Policy on Supplier Representatives

Policy author Matthew Revell Accountable Executive Lead Jonathan Lofthouse Approving body Policy reference ROH/XXX/NNN [Assigned by Governance Team]

POLICY APPROVAL DATE: ESSENTIAL READING FOR THE FOLLOWING STAFF GROUPS: May 2017

1 – All Trust Staff working in Theatres and Pharmacy POLICY 2 – Staff working in partnership with supplier IMPLEMENTATION DATE: representatives June 2016

DATE POLICY TO STAFF GROUPS WHICH SHOULD BE AWARE OF THE POLICY FOR BE REVIEWED: REFERENCE PURPOSES: June 2017

1 – Staff involved with purchasing or procurement

DOCUMENT CONTROL AND HISTORY

Version Date Date of Next Reason for change (e.g. full rewrite, No Approved implementation Review amendment to reflect new legislation, Date updated flowchart, etc.) 1 June 2017 New Policy

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Policy on Supplier Representatives

KEY POINTS

1. Supplier Representatives must not enter any area without an appointment. 2. Supplier Representatives must be registered on the Medical Industry Accredited System. 3. If the meeting is to discuss ANY new product or service then Procurement and Supplies must be informed. 4. Cold calling is not acceptable. 5. Pharmacy representatives must report to Pharmacy. 6. No electro-medical equipment can be used until tested by EBME. 7. Representatives visiting Theatre areas must comply with the Theatre protocol. 8. No sample products can be trialed until the appropriate trials and indemnity documentation has been completed. 9. Contractors undertaking work on the Trust’s sites must adhere to the Control of Contractors Policy.

Do’s and Don’ts  Do meet the supplier representative at an arranged point and don’t allow them to wander around clinical areas unaccompanied.  Do challenge any supplier representative that you see in an area, ask for ID and the purpose of their presence.  Don’t allow supplier representatives into stock rooms unaccompanied.  Don’t provide any commercial information to a supplier’s representative – always refer them to Procurement and Supplies.  Don’t allow trial equipment or products to be brought in without the appropriate trials and indemnity document has been completed.  Don’t sign any contract or agreement that a supplier representative brings – refer them to Procurement and Supplies.  Don’t accept gifts or hospitality without declaring on the Hospitality Register and gaining approval.

PLEASE NOTE THAT THIS LIST IS DESIGNED TO ACT AS A QUICK REFERENCE GUIDE ONLY AND IS NOT INTENDED TO REPLACE THE NEED TO READ THE FULL POLICY

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Policy on Supplier Representatives

Contents Page Number

1. Introduction 5 2. Scope 5 3. Other policies to which this policy relates 5 4. Glossary and definitions 5 5. Policy development principles 5 6. Roles and responsibilities 5 7. Procedure 6 8. Consultation 6 9. Auditable standards/monitoring effectiveness 6 10. Training and awareness 12 11. Inclusion 12 12. Review 12 13. Reference documents and bibliography 12 14. Further enquiries 12

APPENDICES

Appendix A Example of Third Party Paid Expenses Form 13 Appendix B Medical Industry Accredited Systems 13 Appendix C MIA Publicity Poster for ROH 33 Appendix D Draft section from Theatre Guidelines 34 Appendix E Map of Theatre Complex 40 Appendix F Equality Impact Assessment Template 43 Appendix G Policy Implementation Plan 50

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Policy on Supplier Representatives

1.0 INTRODUCTION

The Trust appreciates the role that it’s current and potential suppliers play in supporting health practitioners in providing safe, effective and economic products and services to the patients in their care, and other staff working within the NHS in the delivery of their duties.

This policy and any accompanying procedure will be available to Trust personnel through the Document Library and supplier personnel via the Procurement and Supplies Department.

This version supersedes any previous versions of this document.

The aim of this policy is to ensure a sound, transparent and professional relationship between the staff of the Trust and its suppliers and their commercial representatives. It provides information on how they are expected to behave and what behavior they can expect from the Trust’s staff; clinical and non-clinical.

2.0 SCOPE

2.1 The policy covers all areas of the Royal Orthopaedic Hospital (the Trust) and all premises that the Trust operates from. All staff of the Trust should be aware of this Policy.

