NHS Value-Based Procurement for Medical Devices 2026: The Five-Domain Framework, Evergreen Level 1, and What Changes for Your Tender Score
In June 2026, the Department of Health and Social Care (DHSC), NHS England, and NHS Supply Chain launched the Value-Based Procurement (VBP) National Standard Guidance for Medical Technology — the most significant structural change to NHS medical device procurement in a generation. After pilots at 13 NHS trusts, the framework is now rolling out across England, and it changes how your tender submissions will be scored from this point forward.
The core change: price now accounts for a maximum of 40% of your NHS tender score. The remaining 60% — the majority — is allocated to five value domains that the DHSC has defined specifically for medical technology procurement. At the same time, NHS Evergreen Level 1 (mandatory from 6 April 2026) means that sustainability credentials have moved from a scoring factor to a gateway requirement. Suppliers who do not meet Evergreen Level 1 cannot be awarded NHS Supply Chain contracts, regardless of price or product performance.
This guide explains what the DHSC VBP framework requires of medical device suppliers, how the five domains are scored, what Evergreen Level 1 means in practice, and what you need to update in your NHS tender documentation before your next submission deadline.
Why this change matters
NHS procurement has historically been dominated by product price and technical specification compliance. The VBP framework does not eliminate either — product specification compliance (the Purpose domain) and whole-life cost remain part of the evaluation. But the framework makes two fundamental changes that alter how medical device suppliers must position themselves:
- Evidence beyond price and specification is now mandatory to win. A supplier who submits the lowest price and meets the technical specification can score a maximum of 50% (40% price + 10% Purpose) under the new framework, assuming all value domain criteria are met by competitors. In practice, suppliers who have not developed structured evidence for the social value, efficiency, patient outcomes, and supply chain domains will be outscored by competitors who have.
- Sustainability is now a gateway, not a scoring factor. NHS Evergreen Level 1 is not included in the VBP scoring — it is a pass/fail condition evaluated before scoring begins. Suppliers who have not completed the Evergreen assessment and achieved Level 1 are ineligible for award. This removes any tradeoff between sustainability and commercial competitiveness: Evergreen is a binary requirement.
The five value domains
The DHSC VBP framework allocates the 60% minimum value weighting across five domains. NHS trusts have discretion in how they allocate between the domains within the 60% ceiling, but the Social Value minimum of 10% and the overall 60% floor are fixed in the national standard:
| Domain | What it assesses | Minimum weighting |
|---|---|---|
| Social Value | Wider social and environmental benefits: carbon reduction, net zero roadmaps, ethical supply chains, workforce development, local economic impact | 10% of total score |
| Efficiency | How the device improves the patient pathway: reduced procedure time, bed days saved, clinician workflow impact, pathway cost avoidance | Included within 60% floor |
| Patient & Staff Outcomes | Evidence of patient experience and safety improvement, clinical outcome data, staff safety and training burden | Included within 60% floor |
| Supply Chain Resilience | Supplier risk profile, multi-source capability, lead time reliability, stockout risk, business continuity plans | Included within 60% floor |
| Purpose | Technical compliance with the buyer's product specification — the traditional fitness-for-purpose assessment | Included within 60% floor |
The whole-life cost element — covering purchase price, consumables, maintenance, training, and end-of-life disposal — is capped at a maximum of 40% of the total score. In practice, NHS trusts that previously scored on 80–90% price criteria must now restructure their evaluation matrices.
What evidence each domain requires
Social Value
Social value evidence in NHS medical device tenders now has a 10% minimum weighting and must be documented, not asserted. Procurement evaluators are using structured social value questionnaires aligned with the NHS Social Value Playbook. What they expect to see:
- Carbon Reduction Plan (CRP): A PPN 006-compliant CRP published on your company website. The CRP must include baseline emissions data (Scopes 1 and 2 at minimum), a clear net zero target date, board or director-level sign-off, and annual update commitment. This is now a double requirement: the CRP underpins Evergreen Level 1 (gateway) AND your Social Value score.
- Net zero commitment: A documented, time-bound commitment to achieving net zero emissions by 2050 at the latest. Ambition above this baseline (e.g., net zero by 2040 with interim targets) may attract additional Social Value score.
- Ethical supply chain: Modern Slavery Statement (mandatory for suppliers with £36M+ annual turnover in England, Wales, and Scotland), supplier code of conduct, and evidence of supply chain due diligence for device components and raw materials.
- Workforce and community: Fair employment practices, apprenticeship commitments, local recruitment in NHS regions where relevant, and supplier diversity programs. Evidence should be quantified (e.g., number of apprenticeships, % of spend with SMEs).
