Published: 06/10/2005 Volume 115 No. 5976 Page 28

Andrew Marshall is consultant cardiologist at Derriford Hospital's South West cardiothoracic centre in Plymouth, Ian Shepherd is procurement director at the Peninsula purchasing and supply consortium, and Geoff Morris is regional vice-president of Medtronic.

About 430 pacemakers, costing£1m, are implanted each year in Plymouth. A change in purchasing policy has meant the budget has remained flat for seven years in spite of an annual 6 per cent increase in the number of patients fitted with a pacemaker, creating cumulative savings of some£1.16m.

Historically, pacemakers were bought through NHS Supplies framework contracts following an annual evaluation by the chief cardiac technician in conjunction with the clinical director for cardiac pacing. This was a time-consuming and unnecessarily complicated procedure. Pacemakers were 'called off' against a purchase order and reconciled later with the invoice for payment. Long-term and volume commitment, let alone patientcentred goals, were not encouraged.

The cardiology department wanted to use state-of-the-art technology to treat 10-15 per cent more patients and maintain similar or lower overall costs.

For procurement, the aims were to improve the purchasing process by building relationships, to limit the range of products to fewer topperforming suppliers and to negotiate volume supply contracts to drive quality up and cost out within a capped budget, without compromising choice.

One important aspect of the relationship was for the supplier to provide training and education, and this was written into the contract. In addition, a longer contract term was seen as essential so an initial threeyear period was agreed, with options to extend up to seven years.

Suppliers were sourced from those known to have sound research and development track records. To reduce risk of technical failure, the budget was split equally and commitment made to two different suppliers - including Medtronic and sister company Vitatron - with complementary yet different research and development focuses.

As an agreed approach to innovation, 10 per cent of the annual implant volume was outside the contract so that specific or unusual products could be bought.

The contract covered all pacing equipment, with an agreed price for all products according to an estimated number of pacemakers needed annually within a capped budget, allowing freedom of clinical choice. The pacing clinics have achieved their initial aim of treating 10-15 per cent more patients at the same or lower overall costs as in 1998. Continual monitoring and control checks were undertaken during the initial three years of the contract, and the option to extend was taken up.

An automated replenishment supply station inside the theatre not only smoothes stock availability but also frees up time equivalent to one procedure a week - equivalent to around£200,000 a year.