3.0 OTHER POLICIES TO WHICH THIS POLICY RELATES

3.1 Control of Contractors Policy Theatre Policy and Standards 2016 (under revision) Incident Reporting Policy Counter Fraud Policy

4.0 GLOSSARY AND DEFINITIONS

4.1 Supplier Representatives means all supplier personnel. MIA - Medical Industry Accredited System

5.0 PRINCIPLES

5.1 This policy formally defines the responsibilities of the Trust and of its supplier representatives working together in the interests of patients.

Supplier representatives will be required to pre-book for visits to the Trust and to have a defined purpose in attending. The Trust will also gain assurance on Medical Industry Accredited system issues which are handled by the MIA system. Suppliers will have the opportunity to review relevant Trust Policy on the web so as to be better placed to comply with the Trust’s ways of working.

6.0 ROLES AND RESPONSIBILITIES

Policy on Supplier Representation April 2017 5 | P a g e 6.1 Role of the Director of Finance The Director of Finance has overall responsibility for ensuring good procurement practice throughout the Trust.

6.2 Role of the Head of Procurement and Divisional General Manager The Head of Procurement and Divisional General Manager is responsible for ensuring that Supplier Representatives are made aware of this policy, and for monitoring compliance of the reporting requirements contained within the Policy.

6.3 Role of Trust Managers and Budget Holders Trust Managers are responsible for ensuring that all staff are aware of the policy and adhere to the requirements contained within it.

6.4 Role of the Medical Devices Advisory Group The Group is responsible for:  Receiving feedback on the effectiveness of the policy  Reviewing content and updating the policy as required

6.5 Roles of individual staff

6.6 All staff members are responsible for:  Adherence to the policy  Promoting the policy to supplier representatives and Trust colleagues Notifying the Head of Procurement or Divisional General Manager when they become aware of the policy not being followed

7.0 PROCEDURE

7.1 All supplier representatives are required to register with the Medical Industry Accreditation (MIA) programme. This provides the Trust with assurances about the health status and personal record of the individual. 7.2 Relevant Trust Policies, Standards and Procedures will be uploaded to the MIA website and supplier representatives are required to comply with them 7.3 Supplier representative visits must be pre-arranged with the relevant unit manager prior to attendance on site 7.4 Once on site supplier representatives must present themselves at the agreed contact point where a named member of staff will be responsible for ensuring the visit is safe and mutually beneficial. 7.5 All visits must be recorded on the MIA website. 7.6 Any hospitality offered to staff must be declared.

8.0 CONSULTATION

8.1 Theatre Management Team Pharmacy Management Team Division 2 Board

9.0 AUDITABLE STANDARDS/PROCESS FOR MONITORING EFFECTIVENESS

9.1 Visits to the hospital

Policy on Supplier Representation April 2017 6 | P a g e 9.2 Supplier Representatives will NOT be seen by Trust staff without prior appointment. ‘Cold calling’ is an inefficient use of staff and suppliers’ time – it is not permitted. All supplier representatives must be registered on the Medical Industry Accredited (MIA) system, details of which are attached at Appendix B. All contractors undertaking work on the Trust sites must adhere to the Trust’s Control of Contractors Policy.

9.3 Any Supplier Representative attempting to visit a Trust designated contact without having made a prior appointment should be politely but firmly refused and advised to call and make an appointment and register on the Medical Industry Accredited system.

9.4 When on site, all representatives are expected to comply with the Health and Safety at Work Act, as well as all Trust policies, procedures or guidance, as relevant at the time; e.g. the no smoking policy, the car parking policy etc.

9.5 Supplier Representative must wear a name badge showing the name of the company they are representing as well as their own name.

9.6 When on site, all representatives must comply with any instructions given to them by an authorised member of staff (e.g. in the event of an emergency situation such as a fire or major incident).

9.7 Supplier representatives should note that the Trust has an Incident Reporting Policy. Should anyone be affected (patient, staff, student, visitor, volunteer or contractor) by any behavioural actions from a commercial representative, an Incident Report will be raised and appropriate action taken by the Trust’s Senior Management. This is also the case should a representative be affected by any behavioural actions from a member of the Trust’s staff, a student, visitor, volunteer or contractor. Under the MIA agreement, the Trust reserves the right to make an entry on the individual MIA record of a representative, if necessary.

9.8 Appointments must be made via the appropriate departmental secretary or a Trust host directly. Any literature, product information or samples for consideration must be left with the host or with a representative of the Procurement and Supplies Department.