Efficiency
The Efficiency domain assesses how the device improves the patient pathway and generates resource savings for the NHS. This domain rewards suppliers who have invested in health economics evidence. Evaluators are looking for:
- Reduction in procedure or intervention time (measured in minutes per case)
- Bed days avoided or length-of-stay reduction (measured per patient episode)
- Clinician or nursing time savings (FTE hours per period)
- Pathway cost modelling showing NHS reference cost impact
- Reduction in readmission or complication rates where applicable
Health Technology Assessment (HTA) evidence, NICE Technology Appraisal alignment, or NHS Innovation Accelerator involvement strengthens Efficiency claims. Where clinical trial data is available, it should be structured as a health economics summary, not a clinical paper — procurement evaluators are not clinical reviewers.
Patient & Staff Outcomes
This domain bridges clinical evidence and real-world operational experience. NHS evaluators want evidence from comparable NHS settings (peer hospitals or comparable healthcare systems) rather than idealised trial conditions:
- Patient-reported outcome measures (PROMs) where relevant to the device category
- Adverse event and complication rate data from post-market clinical follow-up (PMCF) studies
- NHS reference site case studies (hospitals or NHS trusts using the device, with documented outcome data)
- Staff training burden assessment: how many hours of training does the device require for clinical competence? Is this lower than incumbent technology?
- Device-related incident reporting history (MHRA yellow card data should be reviewed and available if requested)
Supply Chain Resilience
Supply chain resilience became a formal NHS procurement criterion following COVID-19 supply disruptions, and the DHSC VBP framework codifies it as a scored domain. What evaluators assess:
- Country-of-origin diversity for critical device components
- Dual-source or multi-source capability for core products
- UK or near-shore inventory holdings and lead time commitments
- Business continuity plan covering supply disruption scenarios (supplier failure, logistics disruption, manufacturing site incident)
- MHRA device shortage reporting history and response track record
- For complex devices: service parts availability and engineering response commitments
Purpose
Purpose is the continuation of technical specification compliance. Under the VBP framework, it remains part of the value scoring rather than operating as a separate pass/fail gate (unlike Evergreen Level 1, which is truly a gate). Suppliers must demonstrate that the device meets the functional, performance, and safety specifications set out in the tender document. For medical devices, this typically includes:
- Clinical performance specifications matched against tender requirements
- Regulatory compliance documentation (UKCA or CE marking, MHRA registration)
- Interoperability with the trust's existing clinical information systems
- IFU (Instructions for Use) and labelling compliance
NHS Evergreen Level 1: the sustainability gateway
From 6 April 2026, all suppliers responding to NHS Supply Chain tenders must achieve Evergreen Sustainable Supplier Assessment Level 1 before tender closure. This is not a scored criterion — it is a pre-qualification requirement. Suppliers who have not achieved Level 1 at the point of tender close are ineligible for award.
The Evergreen platform (hosted by NHS England) replaces the Carbon, Waste and Water Reduction Assessment (CWW) that previously applied to NHS procurement. It provides a standardised sustainability data framework that NHS procurement teams use across all suppliers.
What Level 1 requires
| Requirement | Standard |
|---|---|
| Net zero commitment | Published commitment to net zero emissions by 2050 at the latest |
| Carbon Reduction Plan | PPN 006-compliant CRP published on company website; includes Scope 1 and 2 emissions baseline, board-level approval, annual update commitment |
| Evergreen assessment completion | Full completion of the Evergreen Sustainable Supplier Assessment on the NHS England platform at Level 1 maturity |
Additional NHS Supply Chain requirements for medical device suppliers
Alongside Evergreen Level 1, medical device suppliers must meet the following to qualify for NHS Supply Chain tender consideration:
- ISO 9001:2015 or ISO 13485:2016 certification from an accredited body
- CE marking (for EU MDD/MDR) or UKCA marking (for UK market) — or both for products sold in England
- Modern Slavery Statement (suppliers with annual turnover in England, Wales, or Scotland exceeding £36M)
- MSAT (Management Self-Assessment Tool) score of 41% or above
- Carbon Reduction Plan (meets both Evergreen and social value requirements)
ISO 13485:2016 is the preferred quality management standard for medical device suppliers over ISO 9001:2015, given its alignment with the MHRA registration framework, EU MDR Annex IX conformity assessment, and the FDA's QMSR (in effect from February 2, 2026). Suppliers holding ISO 13485 certification from an MDSAP-recognised body satisfy both NHS Supply Chain quality requirements and FDA inspection expectations simultaneously.
