Navigating NHS Market Access: Policy Change and Opportunity in England
With the changes at NHS England and the publishing of the 10-Year Plan, there is a lot of talk of change in the NHS in England. But what do these policy changes mean in practice? At Petauri Evidence, we’ve been asking our NHS Associates to share their on-the-ground experiences and discuss the impact of new policy on their world. In this article, Sarah Everest Ford (Programme Director, Health and Care Partnership) explores the transformation she’s seeing in the NHS, what this means for industry-NHS engagements, and suggests actionable takeaways for Pharma and Medtech teams looking to achieve market access in the UK.
Sarah is a highly experienced senior healthcare leader and nurse, with a background in strategy, commissioning, project and programme management, operational management and, of course, nursing. She has worked across the health and care sector for over 25 years, where she has held roles including Strategy Director at OneMedical Group, Head of Business Development and Strategy at DHU Healthcare, Assistant Chief Commissioning Officer – Integration at North Derbyshire Clinical Commissioning Group (CCG) and Senior Public Health and Commissioning Manager at Nottinghamshire County Council. Over to Sarah…
From Ward to System: A Grounded Perspective on Market Access
My career began in 1997 as a student nurse. I learned early that change in the NHS rarely starts with policy; it starts with people. Fast forward to 2025, with my current role as a Programme Director in a Health and Care Partnership, and I still hold that view. The system is evolving rapidly; however, access to the NHS market remains a complex area. This article aims not to recount policy developments, but to offer my grounded, strategic view on where opportunities genuinely lie and how industry can effectively engage.
The Rules Are Shifting, but Behaviour Change Matters More
The structural evolution from Primary Care Trusts (PCTs) to Clinical Commissioning Groups (CCGs) and now to Integrated Care Systems (ICSs) has changed the mechanics of decision-making; however, not necessarily the dynamics. Nationally, Integrated Care Boards (ICBs) now commission services with population health at the centre, but this has not yet unlocked the clarity that many hoped for. What is the real determinant of access? I think it is relationships and relevance to the providers and clinicians you want to work with.
Industry partners often arrive equipped with national guidance, compelling trial data, or a product aligned to NHS priorities. Yet they sometimes miss the mark by failing to show how their solution fits into existing local priorities. Our local decision-makers are less interested in the what, and more focused on the why now, why here, and why us.
Actionable takeaway for industry:
Do not lead with the product; lead with the problem you are solving locally. Demonstrate understanding of the local clinical or delivery models, local Joint Strategic Needs Assessments (JSNAs), and how your innovation improves outcomes across pathways, not just that single point of activity .
Co-Design Starts with Understanding the Local Context
I have seen commercial proposals that are fully formed before they ever engage the people delivering or receiving care. Co-design and co-production are not token gestures in our Health and Care Partnership; they are core ways of working, such as our developing and implementing our fully co-produced mental health strategy. I think market access today depends less on polished pitches and more on genuine partnership. To succeed, industry needs to understand the nuances of local systems, not just what a place needs, but how it works.
Each area has its own history, workforce model, digital maturity, estate constraints, and clinical priorities. One-size-fits-all approaches no longer work. Companies that thrive are those who come with curiosity, listen well, and take time to build connections with clinicians, programme teams, and people with lived experience.
In our system, for example, we are developing an Integrated Frailty Hub (inspired by a model from another part of the country) bringing together primary care, social care, community teams, voluntary, community, and social enterprises (VCSEs), housing, and others to deliver personalised, wraparound care, based on ‘what matters to the person’. A company offering digital case management or remote monitoring will not get far by pitching functionality alone. They will need to show they understand local workforce pressures, how funding flows across partners, and what matters most in our neighbourhoods. Rather, they need to present how their solution integrates into the existing, benefits or modifies the local care provision. The latter would clearly require further understanding as to the implications of the required modifications.
Actionable takeaway for industry:
The system isn’t always easy to navigate, and relationship-building is a long game, but there are routes in. The more you align with local dynamics, the more trusted and influential your role becomes.
(Download the PDF at the bottom of this article for even more practical tips and considerations from Sarah.)
A System That Buys Outcomes, Not Units
A major mindset shift is underway. We are no longer simply procuring services or products; we are trying to improve health and wellbeing outcomes, from the way services are commissioned, delivered, and measured. We are building dashboards that measure wellbeing, not just activity. We are interested in whether frailty is being delayed, not just how many appointments were delivered.
This creates an opening for innovators, particularly in digital health, remote monitoring, and workforce enablers. Outcome-based commissioning and delivery demand shared risk and shared insight. If your offer does not show how it helps us improve our population health and wellbeing outcomes, it will not gain traction.
Industry often asks: “How do we demonstrate value in an outcome-focused system?”
Here are some actionable takeaways:
- Start with the Outcomes Frameworks
- Use NHS language systems to understand and be understood
- Build in your own evaluation approach
- Offer shared risk models
(Sarah expands further on these points in our PDF download… Scroll down to download your copy!)
How can industry get commissioners or other health colleagues to listen?
We know it can feel like doors are closed or conversations are one-sided. However, there are ways to build meaningful relationships with system leaders, and it starts with shifting from selling to solving together.
Actionable takeaways for industry:
- Understand the system pressures
- Offer insight, not just an introduction
- Find your allies and they may not be commissioners
- Be present before you’re needed
(Again… Sarah expands further on these points in our PDF download… Scroll down to download your copy!)