9.9 Any supplier representative wishing to visit a clinical area must obtain the prior consent of either the Clinical Service Manager, Clinical Service Lead, Matron or their appointed nominee(s), and must register the visit on the Medical Industry Accredited system. Approval for the supplier representative’s visit relates to the individual department/theatre only. It is not general agreement for access across other locations/theatres. Supplier representatives MUST NOT be left unattended at any time. If direct patient contact is required, patient consent MUST be obtained and documented first to ensure that the clinician involved has confirmed this with the patient.

9.10 Supplier representatives cannot be present at MDT meetings whilst patient details are being discussed. If supplier representative input is required, this must be within a confined part of the MDT meeting.

9.11 Supplier representatives visiting theatre areas must report to the Theatre Reception and must be registered on the Medical Industry Accredited system. Supplier representatives must sign the Theatre Record of Visitors, and comply with the section from the Theatre Policy Relating To Access Restriction and Attire (See Appendix D).

9.12 Supplier representatives should limit their visits to the Trust premises to a reasonable number. If this is not the case, Trust staff can contact the Procurement department, who will ask the sales representative to refrain from conducting business for a defined period of time. In extreme cases, the Trust may make a decision to cease trading with that supplier entirely.

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9.13 Supplier representatives cannot seek appointments with junior members of the clinical staff, but may hold open meetings with staff in a group (e.g. product presentations or training sessions). The emphasis in such meetings must be educational and not exclusively promotional. All such visits must be recorded on the Medical Industry Accredited system. The Trust will actively support all collaborations and efforts to enhance contact through educational programmes which work for the collective benefit of patients, the Trust/NHS suppliers.

9.14 Promotional Activity It is 8ecognized that, in addition to providing information to health practitioners, the prime function of representatives is to promote and sell their products and services. This function should be carried out in a proper and ethical manner, and not contravene Trust or NHS policies.

9.15 Representatives should be well informed about the products they are promoting. In addition to standard technical (and where appropriate clinical) data, information should be available on product effectiveness. Price comparisons must not be discussed with a supplier, as this may adversely influence any future tendering exercise.

9.16 Where any teaching and/or promotional activity is planned, representatives must advise the Department Manager and record the meeting on the Medical Industry Accredited system. The intent of the meeting must not contravene existing Trust policies.

9.17 Leaflets and posters produced by suppliers may not be distributed or displayed in clinical areas, unless approved by the ward or departmental Senior Nurse/Manager in that area.

9.18 Code of Ethics For the purposes of this policy, commercial sponsorship is defined as including: NHS funding from an external, non-charitable source (including funding of all or part of the costs of NHS research)  Staff  Training  Pharmaceuticals  Equipment  Meeting rooms (or any cost associated with meetings)  Meals  Gifts  Hospitality  Hotel and transport costs (including trips abroad)  Provision of free services (speakers), building or premises.

9.19 The staff of the Trust are subject to standards of conduct in line with national guidance and staff should be aware of the Standards of Business Conduct for NHS Staff (HSG(93) and Core of Conduct for NHS managers (2002), as well as the Trust’s Standards of Business Conduct, Commercial representatives should note the following points:

9.20 All offers of hospitality or gifts made to staff must be recorded in the appropriate register. The relevant permission must be obtained in advance in relation to the acceptance of any hospitality or gift with the exception of items with a nominal finance value (pens, calendars, diaries etc). If in any doubt, staff must seek advice from the Trust Board Secretary or relevant head of department.

9.21 Suppliers must not attempt to influence business decision making by offering hospitality to Trust staff. The frequency and scale of any hospitality accepted will be managed openly by the Trust.

9.22 If material gifts or hospitality are accepted, and business is subsequently awarded to the supplier in Policy on Supplier Representation April 2017 8 | P a g e question, then the individuals who are in receipt of said gifts and hospitality should be aware that they may be in breach of the Standards of Business Conduct, but also open to allegations of corruption under the local Counter Fraud Policy and Bribery Act. Staff should contact the Local Counter Fraud Specialist if unsure.

9.23 Any travel arrangements for conferences or for viewing equipment and services should be paid for by the Trust unless the Director of Finance gives written approval for the supplier to take responsibility for travel arrangements or travel costs.

9.24 Commercial sponsorship relating to conferences or courses is only acceptable if the attendance of the Trust’s staff forms part of an educational/training course approved by an accountable manager of the Trust or is with the prior written authorisation of the relevant Divisional General Manager.