UK vs EU: how VBP differs from MEAT criteria
Medical device suppliers operating across UK and EU hospital markets need to maintain parallel tender evidence frameworks:
| Criterion | NHS (DHSC VBP framework) | EU hospital tenders (MEAT criteria) |
|---|---|---|
| Price weighting | Maximum 40% of total score | Authority discretion — typically 30–70% |
| Quality/value weighting | Minimum 60% (structured 5 domains) | Minimum 30% (unstructured by default) |
| Social value | Minimum 10% mandatory | ESG criteria optional (growing but discretionary) |
| Sustainability gate | Evergreen Level 1 — pass/fail mandatory (NHS SC) | No equivalent mandatory gate (ESG criteria vary by country) |
| Clinical evidence framing | Domain-specific (Efficiency, Patient & Staff Outcomes) | Technical and quality criteria (varies) |
| Supply chain resilience | Scored domain (Supply Chain Resilience) | Not standard; increasingly appearing post-COVID |
| Framework specificity | Medtech-specific national standard | Generic public procurement (EU Directive 2014/24/EU) |
Suppliers who have invested in MEAT-aligned evidence for EU hospital tenders (clinical value data, total cost of ownership modelling, sustainability credentials) can adapt much of this evidence for the DHSC VBP domains. The key additions for the UK market are the structured social value evidence to the 10% threshold and the Evergreen Level 1 gateway compliance.
What medical device suppliers need to update before the next NHS tender
Immediate actions (before next tender submission)
- Complete Evergreen Level 1: Register on the NHS Evergreen platform (evergreen.nhssupplychain.nhs.uk) and complete the sustainability assessment to Level 1 maturity. Allow 2–4 weeks for completion and verification.
- Publish a Carbon Reduction Plan: If your company has not yet published a PPN 006-compliant CRP on your website, this is now a blocking requirement for NHS Supply Chain tenders. The CRP must be publicly accessible — a PDF on your company website is the standard format.
- Confirm ISO 13485 certificate scope: Verify that your ISO 13485 certificate covers all products being tendered and that the certificate validity extends beyond the contract period. NHS Supply Chain requires valid certificates at the time of submission.
- MSAT score check: Confirm your MSAT (Management Self-Assessment Tool) score is at or above the 41% minimum. If not, identify improvement areas before submitting.
Evidence development (next 3–6 months)
- Social value evidence pack: Build a structured social value evidence document covering: Carbon Reduction Plan summary, net zero commitment, Modern Slavery Statement (if applicable), workforce development initiatives, and quantified community impact. This document will be required for every NHS tender from this point forward.
- Health economics brief: Commission or compile a health economics summary for each major device category. The Efficiency domain rewards pathway-level evidence; clinical papers are not substitutes. Structure the summary around NHS reference costs and per-patient pathway impact.
- Patient outcome data compilation: Gather PMCF data, NHS reference site case studies, and PROM data into a structured outcomes brief. Identify NHS reference sites who would provide positive testimonials and outcome data.
- Supply chain resilience documentation: Document country-of-origin distribution for critical components, UK/near-shore inventory levels, lead time commitments, and business continuity plans. This can draw on existing ISO 13485 supplier qualification records (ISO 13485 §7.4).
How MedStrato helps NHS medical device suppliers with VBP submissions
The DHSC VBP framework changes NHS medical device tenders from a primarily specification-and-price exercise to a multi-domain evidence exercise. The compliance burden — maintaining evidence across five domains, tracking Evergreen status, aligning ISO 13485 documentation with NHS requirements, and mapping clinical outcome data to efficiency criteria — is substantial.
MedStrato's compliance engine maintains a structured evidence repository across all five VBP domains and maps available evidence to specific NHS tender requirements automatically. When your team responds to an NHS Supply Chain tender:
- Evergreen Level 1 completion status and Carbon Reduction Plan currency are verified against tender eligibility requirements before submission
- ISO 13485 certificate scope and validity are checked against the tendered product list and contract period
- Social value evidence is matched against the 10% minimum weighting and formatted to the NHS Social Value Playbook structure
- Health economics data, PMCF evidence, and reference site outcomes are mapped to the Efficiency and Patient & Staff Outcomes domains
- Supply chain resilience documentation is assembled from supplier qualification records and business continuity plan summaries
With the DHSC VBP framework now in force, the suppliers who win NHS medical device contracts will be those who have structured their evidence as systematically as their pricing. Book a demo to see how MedStrato manages NHS VBP evidence across your product portfolio, or read our UK medical device procurement guide for the full NHS market access context.