The Procurement Paradox: Opportunity in Constraints
Procurement is often painted as the villain in NHS market access; however, it can also be a powerful enabler when approached collaboratively. Budget constraints are very real, but there is increasing appetite for value-based procurement models that focus on outcomes rather than just cost or volume.
What matters is demonstrating how an innovation delivers system-wide value. Too often, proposals highlight return on investment without addressing where that value lands. If savings are realised in one part of the system but create cost pressures elsewhere, the case may not progress. The most effective partnerships are those where suppliers help us build a shared business case, grounded in real understanding of cross-sector pressures and priorities.
Actionable takeaway for industry:
Do not just talk Return-on-Investment (ROI). Understand how the NHS segments cost and benefit across systems. If your innovation saves money for social care but costs the NHS, it is a harder sell. Collaborate with us to build the business case across the entire system, not just the silo that buys.
Making Equity the Entry Point
Health inequalities are not just a policy priority; they are often one of the biggest lenses through which we are now asked to view innovation. In practice, this means we prioritise solutions that support reducing inequalities and increase inclusion, such as improving digital literacy or increasing access for inclusion health groups.
Actionable takeaway for industry:
Design for inclusion from the start. If your solution can only work for digitally literate, self-managing patients, it may unintentionally widen inequalities. Consider partnerships with VCSE organisations to reach groups that are often excluded.
Giving Back in a Financially Pressured System
The NHS is facing one of the most financially challenging periods in its history. With resources under immense strain, our focus is increasingly on securing maximum value, not just from contracts, but from the partnerships behind them. Innovation alone is not enough; we are looking for collaborators who are willing to contribute to the broader social and economic fabric of our communities.
This is where the concept of social value becomes essential. We are starting to ask: what else does this supplier bring? Can they offer local employment opportunities, support skills development, or contribute to sustainability goals? Even modest commitments, like hosting apprenticeships, support local research, investing in community spaces, or supporting local VCSE organisations, can tip the balance in favour of a partnership.
In some cases, we are exploring mechanisms like social bonds or shared benefit clauses to ensure contributions are visible, measurable, and locally meaningful. These approaches signal a shift in mindset: from buyers and sellers to long-term system partners.
Actionable takeaway for industry:
In a financially constrained NHS, partnerships are forged not just through price and performance, but through purpose. Think beyond the product: how can your organisation add value to the place it is operating in? The more you align with local priorities and invest in communities, the more doors will open to genuine, lasting collaboration.
Culture Over Strategy: The Reality of System Change
Many industry colleagues ask why it takes so long for decisions to be made in the NHS. The truth? Culture eats strategy for breakfast! Even when funding is available, the appetite for risk, change fatigue, and competing priorities often stall progress.
In my role, part of the work is storytelling, helping partners see how innovations fit into their mission, not just their workload. The most successful industry partnerships I have seen are those that act as allies, not just suppliers. They understand our pressures, adapt to our pace, and stay the course through governance hurdles.
Actionable takeaway for industry:
Patience and persistence matter. Keep engaging, even if the first conversation does not yield a contract. Offer support with business case development, help us articulate benefits, and be a learning partner, not just a supplier.
Partnering with the Real Power Centres
Traditional commissioning routes are no longer the only, or even the most effective, access points for innovation. Increasingly, the centre of gravity is shifting towards place-based arrangements such as Health and Care Partnerships, particularly provider collaboratives and place-based delivery alliances. These are the spaces where transformation is happening, budgets are being blended, and decisions are being made closer to communities.
In our Health and Care Partnership, we are actively strengthening our Section 75 arrangements to pool more resources and align decision-making across NHS and local authority budgets. This gives us greater flexibility to innovate at place level, trial new models, and deploy funding where it can have the biggest impact. It also means that providers, across primary care, community services, mental health, and the VCSE sector, are working together with shared responsibility for outcomes.
For industry, this presents a clear opportunity. The organisations driving service redesign and holding financial levers may no longer be commissioning teams alone, but the local place collaboratives and the integrated teams working together on the ground.
Actionable takeaway for industry:
Build relationships with Health and Care Partnerships, not just traditional commissioners. Understand how provider collaboratives are working in your target area, and where Section 75 or pooled budget arrangements are creating space for innovation. If you want to influence the future, engage with the people shaping it at place.
Final Reflections: A Nurse’s Lens on Innovation
What drew me to nursing was the belief that good care changes lives. What keeps me in system leadership is the belief that the right partnerships can change systems and improve health and wellbeing for local communities. Through the NHS 10-Year Plan, we are entering a period of profound transformation in the NHS, not just structurally, but philosophically. Population health, prevention, and place-based care are more than buzzwords; they are reshaping what it means to ‘access’ the NHS.
For industry, the message is clear: the door is open, but not in the way it used to be. It is no longer about selling to a commissioner; it is about co-creating with a community, developing local partnerships with provider collaboratives. It is not just about price; it is about purpose, and success will come not from presenting solutions, but from helping us ask better questions and really understand the problems we are all trying to solve.
We would like to thank Sarah for sharing her perspectives and recommendations in this article. If you’d like to reflect further on any of the points raised or would like support actioning any of Sarah’s takeaways, get in touch today: email evidence@petauri.com.
Download Sarah’s key takeaways:
Submit you details below to download a copy of all the key takeaways and some further additional insights from Sarah on how to drive change and engage with NHS stakeholders.