PROCUREMENT
From theory to practice: a step-by-step pathway
A pragmatic VBP process for diagnostics might proceed as follows:
1) Define the clinical decision: what decision will the test inform, and within what timeframe? 2) Map the pathway: identify where the test sits, what steps change, and who needs to act differently.
3) Set the baseline: capture current turnaround times, error rates, admissions or referrals to establish a comparator.
4) Specify the non-negotiables: regulatory status, minimum performance, connectivity, and safety.
5) Choose 3–5 value measures: select observable indicators linked to the decision and pathway. 6) Invite supplier input: ask vendors to present evidence and clearly state assumptions. 7) Model the whole-system impact: include downstream costs and perform sensitivity testing. 8) Align contracts with enablers: build commitments around training, integration, uptime, and data sharing.
9) Monitor and learn: use simple dashboards and periodic reviews to confirm benefits or adjust course.
10) Share results: capture lessons and standardise what works into future tenders.
post-implementation early supplier engagement sessions focused on pathway design rather than price alone.
SMEs and a fair playing field The IVD market relies on SMEs for innovation. VBP must not become a compliance hurdle that only large firms can clear. Buyers can level the field by limiting the number of value domains scored, focusing on the few measures that mater most for the pathway, and accepting proportionate evidence where risks are low. Frameworks should avoid excessive narrative duplication and request data in standardised, reusable formats. Where appropriate, pilots with clear learning objectives can generate the local evidence needed for scale without imposing unrealistic burdens on early-stage companies.
Value of sustainability and resilience Pathology services can contribute to the NHS sustainability agenda through energy-efficient platforms, reduced consumables, consolidated logistics and lower waste. Resilience – assured supply, multi-sourcing options, and rapid recovery from disruptions – is also a legitimate value dimension. The key is to quantify these benefits over the whole life of the contract and to ensure sustainability features do not merely shift burden upstream or downstream (for example, by reducing plastic at the expense of increased cold-chain failures). Including carbon lifecycle and resilience metrics as part of value scoring, rather than as pass/fail requirements, allows innovative solutions to be recognised without compromising safety.
Traditional tenders
emphasise specification compliance and unit pricing, with limited mechanisms to share
risk or reward based on delivered outcomes
Governance and risk management Because diagnostic value depends on shared actions, governance must be explicit. Define ownership of each enabler: protocol updates, training completion rates, integration milestones; and schedule checkpoints before go-live. Where risk-sharing is contemplated, distinguish between supplier-controlled factors (instrument uptime, reagent availability, training quality) and system factors (clinical adherence, bed pressures) to avoid unfair penalties. Establish data-sharing agreements early so that outcome monitoring does not stall post-award. Finally, pre-agree how learning will be incorporated into contract variations; VBP should encourage adaptation, not lock services into an unchangeable design.
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What scientists should do differently For scientists and laboratory leaders, succeeding in a VBP environment means broadening the narrative from analytical excellence to pathway impact. During evaluations and pilots:
gather time-and-motion data to quantify hands-on time and botlenecks record how result availability aligns with clinical rounds and decision points track repeat rates, sample transport delays and IT interface errors document staff skills mix before and after implementation.
These measurements, combined with clinical input, turn technical performance into a persuasive value story. Looking ahead, designing studies that capture operational and pathway effects alongside accuracy will make future tenders much easier to win.
Making VBP work for pathology Value-based procurement promises a healthier market where genuine impact is rewarded. To realise that promise in pathology, the NHS should: tailor evaluation frameworks to the indirect nature of diagnostic value; separate specification from value scoring; invest in data linkage that connects laboratory activity to outcomes; and build capability across laboratories, procurement and suppliers. None of these steps require perfection – only clarity, proportionality and a willingness to learn. With these changes, diagnostics can be procured for the value they unlock across whole pathways, accelerating innovation and improving care for patients.
PPi
Beth Loudon is Director of Market Access at the British In Vitro Diagnostic Association (BIVDA) – the national industry association for manufacturers and distributers of in vitro diagnostics. Previously she was the Medical and Surgical Consumables Director for NHS Supply Chain, leading the clinical and commercial team responsible for assurance of value and resilience for the supply of clinical goods to the NHS and was also Category Director for Pathology and Therapies for NHS Supply Chain during the COVID-19 response. Beth has broad and deep experience across the NHS procurement and commercial landscape, gained over 25 years. As well as senior roles in the NHS, she has worked in consultancy, industry, government policy and achieved Fellowship status with the Chartered Institute of Purchasing and Supply. She has held governance positions with CIPS Congress and has been an active member of the Healthcare Supplies Association.
www.bivda.org.uk
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