9.25 It is an offence for employees to accept any gifts or consideration as an inducement or reward to:  Doing or refraining from doing anything in their official capacity; or  Showing favour or disfavor to any person in their official capacity.

9.26 Anyone incurring expenses, which are to be paid by a supplier, must complete the Third Party Paid Expenses Approval Form in Appendix 1. The activity will not be supported by the Trust unless this is authorised by a Divisional General Manager or the Director of Finance. Payment of expenses by suppliers must not be undertaken whilst a tender exercise is being considered, or undertaken unless specifically agreed by the Director of Finance.

9.27 Ethics Summary Staff may not: Accept gifts other than those with a nominal finance value (pens, calendars, diaries etc). Accept sponsorship for expenses such as travel, accommodation, food or course fees, unless previously agreed with a Divisional General Manager – see Appendix A. Show favour to a supplier.

9.28 Failure to comply with these rules may lead to disciplinary action, up to and including dismissal.

9.29 Staff must:  Refuse to see a supplier representative if a prior appointment had not been made and the visit has not been registered on the Medical Industry Accredited system.  Report that matter to the relevant Divisional General Manager if the activities of a company representative are affecting their ability to carry out their work.  Report that matter to the relevant Divisional General Manager if a company representative offers any gift or hospitality beyond that outlined as acceptable.  Declare any personal interests which may conflict or bias the dealings with a company or contract.  Ensure representatives are not left unaccompanied, especially with patients.

9.30 Infection Prevention and Control Policy All personnel who visit and any equipment brought into the Trust has the potential to introduce infection and the Trust requires that all sales representatives respect the appropriate Control of Infection protocols/procedures when visiting the hospital.

9.31 It is the responsibility of the company representative to ensure any equipment is sanitised according to the Decontamination Policy and Infection Control Policy and manufacturer’s guidelines, where indicated.

9.32 All staff must be aware that the Trust will require a decontamination certificate as proof that a decontamination procedure was performed, prior to a piece of equipment being brought into the Policy on Supplier Representation April 2017 9 | P a g e Trust for use.

9.33 Product Trials, Evaluations, Studies and Research Projects Supplier representatives must not expect to enter into any agreements in relation to the trial of products without adherence to the Trust approved Trials Policy, a copy of which is available to Trust staff on the Document Library or for supplier representatives from the Procurement and Supplies Department. No products or equipment can be trialed until the relevant documentation and authorisation is completed.

9.34 Medical samples must only be left with the Senior Nurse/Manager on duty, or a representative of the Procurement and Supplies Department.

9.35 Unless sterile, suitable and agreed by the Medical Device Advisory Group, medical samples are not to be used clinically and must be clearly marked as not for clinical use.

9.36 Medicine and Drug samples (including interactive dressings) must only be left with Pharmacy with clear indication of the requesting Consultant. Pharmacy will accept samples for use in the hospital only if there has been a written and signed request from a Consultant.

9.37 EMBE equipment must be left with the EBME Department in order that appropriate testing can be carried out before use.

9.38 Representatives leaving samples must complete a proforma regarding compliance, reason for provision of the samples, and at whose request. This proforma must be completed prior to any of the sample products being used or trialed and provided to the Trust personnel involved with the use or trial of the products, together with details of the supplier representatives Competencies for Training documentation. A copy of the completed proforma must be provided to the Head of Procurement and Supplies, in order that a register can be maintained for reference in the event of a product safety alert/recall.

9.39 Indemnity information and Pre Purchase information (where appropriate) must be completed prior to any trial or evaluation being undertaken.

9.40 Any equipment or products being trialed on patients must have the necessary informed consent approval, and Ethics Committee approval where appropriate.

9.41 NHS Conditions of Contract All goods (donated or otherwise) and services offered to the Trust will be procured against the standard NHS Conditions of Contract, these include the following conditions which are also applicable to items supplied on loan which will require an Indemnity Agreement being signed by both the supplier and the Trust.

9.42 Condition 12 – Indemnity This ensures that the Trust is given protection of an obligation on the part of the supplier to pay compensation for damage or injury to persons or property. This is in addition to any specific rights under the contract or under statute or common law. Indemnity documentation is available upon request from the Procurement and Supplies Department.

