Frameworks for the future

  • 24th April 2024

This article looks at how NHS organisations across England, Wales, and Scotland are using construction framework agreement to support the delivery of capital projects

Earlier this year, Integrated Health Projects (IHP), a joint venture between VINCI Building and Sir Robert McAlpine, was appointed by The Shrewsbury and Telford Hospital NHS Trust (SaTH) under the P23 framework as its design and construction partner to progress the Hospitals Transformation Programme (HTP)


Launched in 2022, the ProCure23 (P23) framework agreement is the fourth generation of NHS England’s route to market for the provision of design and construction services for NHS capital projects.

NHS England has collaborated with Crown Commercial Service (CCS) to deliver P23 as part of the Construction Works and Associated Services 2 (CWAS2) procurement framework to ensure that NHS capital works adopt the principles of the Government’s Construction Playbook, modern construction delivery, and have a focus on sustainability and social value.

And, through this route to market, NHS trusts and Integrated Care Systems (ICSs) can quickly access experienced and proficient partners to support excellence in all aspects of NHS capital project delivery including business case development, sustainability, design, construction, disruption mitigation, benefit realisation, and optimised occupation.

To run over four years to October 2026, P23 has an expected cumulative spend of £9bn and builds on the successes of three previous iterations, which together delivered over £10bn worth of infrastructure projects for the NHS.

P23 operates under three ‘Lots’ covering different values ranging from under £20m to over £70m.

And, for the first time as part of the ProCure structure, the lower-value lot (under £20m) will be split into the seven NHS England and NHS Improvement geographical regions. This is intended to open the framework to suitable regional contractors, enhance capacity, and increase local backing for projects.

There are 12 national suppliers and 21 regional suppliers available via the framework, including Balfour Beatty Construction, BAM Building & Infrastructure, Kier Construction, McLaughlin & Harvey, Galliford Try, Integrated Health Projects, ISG Construction, GRAHAM Construction, and Laing O’Rourke.

And, to date – halfway through the framework’s intended lifespan – there have been 95 NHS clients, collectively spending £5.8bn on delivering more than 50 projects.

A new daycase surgical unit at Hereford County Hospital, designed by ADP Architects and being built by Speller Metcalfe, was the first project procured under the P23 framework

The benefits

P23 offers a number of key benefits to NHS clients, including:

  • Confidence that all suppliers are proficient with health/complex project design and construction
  • Increased supplier capacity, including access to regional suppliers
  • Use of modern methods of construction, including a range of standardised, project share, and repeatable rooms options to provide reliable, evidence-based designs and to reduce capital cost
  • Call-off options to suit differing project needs, values, and complexities while ensuring clients’ post-construction review (PCR) compliance
  • A fast-track process without the need to open tender, making the approvals process more efficient and reducing associated costs
  • The ability to set the quality/price ratio for call-offs according to project needs
  • Free-of-charge training for all project team members to enhance project proficiency (more than 25 hours each)
  • All projects will use tried-and-tested NEC contract processes, enabling collaboration and collective risk sharing between partners
  • Implementation advisor support, offered in a neutral capacity, free of charge

A spokesman for the NHS Estates and Facilities division at NHS England, said: “As of January 2024, the committed value of P23 stands at £2.58bn, with 54 procurements completed a further six currently live.

“The framework’s ability to expedite projects while maintaining fiscal responsibility has garnered attention within the construction industry.

“This achievement not only highlights the efficiency of the procurement process, but also reflects the trust that clients and stakeholders have placed in ProCure23.”

He added: “ProCure23’s success extends beyond individual projects to its impact on the overall construction landscape.

“The framework has become a catalyst for positive change, fostering collaboration and innovation within the industry.

“And its ability to adapt to evolving challenges has positioned it as a dynamic force that continues to redefine procurement norms.

“As ProCure23 looks towards the future, its success is setting the benchmark for other frameworks and industry players.

“The framework’s achievements in surpassing financial targets, winning prestigious awards, and delivering exceptional projects highlight the transformative power of effective procurement practices in the construction sector.”

Under the NHS Building for Wales framework, Kier recently completed Phase 1 work on the Aneurin Bevan Health and Wellbeing Centre, a £19m Primary Care facility in Tredegar


Similar to the approach in England, the Welsh Government also has a procurement framework to deliver the next generation of health and care facilities.

Replacing the Designed for Life 2 & 3 frameworks in 2018, the NHS Building for Wales frameworks continue to drive forward improvements in the delivery of major capital construction projects for NHS Wales, working closely with health boards and trusts to deliver high-quality healthcare facilities.

Now in its fourth iteration – with the fifth generation due to be launched this spring – the current procurement model is the preferred approach for major NHS capital projects with construction costs in excess of £4m.

The framework is based on the fundamental principles of collaborative working, integrated supply chains, and continual improvement. delivering value for money and helping to develop best practice and sustainability and other core objectives on behalf of the Welsh Government.

