How do NHS procurement teams manage clinical and non-clinical spend?

NHS procurement teams manage clinical and non-clinical spend through distinct governance structures, category strategies, and procurement frameworks, reflecting the fundamentally different risk profiles and supply chain dynamics of each spend type. Clinical spend, covering medicines, medical devices, and consumables, is tightly regulated and often routed through national frameworks, while non-clinical spend spans a broader range of categories managed with greater local flexibility. Understanding how NHS organisations navigate both is essential for any procurement professional working in or with the health sector.

What is the difference between clinical and non-clinical spend in the NHS?

Clinical spend in the NHS refers to expenditure on goods and services that directly support patient care, including medicines, medical devices, surgical consumables, diagnostic equipment, and clinical services. Non-clinical spend covers everything else the organisation needs to operate, such as facilities management, IT systems, catering, estates, uniforms, and professional services. The distinction matters because each category carries different regulatory requirements, risk levels, and procurement approaches.

Clinical spend is subject to additional layers of oversight beyond standard procurement rules. Products must meet stringent safety standards, and purchasing decisions often involve clinical stakeholders, consultants, pharmacists, and nursing staff, who have professional accountability for the products they use. This means procurement teams must balance commercial objectives with clinical governance requirements.

Non-clinical spend, while still subject to public sector procurement regulations, offers more flexibility in how categories are structured and sourced. The risk profile is generally lower, and commercial criteria tend to carry greater weight in supplier selection. However, non-clinical spend is often where NHS trusts have the most untapped savings potential, making it a priority area for cost optimisation programmes.

How do NHS procurement teams structure their category management?

NHS procurement teams typically structure category management by grouping related goods and services into defined spend categories, then assigning specialist buyers or category managers to develop and execute sourcing strategies for each area. Categories are usually aligned with the NHS Supply Chain category towers for clinical goods, while non-clinical categories are managed locally or through regional collaborative arrangements.

In larger NHS trusts, category management operates across several distinct areas:

• Clinical categories: Medicines and pharmacy, medical devices, surgical consumables, diagnostics, and clinical services
• Facilities and estates: Building maintenance, cleaning, catering, energy, and waste management
• IT and digital: Hardware, software, managed services, and digital transformation programmes
• Workforce and professional services: Agency staffing, consultancy, training, and HR-related services
• Corporate services: Finance, legal, communications, and administrative supplies

Effective category management in the NHS requires close collaboration between procurement professionals and the clinical or operational leads who use the goods and services in question. Without that alignment, category strategies risk being commercially sound but operationally impractical. Many trusts have invested in building category management capability internally, though gaps in specialist expertise remain a persistent challenge, particularly for complex or lower-volume categories where deep market knowledge is difficult to maintain.

What procurement frameworks do NHS organisations use for clinical spend?

NHS organisations primarily use nationally negotiated frameworks for clinical spend, with NHS Supply Chain being the dominant route to market. NHS Supply Chain operates a series of category towers covering medical devices, consumables, and other clinical products, providing pre-tendered agreements that trusts can call off directly. This approach reduces the administrative burden on individual trusts and leverages collective buying power across the health system.

Beyond NHS Supply Chain, clinical procurement teams also draw on frameworks from:

• NHS Shared Business Services (NHS SBS): Offering frameworks across clinical and non-clinical categories, including pharmacy and diagnostics
• Crown Commercial Service (CCS): Relevant where clinical organisations need to procure professional or technology services
• Regional procurement hubs: Including organisations such as NHS London Procurement Partnership and NHS Commercial Solutions, which develop frameworks tailored to regional needs
• Collaborative procurement partnerships: Where groups of trusts pool resources to run joint tenders for high-value or specialist clinical categories

Medicines procurement operates somewhat differently, with NHS England and NHS Improvement playing a central role in negotiating national pricing through the Drug Tariff and commercial medicines frameworks. Pharmacy teams within trusts work closely with procurement to manage formulary decisions and ensure compliance with national pricing agreements.

Using established frameworks reduces procurement risk and helps trusts demonstrate compliance with the Procurement Act 2023, which replaced the previous Public Contracts Regulations and introduced new transparency and value for money obligations for public sector organisations.

How is non-clinical procurement governed differently in NHS trusts?

Non-clinical procurement in NHS trusts is governed by the same public sector procurement legislation as clinical spend, but it typically operates with greater local autonomy. Trusts have more discretion over how they structure non-clinical categories, which frameworks they use, and how they engage the market, provided they meet the thresholds and transparency requirements set out in the Procurement Act 2023.

In practice, non-clinical procurement governance varies considerably between trusts. Larger foundation trusts often have dedicated non-clinical category managers and well-developed supplier management processes. Smaller trusts may rely on shared services arrangements or lean heavily on national frameworks to compensate for limited internal resource.