9.43 Condition 14 – Insurance This condition imposes an obligation to insure against the liabilities resulting from that indemnity. It specifies a minimum sum for insurance cover.

Policy on Supplier Representation April 2017 10 | P a g e 9.44 Signing of Contracts/Agreements and Samples Commitment to purchase goods and services is only entered into by the raising of an official Trust Purchase Order. Suppliers must not deliver goods or provide a service without first receiving an official Trust Purchase Order.

9.45 Contracts and product trials for all equipment/services (e.g. medical devices, clinical products and non-medical items like photocopiers, furniture etc) must be arranged in accordance with the Policy for the trial and evaluation of Medical Devices and/or through Procurement and Supplies Department. Individual departmental managers are NOT authorised to enter into contracts or trials, and must refer to the Procurement and Supplies Department.

9.46 CE Marking All medical samples must be CE (Conformité Européenne) marked. ‘CE’ marking is an indication that the product has undergone some form of verification and validation process acceptable to the European Community (EC).

9.47 The Trust requires that all electro-medical equipment is obtained in agreement with the Medical Engineering Department. This includes all equipment on loan (for trial or testing) and free issues (for trial or testing).

9.48 All electro-medical equipment must be tested prior to delivery to a ward or department. Under no circumstances should electro-medical equipment be delivered directly to a ward/department without the prior knowledge of Medical Engineering.

9.49 For the purposes of signing contracts and agreements for the purchase/hire/leasing of goods and services, the first point of contact must be the Procurement and Supplies Department.

9.50 Dissemination and Implementation The policy will be disseminated via the members of the Medical Devices Advisory Group. Trustwide email and via the Procurement and Supplies Department. The policy will be held on the Document Library.

9.51 Monitoring compliance and effectiveness

Element to be Adherence to use of the Medical Industry Accredited system. monitored Lead Medical Devices Advisory Group Tool Monitoring will be undertaken by the Head of Procurement and Supplies reviewing the Medical Industry Accredited system Frequency Quarterly Reporting Arrangements Results of the review will be presented to the Medical Devices Advisory Group. Acting on Medical Devices Advisory Group, Divisional General Managers. recommendations and Lead(s) Change in practice and Required changes to practice will be identified and actioned within lessons to be shared three months. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders.

9.52 Adherence to this policy will be monitored by the incidences of complaints to the Procurement and Policy on Supplier Representation April 2017 11 | P a g e Supplies Department. These will be reviewed annually or more frequently if continued complaints are received directly by any Trust member of staff, and the findings maintained by the Procurement and Supplies Department.

9.53 These arrangements may be subject to review under the Trust’s Internal Audit Plan, either on a cyclical or adhoc basis. Any allegations/suspicions of fraudulent activity, either by Trust staff or suppliers, should be reported to the Local Trust Counter Fraud Specialist.

9.54 Updating and Review The policy will be reviewed every 3 years unless the ongoing monitoring indicates that a review is required earlier.

9.55 Equality and Diversity This document complies with the Royal Orthopaedic Hospital NHS Foundation Trust service Equality and Diversity statement which can be found in the Equality, Diversity and Human Rights Policy or the Equality and Diversity website.

9.56 The initial Equality Impact Assessment Screening Form is at Appendix 4.

10.0 TRAINING AND AWARENESS

10.1 The majority of the requirement for training will be through Theatres. Training weeks are planned in May 2016, prior to initiation of the MIA registration system in early June 2016.

11.0 INCLUSION

11.1 This policy will apply to all supplier representatives and all service engineers Trustwide. Exceptions must be approved by the Divisional General Manager, Divisional Medical Director or the Director of Operations.

12.0 REVIEW

12.1 Trust Management Committee December 2017 then annually.

13.0 REFERENCE DOCUMENTS AND BIBLIOGRAPHY

13.1 Full details of the MIA scheme http://www.miaweb.co.uk

14.0 FURTHER ENQUIRIES

14.1 Associate Medical Director for Division 2

Policy on Supplier Representation April 2017 12 | P a g e Appendices

APPENDIX A Appendix A – Example Third Party Paid Expenses Approval Form

Policy on Supplier Representation April 2017 13 | P a g e Appendix B Medical Industry Accredited Systems

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Policy on Supplier Representation April 2017 15 | P a g e Appendix 3b MIA Participating Companies, Trusts and Other Organisations

