The NHS market is a market in which establishing personal relationships is fundamental. It is all about finding (and supporting) determined individuals, those willing to challenge the norms and make the right connections.

However, a single individual is not enough. Since NHS entities have complex governance and NHS managers and clinicians often move on, it is necessary to get different individuals on board to increase the possibilities of success of a particular proposition.

Once success is achieved with one organization, the preparation and documentation of case studies may help to spread the results to other similar organisations.

From an NHS point of view, the digital challenge is large and multifaceted, and the offering of any one SME is likely to be a small cog in the wheel. Therefore, building relationships and partnerships with other SMEs with complementary offers may be a useful strategy. On a broader level, anyone operating in this digital health space is effectively part of the movement that is pushing and supporting the NHS to move towards a digital future. It follows that there is a risk that negative competition between digital health SMEs diminishes everyone and undermines a common goal.

“The centralization of purchases has been increasingly a strategic trend, particularly in the health sector.
In Portugal, the SPMS, Serviços Partilhados do Ministério da Saúde, E.P.E., was established in 2010 as a central purchasing entity for the health sector” ⁰.

Selling to the NHS is difficult, the manufacturer must consider several aspects when developing the product.

When we focus on public procurement, there are two criteria to keep in mind:

• Ensure the requirements, i.e., ensure that the product/solution meets all the functional requirements necessary for it to function correctly and error-free;
• Ensure that the product/solution is the lowest unit cost, which is made with constituents that ensure quality and price.

The solution selected in public procurement will be the one that meets all requirements as expected when purchasing the product/solution and has the lowest unit cost.

Pilots are often a default option. However, when deciding to install a pilot it is needed to carefully analyse what are the possibilities of success after the pilot’s finish.

The SPMS is responsible for the procurement for the provision of healthcare services, at a national level2. The applicable rules are set forth in Decree-Law 18/2008 of 29 January, as amended, which introduced the Public Contracts Code. Other rules also apply, such as the Administrative Procedure Code and the Procedure Code of the Administrative Courts. Moreover, the Minister of Health issued, on 16 January 2017, Order n.o 851-A/2017 with recommendations aimed at preventing the violation of the principles of transparency, competition and pursuit of public interest in the area of public procurement ⁰.
The SPMS provides a single contracting platform to support all the processes related to public purchases for the NHS. The SPMS publishes on the platform a Public Health Supply Catalogue, “which provides, among other things, updated information on existing goods and services under public procurement contracts and allows for the online consultation of the ongoing public tenders, as well as the online submission of supply proposals” ⁰.
Looking for the procurement procedures, the Public Contracts Code provides the following types of procedures: direct fit, public tender, public tender limited by prior qualification, negotiation procedure, competitive dialogue and the framework agreement. As a rule, the choice of procedure is determined by the maximum value of the economic benefit that can be obtained by the contractor. However, specific circumstances provided by law can determine the procedure to be followed. The Public Contracts Code allows the challenging of the procurement decisions either at an administrative or at a judicial level ⁰.

In the swing of developing a business and delivering for customers, it is easy to neglect some important things. Never forget to:

• identify the data that is meaningful and useful to your customer (not just you).
• invest in collecting outcomes data from the start, even if your contracts only require process-oriented KPI reporting.
• keep gathering data on value and outcomes.
• ask for endorsements and referrals to other potential customers.
• produce strong case studies, preferably co-authored by your customers.
• enter your customers into awards and make them heroes. They have, after all, moved mountains and resolved seemingly intractable obstacles to get you and your product working well in their organisation.

In Portugal, there are some financing opportunities where small and medium-sized enterprises can find support to develop products for the national health system.

SAMA2020 is one of the financing opportunities in Portugal. “The Support System for the Modernization and Training of Public Administration (Sistema de Apoio à Modernização e Capacitação da Administração Pública, SAMA2020) aims to support operations that contribute to the pursuit of the thematic objectives and investment priorities related to improving access to information and communication technologies and strengthening the institutional capacity of public entities and stakeholders and the very efficiency of public administration” ⁰.

Other opportunities are related to the programmes of the Fundo Europeu de Desenvolvimento Regional (FEDER), such as the Portugal 2020⁰.

In Portugal, there is no public entity directly supporting SME’s working in the field of medical devices.

The only public identity that can clarify possible issues is INFARMED, as Competent Authority in Portugal.

SMEs for support will have to go to private entities with knowledge in the intended area.

To support technology development and implementation, as private entities, can be named:

• APIFARMA (represents the IVDs industry);
• Apormed (“Is the nationwide association with the largest representation in the medical device production and distribution sector” ⁰);
• Cluster HCP (“Its mission is to make Portugal a competitive player in the research, design, development, manufacture and marketing of health-related products and services in selected niche markets and technology, targeting the most demanding and relevant international markets, within a framework of recognition of excellence, technological level, innovation skills and competences” ⁰);
• HUBS implemented or under development in Portugal, for example, DIATOMIC Health DIH (“DIATOMIC Health focuses on establishing a sustainable ecosystem to facilitate digital innovation in the health sector and is of prime importance both for society and the economy. The “heart” of DIATOMIC Health is accelerating the development of novel solutions based on microelectronics & smart systems integration” ⁰);
• Universities and institutes;
• Among others.