products need to be reliable and robust but will generally be used for prolonged periods of time. Secondary care will require equipment for the hospital market. Such equipment will need to have multiple functions to meet the often complex needs of acutely ill patients and the complex care settings (such as ITU) that these patients will be in. some areas such as ITU and coronary care will have specific functionality requirements such as integrated bed frame and mattress provision. Tertiary care markets are highly specific; with specific functions and care needs.
Squirrel Medical produced a specialise mattress replacement with the clinicians and technicians of Hampshire PCT, with the brief to produce an airflow air mattress that would help prevent bed falls and be suitable for patients of all risks. This later point was to help stop the practice of mattress swapping which is a major source of infection. The end product, the Squirrel Diamond has proven a huge success and is now used within Hampshire PCT, Sue Ryder Care and several other premium providers.