Participating companies The following medical technology companies are participating in the scheme. Details of individual companies can be found by clicking through to their websites Company name Phone number Web address 3M Health Care 08705 360036 www.3m.com/uk Abbott Vascular 01628 773355 www.abbottvascular.com Able Medical 07831 660066 www.ablemedical.co.uk/ Adler Ortho UK Ltd 01513 290427 www.adlerortho.com Accord Medical Ltd 01278 455144 www.accordmedical.co.uk Acelity +1 800 275 4524 www.acelity.com/ ACIST Europe BV +31 04 335 45 030 www.acist.com Admedus GmbH 04456 27199 www.admedus.com Arcomedical Infusion Ltd +41 43 388 90 30 www.arcomed.co.uk/arcomedical_Ltd/Home.html Acrostak UK Ltd +41 22 347 68 70 www.acrostak.com Activa Healthcare Ltd 01283 576800 www.activahealthcare.co.uk Acumed Ltd 01264 774450 www.acumed.net/ Advanced Bionics UK Ltd 01223 847888 www.advancedbionics.com Advanced Medical Solutions Group plc 01606 863500 www.admedsol.com Advanced Medical Solutions Ltd – Woundcare 01606 863500 www.activheal.com Advanced Sterilization Products (ASP) 01344 871081 www.aspjj.com/emea/ Advancis Medical 01623 751500 www.advancis.co.uk Advantech Surgical Ltd 08451 305866 www.advantechsurgical.com Albyn Medical Ltd 01349 862388 www.albynmedical.com Alchemy DKG Ltd - www.alchemydkg.co.uk Alcon Eye Care UK Ltd 01276 673311 www.uk.alcon.com Alesi Surgical Ltd 02920 682106 www.alesi-surgical.com Algotec Research & Development Ltd 01293 763070 www.algotec-ltd.com/ Insurance Details Alimera Sciences Limited 01252 762014 www.alimerasciences.com All in One Medical (DCCL) Group 01293 854818 www.allinonemedical.com Allergan Ltd 01628 494444 www.allergan.co.uk/Home.aspx Alphatec Spine 08003 134471 www.alphatecspine.com Altacor Limited 01223 421411 www.altacoreyeproducts.com Altomed Limited 01915 190111 www.altomed.com Ambu 01480 498403 www.ambu.co.uk American Medical Systems UK Ltd 02089 963100 www.americanmedicalsystems.com AMI Medical Ltd 01159 861888 www.suportx.co.uk AMO United Kingdom Ltd 01628 551600 www.abbottmedicaloptics.com Anetic Aid Ltd 01943 878647 www.aneticaid.co.uk/ AngioDynamics 01223 729361 www.VenaCure-EVLT.co.uk Ansell Medical UK +32 2 528 7400 www.ansell.com Anser Medical Ltd 01799 521050 www.ansermedical.com APA Parafricta Ltd 01234 834525 www.parafricta.com APC Cardiovascular 01270 216142 www.apccardiovascular.co.uk Apex Medical Limited 01204 692811 www.apexmedical.co.uk/ Apple Technologies Ltd 01708 200545 www.appletechnologies.co.uk Applied Medical 08008 766882 www.appliedmed.com/ Applied Medical technology Ltd 01223 420415 www.applied-medical.co.uk/ Apollo Endosurgery UK Limited 01423 611000 www.apolloendo.com APR Medtech 01844 340620 www.aprmedtech.com Aquilant Critical Care 01256 306525 www.aquilantcriticalcare.com/ Aquilant Endoscopy 01256 365456 www.aquilantendoscopy.com/