For schemes with a capital value of less than £4m, each health board or trust is responsible for making its own arrangements to procure works and each will have either traditional tendering or framework arrangements in place.

To date, the 4th framework agreement has tendered in excess of £520m worth of healthcare infrastructure, with 33 projects in development or completed during the extended six-year duration.

It is particularly appealing to health boards and trusts as the framework pre-approves principal supply chain partners – fronted by a management contractor with an established team of building services installers, architects, and engineers already on board.

This means the project teams are used to working together and have the capacity and capability to meet the specific requirements of project delivery within the healthcare sector.

Contractors on the current NHS Building for Wales framework include BAM Construction, Interserve, Willmott Dixon, Kier, and IHP.

Speaking to Healthcare Property, Andrew Waddington, head of NHS Building for Wales at NHS Wales Shared Services Partnership’s Specialist Estates Services division, explains: “Over the past six years the framework has developed a variety of schemes, with a particular focus on Welsh Government’s pipeline of health and wellbeing hubs (HWBs)  to enhance provision of primary care services across Wales.

“This investment is quite significant – with projects worth between £7m-£100m delivering a variety of clinical services, also including mental health, radiology, and operating theatres.”

And he said the current framework has been one of the busiest.

“Health boards like the framework because it offers a one-stop shop where they can appoint a contractor and these companies already have their designers and installers on board,” he adds.

“It allows for a single point of contact, and this drives efficiencies.

“They also recognise the broader benefits of the framework, through shared best practice and lessons learnt.”

NHS Wales Shared Services Partnership has also established supporting frameworks for project and cost management services, allowing health boards to deliver projects in a timely manner.

Through the management of the frameworks, NHS Wales Shared Services Partnership is leading on the creation of best-practice guidelines and standardised models, including a drive to increase the use of modern methods of construction (MMC).

Projects completed under the current framework include the All-Wales Medical Genomics Services, a £15.3m state-of-the-art genomics facility in Cardiff delivered by Tilbury Douglas; Kier recently completed Phase 1 work on the Aneurin Bevan Health and Wellbeing Centre, a £19m Primary Care facility in Tredegar; and Willmott Dixon recently completed work on the Maelfa Health and Wellbeing Centre, a £14m facility in Cardiff which brings a range of health and social services under one roof.

Willmott Dixon recently completed work on the Maelfa Health and Wellbeing Centre, a £14m facility in Cardiff which brings a range of health and social services under one roof



Frameworks Scotland 3 is a procurement programme which provides a wide variety of construction-related services for new-build, backlog maintenance, and refurbishment projects across the healthcare estate.

The national agreement, which launched in November 2020 and will run until 2025, features five Principal Supply Chain Partners (PSCPs) and one reserve PSCP selected via an Official Journal of the European Union (OJEU) tender process. They are Balfour Beatty Group, John Graham Construction, Kier Construction, McLaughlin & Harvey, RMF Health, and BAM Construction.

And it provides a route for the procurement of publicly-funded health, social care, or other associated facilities operated by, or to be operated on behalf of, any NHSScotland board.

The current iteration of the agreement is worth in excess of £650m, with a particular focus around the acute sector.

Previous agreements have seen more than 90 projects delivered with an overall value of more than £1.1bn.

A spokesman for the framework said: “Frameworks Scotland 3 is structured to provide a ‘one-stop shop’ for project delivery using a develop-and-construct contract arrangement.

“Contracts can be entered into at the earliest stages of design through to Full Business Case (FBC) stage.

“The contract is entered into on a staged basis, with stages aligned to the Scottish Capital Investment Manual (SCIM) Business Case stages.

“A contract is entered into only for the current stage. However, it is intended that the contract continues through the stages to construction delivery.

“Each PSCP has an extensive supply chain of designers, specialist consultants, and sub-contractors and offers the rapid mobilisation of projects with extensive supply chains who have excellent NHS experience.

“It provides joint incentives, long-term collaborative relationships and performance, and affords NHS boards or permitted organisations more certainty of time, cost, and quality than other traditional procurement routes.”

However, the framework does not facilitate the provision of funding, which remains the responsibility of the NHS board or permitted organisation.

Among the projects supported by the framework is the National Treatment Centres Programme.

Both Frameworks Scotland 2 and the current agreement are supporting all aspects of the programme delivery, with PSCPs appointed to take forward a number of projects including the Golden Jubilee expansion programme, NTC Highland, NTC Fife, NTC Tayside, NTC Ayrshire and Arran, NTC Grampian, NHS Lothians NTC, and the Eye Centre.

The new facilities will offer state-of-the-art care to patients requiring elective surgery through improved services and facilities, helping to reduce patient waiting times and support the recovery, enhancement, and sustainability of planned patient care.

And RMF Health has carried out a programme of works at Western General Hospital worth around £48m.

These include refurbishment of haematology services, a new-build renal unit, a LINAC facility, and a district heating network and energy centre.

RMF Health has carried out a programme of works at Western General Hospital worth around £48m

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