Key governance differences include:

• Clinical involvement: Non-clinical procurement decisions rarely require clinical sign-off, though operational stakeholders such as estates managers, IT leads, and finance directors are typically engaged
• Framework usage: Non-clinical categories often use Crown Commercial Service frameworks, regional hub agreements, or locally negotiated contracts rather than NHS Supply Chain
• Savings targets: Non-clinical spend is frequently targeted in efficiency programmes because it offers more scope for commercial renegotiation and supplier consolidation
• Contract management: Non-clinical contracts, particularly in facilities, IT, and professional services, tend to be longer in duration and more complex to manage, requiring ongoing supplier relationship management rather than transactional purchasing

What are the biggest challenges NHS procurement teams face managing both spend types?

The biggest challenges NHS procurement teams face include resource constraints, clinical stakeholder engagement, regulatory complexity, and the difficulty of maintaining consistent category management capability across both clinical and non-clinical spend simultaneously. These pressures are compounded by ongoing financial constraints across the health system and the growing complexity of the NHS supply chain following post-pandemic disruption.

Balancing clinical and commercial priorities

Clinical procurement decisions are rarely made on commercial grounds alone. Clinicians have legitimate authority over product selection, and procurement teams must navigate situations where a preferred clinical product carries a higher cost than a commercially equivalent alternative. Building trust with clinical stakeholders and developing shared decision-making processes are two of the most persistent challenges in NHS procurement.

Capacity and specialist expertise gaps

Many NHS trusts lack sufficient procurement resource to manage the full breadth of their spend categories to a high standard. Non-clinical categories in particular, including IT, estates, and professional services, require specialist market knowledge that is difficult to maintain internally. When key procurement staff leave, institutional knowledge and supplier relationships can be lost quickly, disrupting ongoing programmes and contract management activities.

Supply chain resilience has also become a more prominent concern. The disruptions experienced during the pandemic exposed vulnerabilities in single-source clinical supply arrangements, prompting many trusts to reassess their supplier diversification strategies and stock management approaches.

How can NHS procurement improve value across clinical and non-clinical categories?

NHS procurement teams can improve value across both spend types by investing in category management capability, making better use of national frameworks, strengthening supplier relationship management, and ensuring procurement is involved earlier in organisational decision-making. The most effective trusts treat procurement as a strategic function rather than a transactional one, integrating it into service planning and capital programmes from the outset.

Practical steps that deliver measurable improvement include:

• Spend analysis: Conducting regular, data-driven reviews of both clinical and non-clinical spend to identify consolidation opportunities, maverick buying, and under-leveraged framework agreements
• Collaborative procurement: Joining regional or national collaborative arrangements to access better pricing and reduce the resource burden of running individual tenders
• Supplier rationalisation: Reducing the number of active suppliers in non-clinical categories to improve contract management efficiency and negotiate stronger commercial terms
• Clinical engagement programmes: Developing structured processes for involving clinicians in product selection decisions, with shared understanding of the cost and quality trade-offs involved
• Contract management investment: Ensuring that post-award contract management receives the same attention as the sourcing process, particularly for high-value or long-term non-clinical contracts
• Procurement capability development: Building internal skills through training, coaching, and access to specialist expertise for complex or unfamiliar categories

Value improvement in NHS procurement is rarely achieved through a single intervention. The trusts that sustain long-term savings and service improvements are those that build procurement capability as an ongoing organisational priority, supported by strong leadership and consistent investment in people and processes.

How eXceeding supports NHS procurement teams

eXceeding has direct experience supporting NHS organisations, including Cambridge University Hospitals NHS Foundation Trust, with complex procurement challenges across both clinical and non-clinical spend. As an independent consultancy with no ties to suppliers or frameworks, eXceeding always acts in the client’s best interest.

For NHS procurement teams, eXceeding can help by:

• Providing interim procurement professionals to fill capacity or specialist expertise gaps quickly
• Running complex tenders and sourcing exercises across non-clinical categories where internal resource is stretched
• Conducting spend analysis and cost optimisation reviews to identify savings across both spend types
• Supporting supplier rationalisation and contract management improvement programmes
• Delivering category management training and coaching to strengthen internal procurement capability

Whether your NHS organisation needs short-term project support or longer-term strategic capability, eXceeding’s team of experienced procurement consultants can provide the expertise you need. Contact eXceeding today to discuss how we can help your procurement team deliver better value across clinical and non-clinical spend.

Related Articles

• What is the difference between procurement outsourcing and a GPO?
• What SLAs should a procurement outsourcing agreement include?
• How does procurement maturity affect supplier negotiation outcomes?
• Should you centralise or decentralise your procurement function?
• What is the difference between procurement and supply chain?