Guidance

About this guide: harnessing the value of SMEs in healthcare

Published 24 February 2026

Applies to England

Background and purpose   

Small and medium-sized enterprises (SMEs) play a vital role in the UK economy and the delivery of health services. They are a source of innovation, agility and cost-effectiveness - qualities that are essential for meeting the ambitious goals set out in the 10 Year Health Plan for England: fit for the future and responding to evolving healthcare needs.

Today, SMEs represent 85% of NHS suppliers and contribute significantly to third-party spend, forming the backbone of a system that serves millions every day.

In 2024, NHS England created an SME Advisory Group and published its SME action plan 2024. This plan stated:

Working with DHSC [the Department of Health and Social Care] and NHS Supply Chain, NHS England established an SME Advisory Group to advise NHS Commercial on issues affecting SMEs and their experiences with doing business with the NHS. Its focus is on improving the opportunities for SMEs to engage with and compete for NHS business.

This guide has been created by the SME Advisory Group as a practical resource to support SMEs^{[footnote 1]} to develop, grow and thrive within the health and care ecosystem. It is aligned with the primary objectives set out in NHS England’s SME action plan 2024 and is designed to turn policy into action.

What sets this guide apart is its focus on the lived experiences of SMEs. Through real-world case studies and insights - many provided by members of the NHS England SME Advisory Group - it shares:

• practical lessons
• common challenge
• proven strategies for success

These examples are woven throughout the guide, alongside spotlight articles that highlight important developments, resources, and support from across the wider health and care system.

At its heart, this guide is about connection - connecting:

• policy with practice
• buyers with suppliers
• SMEs with the tools and networks they need to succeed

Since work on this guide began, the policy landscape has continued to evolve. Significant developments include the implementation of the Procurement Act 2023, and the publication of the 10 Year Health Plan for England, the UK’s Modern Industrial Strategy, and the Life Sciences Sector Plan - all of which acknowledge the vital role that SMEs play in driving innovation, resilience and economic growth.

In conjunction with this guide, DHSC is soon publishing its updated SME action plan 2025 to 2028, further underlining the health sector’s commitment to supporting SMEs.

No matter how policies evolve or what details they hold, the insights, advice and real-world examples in this guide remain a compass for SMEs navigating the health system.

The core challenges and opportunities for SMEs engaging with the health system persist - and the practical guidance offered here is designed to support real-world action, whatever the wider policy context.

Who this guide is for

This guide is aimed at 2 audiences:

Health sector buying community

To encourage greater consideration of the SME agenda in procurement decisions, the guide provides:

• practical suggestions
• case studies
• examples of how buyers can work more effectively with SMEs to unlock innovation and value

SME community

To offer a structured, accessible guide to navigating the NHS, it includes insights into:

• how the system works
• where opportunities exist
• what approaches are most effective

All of the above guidance is supported by peer advice from SMEs who have successfully worked with the health service.

Conclusion

The journey for SMEs in the health sector is both challenging and full of opportunity. As outlined in this guide, essential steps toward successful collaboration are:

• understanding the NHS landscape
• demonstrating value
• navigating procurement pathways

In the context of the 10 Year Health Plan for England and its 3 major shifts - moving care closer to home, integrating services around the patient and harnessing digital innovation - SMEs are well placed to deliver agile, locally rooted and tech-enabled solutions that align with system priorities.

However, SMEs cannot do this alone. Buyers are fundamental enablers of SME success. Buyers can unlock the full potential of SME innovation by:

• engaging early
• applying proportionality in evaluation
• designing inclusive, outcome-focused procurement processes

Their decisions shape the market, influence supplier diversity and ultimately determine whether the NHS benefits from the creativity, responsiveness and value that SMEs offer.

This guide is an output of the SME Advisory Group that was started by NHS England and the wider health family in 2024. It is intended to be a practical resource - one that supports SMEs when navigating the health sector and helps buyers in their consideration of SMEs when going to market. It is by no means exhaustive - it is a starting point.

Our intention as an SME Advisory Group is to build and iterate further to ensure we can produce purposeful and valuable outputs, and we welcome feedback and suggestions for future versions. Contact us at england.supplier@nhs.net.

1. ‘Small and medium-sized enterprises’ means suppliers that: (a) have fewer than 250 staff, and (b) have a turnover of an amount less than or equal to £44 million, or a balance sheet that totals an amount less than or equal to £38 million. See section 123 of the Procurement Act 2023. ↩