How to get a product adopted by the NHS: Start with the pathway
How to get a product adopted by the NHS: Start with the pathway
I’m seeing the same pattern repeatedly in conversations between NHS leaders and industry. The product is good. The evidence is credible. The strategic alignment is clear. The unmet need is real. Yet the opportunity still stalls.
The reason is often simple; nobody has made the pathway change operationally credible.
The NHS doesn’t adopt products in isolation. It adopts workable models of care. A product becomes adoptable only when the NHS can see how it will be used safely, affordably and sustainably within a real pathway.
That requires clarity about who will do the work, how patient flow will change, where activity will move, which budget will pay, who will own the risk and what evidence will support scale.
In essence, a strong value proposition may create interest. A credible NHS adoption strategy shows how the service can implement the change in practice.
Why a value proposition isn’t an NHS adoption strategy
A value proposition explains why a product matters. An adoption strategy explains how the NHS can use it safely, affordably and sustainably inside a real model of care.
A value proposition may cover the clinical benefit, patient outcomes, economic case, guideline fit, unmet need and strategic relevance. None of that answers the operational questions that determine whether adoption is possible:
- Who will do the work?
- Where will patient flow change?
- Which appointment or activity will be removed?
- Which role will absorb any new activity?
- Which budget will pay?
- Which provider will own the risk?
- Which commissioner will support the model?
- Which data will show that it’s working?
- Which local leader has the authority to scale it?
Until those questions are answered, the NHS may be interested but won’t necessarily be ready to adopt.
A good meeting isn’t adoption. A supportive clinician isn’t a pathway. A pilot isn’t scale. A slide showing alignment with national policy isn’t a delivery model. A strong product message isn’t, on its own, a strategy for NHS change.
Why good pharma, medtech and digital health ideas stall in the NHS
I’ve spent much of my career watching good ideas struggle inside the NHS.
Products, services, diagnostics, technologies and new models of care can make complete sense on paper. They may improve outcomes, reduce risk, support earlier diagnosis, release capacity, align with national policy and offer better value. Yet they still fail to move.
The idea makes sense in a presentation, but not in a clinic template. It makes sense in a national policy document, but not in a GP practice on a Monday morning. It makes sense to the commercial team, but not to the operational manager who has no staff. It makes sense to the clinician, but not to the finance team. It makes sense on the pathway map, but not in the contract. It makes sense in a pilot, but not at scale.
Most NHS product adoption problems aren’t caused by the product itself. They arise from the pathway, workforce, funding, governance, data, risk and implementation model. That’s why I keep returning to the same principle; Pathway Over Product.
What Pathway Over Product means for NHS adoption
Pathway Over Product means starting with the NHS problem before developing the product message.
It means identifying where the pathway is under pressure, understanding who owns that pressure and working out what will change in the real world if the product, service or innovation is adopted. It also means being honest about whether the NHS has the capacity, capability, funding and governance needed to make that change happen.
Adoption is more than a decision to use a product. It’s a redesign of the way care is delivered.
So much NHS policy points in the same broad direction: move care closer to home, diagnose earlier and reduce inequalities. Almost every industry proposition can now find a line of policy alignment somewhere. Policy alignment alone, however, doesn’t prove that the model can be delivered.
The more useful question is; can we show that this works inside the operating reality of the NHS?
Why the NHS left shift exposes weak delivery models
The left shift is a good example. The ambition is clear, with a desire for more care closer to home, more prevention, more community based models, more support outside hospital and more neighbourhood working.
In principle, it’s difficult to argue with. In practice, somebody still has to do the work. That’s where many conversations become vague.
Once the responsible team has been identified, the next questions become even more important:
- What workforce will deliver the model?
- How will the work be funded?
- What governance will be required?
- Which clinical protocol will be used?
- What training will teams need?
- What data and coding will support delivery?
- What escalation route will be available?
- Which outcomes will be measured?
- What contractual mechanism will support the work?
- How will the model avoid adding more pressure to an already stretched part of the system?
The left shift can’t be treated as a policy slogan. It’s a service design challenge. Industry therefore must move beyond saying, “our product supports care closer to home.”
The NHS needs to know how the model will work.
What an NHS product adoption model must explain
This is where some commercial strategies fall down.
A company may understand its product, clinical evidence, target patients, competitors, value messages and national policy hooks, but it may know far less about where the workload sits, who has the authority to change the model and whether the promised saving is real, cash releasing, theoretical, delayed or held in a budget that the decision maker can’t access. That gap is often where the opportunity stalls.
The NHS isn’t short of ambition. It has plans, strategies, reviews, frameworks, operating models, transformation programmes and clinical priorities. It knows that it needs to improve access, reduce variation, use resources better, move care upstream, prevent more illness, make better use of data and digital tools, and release hospital capacity.
The constraint is frequently delivery capacity. That’s the space industry needs to understand.
If your proposition helps the NHS deliver something it’s already trying to achieve, there may be a genuine opportunity, but the delivery model must be credible. You need to show how the pathway will change, which work will be removed, added or moved, whether the financial case works for the organisation being asked to act, and who must approve the change.
Don’t start with the product and search for a pathway. Start with the pathway and work out whether the product has a credible role within it.
Five questions to answer before taking a product to the NHS
Before taking a product, service, diagnostic test, device or digital tool to the NHS, I’d ask five questions:
1. Which NHS pathway pressure does it solve?
- Does it reduce avoidable appointments?
- Does it speed up diagnosis?
- Does it prevent avoidable escalation?
- Does it reduce admissions?
- Does it release specialist capacity?
- Does it improve patient flow?
- Does it reduce unwarranted variation?
- Does it support a safer transfer of care?
- Does it help a team manage demand that it can’t currently manage?
If you can’t name the pathway pressure clearly, the NHS may struggle to understand why the proposition matters now.
2. Who currently owns that pathway pressure?
- It may sit with primary care.
- It may sit with a hospital specialty.
- It may sit with community services.
- It may sit with diagnostics.
- It may sit with medicines optimisation.
- It may sit with the integrated care board.
- It may sit with a provider collaborative.
- It may sit between organisations, which is often why it hasn’t been solved.
If nobody owns the pressure, the adoption strategy must explain how ownership will be created. When the wrong stakeholder owns the conversation, the idea tends to drift.
3. What workload will move, reduce or increase?
- Some innovations save time in one part of the system by adding work somewhere else.
- Some reduce outpatient activity but increase primary care workload.
- Some reduce admissions but require community monitoring.
- Some improve diagnosis but increase follow-up demand.
- Some identify more patients but create pressure on treatment capacity.
None of this is necessarily wrong, but it must be understood. The NHS will want to know whether the offer genuinely releases capacity or simply redistributes pressure.
4. What funding, contracting or governance route makes adoption possible?
- The provider may benefit, but the commissioner may pay.
- The system may save money, but the saving may not be cash releasing.
- A pilot may be funded, but business as usual may not be.
- The pathway may require shared care, but no governance model may exist.
- The work may sit in primary care, but the contract may not support it.
This is why NHS adoption requires more than evidence. It also requires a practical route into the system.
5. What evidence will make the model safe to scale?
- Can the model be delivered in practice?
- Does it work within a real care pathway?
- What happens to workload and waiting times?
- What happens to patient experience and health inequalities?
- What happens to cost and safety?
- What happens when activity increases?
- What happens when the enthusiastic pilot site is no longer the only site?
Scale is where weak models are exposed. Build the evidence for scale from the beginning rather than treating it as a later question.
What pharma, medtech, diagnostics and digital companies need to change
The challenge for pharma, medtech, diagnostic, device and digital health companies is straightforward.
Don’t confuse policy alignment with adoption readiness, interest with implementation, a pilot with scale, or a value proposition with a pathway strategy. Never assume the NHS will work out the operating model for you.
If your offer depends on a GP practice, Primary Care Network, federation, community provider, hospital team, diagnostic service, pharmacist, nurse specialist, integrated care board or provider collaborative doing something differently, you need to understand why that stakeholder would say yes.
What problem does the change solve for them? What new pressure could it create? What would make the model workable inside their service?
The NHS is adopting a change to the way care is delivered. That’s a much bigger ask than buying a product, but it also creates a much better opportunity for companies that can make the change credible.
Where the NHS/industry opportunity really sits
I remain optimistic about the role industry can play. The opportunity lies in helping the NHS deliver change that it can’t deliver alone.
That may mean supporting pathway mapping, building a demonstrator site, helping to quantify workload, designing a left shift model that doesn’t overload primary care, or creating the training, governance, data capture and escalation processes needed for implementation.
A strong product still matters. So do clinical evidence, outcomes, guidelines and health economics, but none of those elements will secure adoption on their own if the pathway is unclear, workload is unresolved, the funding route is vague, governance is missing or the teams being asked to change can’t see how the model will work in practice.
From product led selling to pathway based NHS adoption
Perhaps the most important question for industry is: “What pathway pressure are we helping the NHS solve, and have we made the solution operationally credible?”
That’s the shift from product led selling to pathway based adoption. That’s Pathway over Product. For pharma, medtech, diagnostic, device and digital health companies, it may be the difference between being interesting and being adopted.
Practical NHS insight for your next customer conversation
Why do promising NHS conversations stall? What needs to change before an innovation can be adopted?
I explore questions like these in Embedded Edge, my free online learning platform for pharma, medtech and medical device professionals.
Each month, I explain an important NHS development, what it means for your customers and accounts, and how to respond. Alongside the briefings, you’ll find video explainers, practical tools and frameworks to help you apply the thinking to the pathways and opportunities you’re working on.
The content draws on my experience working directly with NHS teams to redesign pathways, solve delivery problems and put change into practice. It’s designed to help you ask more useful questions, spot adoption barriers earlier and approach your next NHS conversation with a clearer plan.
Create your free login and explore the growing resource library at your own pace, starting with the topics most relevant to your work.
At www.scottmckenzieconsultancy.com, I work directly inside the NHS, supporting provider collaboratives, commissioners and system leaders to implement real change. I then help pharma, medtech and device companies interpret what’s happening, so they can engage the right stakeholders, align with NHS priorities and get their innovations embedded into care pathways.
With more than 20 years working within the NHS and pharma, medtech and device companies, I bring a unique dual perspective, now captured in my book, Embedded: How Pharma, MedTech, and Device Companies Can Get Their Products into NHS Pathways and Stay There, which distils everything I’ve learned into a practical playbook.