Policy on Supplier Representation April 2017 16 | P a g e Aquilant Interventional 08456 024007 www.aquilantinterventional.com/ Aquilant Medical 01256 365490 www.aquilantmedical.com Aquilant Medical Ireland +353 860 519 409 www.aquilantservices.com Aquilant Orthopaedics 01256 365474 www.aquilantorthopaedics.com Aquilant Surgical 01256 365450 www.aquilantsurgical.com/ Arcomedical infusion Limited 01277 810432 www.arcomed.co.uk Arena Instrumentation 01513 551314 www.arena-instrumentation.com Aria Medical 01482 975759 www.ariamedical.co.uk ArjoHuntleigh 01582 413104 www.arjohuntleigh.com Armstrong Medical Ltd 02870 356029 www.armstrongmedical.net Arthrex Ltd 01142 329180 www.arthrex.com ArthroCare UK Ltd 01423 888806 www.arthrocare.com/uk Ascom (UK) Ltd 01213 536151 www.ascom.com AS Diagnostics Ltd. 01253 353497 www.asdiagnostics.co.uk/ Ashfield Healthcare 08708 501234 www.ashfieldhealthcare.com Ashley Meerloo 07880 948280 - ASPECTUS-UK Limited 07530 041994 www.aspectus-uk.com Insurance Details Aspen Europe GmbH 08001 22912 www.aspenpharma.com Aspen Medical Europe Ltd 01527 587700 www.aspenmedicaleurope.com Aspen Pharma UK 01606 863500 www.activheal.com Assut UK Ltd 01484 602222 www.assuteurope.com Aston-Med Ltd UK 08003 167172 www.aston-med.com Athrodax Healthcare International Ltd 01594 544440 www.athrodax.co.uk Atos Medical 01157 841899 www.atosmedical.co.uk AtriCure 05137 554100 www.atricure.com Aurora Health Physics Services Limited 01235 820049 www.aurorahp.co.uk/ Avantec Limited 03300 240850 www.avantec.uk.com Avita Medical Europe Ltd 01763 269770 www.avitamedical.com Axis Medical Ltd 07955 265713 www.axismedical.co.uk Axonics Modulation Technologies Inc +1 949 396 6322 www.axonicsmodulation.com B Braun Medical Ltd 01142 259000 www.bbraun.co.uk Bard Ltd 01293 527888 www.crbard.com Bausch and Lomb UK Ltd 02087 812900 www.bausch.com Baxalta UK Limited 07717 547924 www.baxalta.com Baxter Healthcare 01635 206000 www.baxterhealthcare.co.uk Bayer HealthCare 01635 563248 www.bayer.co.uk Bayer plc 01635 563000 www.bayer.co.uk Baylis Medical Company +1 514 488 9801 www.baylismedical.com BD Medical 01256 388284 www.carefusion.com BD UK Ltd 01865 748844 www.bd.com Beagle Orthopaedics 01254 268788 www.beagleorthopaedic.com Beaver Visitec International 01865 601256 www.beaver-visitec.com Bedfont Scientific Ltd 01622 851122 www.bedfont.com/ Bellcraig Medical Ltd 01418 804141 - Bender UK Ltd 01229 480123 www.bender-uk.com Benmor Medical (UK) 03338 009000 www.benmormedical.co.uk Biedermann Motech International Limited 02079 479525 www.biedermann.com Biocompatibles UK Ltd 01276 902020 www.btgplc.com Biocomposites Ltd. 01782 338580 www.biocomposites.com Biosense Webster 01344 864000 www.biosensewebster.com Biosensors International +41 021 804 80 00 www.biosensors.com Biotherapy Services Ltd 02077 887828 www.biotherapyservices.com Biotronik UK Ltd 01869 362100 www.biotronik.com

Policy on Supplier Representation April 2017 17 | P a g e Biovation UK Ltd 01143 992990 www.bio-vation.co.uk Bioventus 08000 516384 www.BioventusGlobal.com Birmingham Optical Group 08452 303020 www.birminghamoptical.co.uk BK Medical 01582 433710 www.bkmed.com/ Blink Medical Ltd 01213 868433 www.blinkmedical.com Blue Box Medical Ltd 02380 669000 www.blueboxmedical.co.uk Blue Surgical 08004 049664 www.bluesurgical.co.uk/ Bolton Medical SLU +34 93 509 01 70 www.boltonmedical.com/ Bolton Surgical 01142 404400 www.boltons.co.uk Boston Scientific Ltd 01442 411600 www.bostonscientific-international.com Bracco UK Limited 01628 851500 www.imaging.bracco.com/gb-en Brainlab Ltd 01223 597817 www.brainlab.com Brandon Medical Co Ltd 01132 777393 www.brandon-medical.com Broadway Transport 01905 799094 www.broadwaytransport.co.uk Bruin Biometrics Europe Ltd 01612 661016 www.bruinbiometrics.com BTG Gases 01622 851415 www.solworld.com BVM Medical 01455 614555 www.bvmmedical.com C Franklin Ltd 07776 078028 www.cfranklinltd.com/ Cairn Technology Limited 08452 260185 www.cairntechnology.com CalMedical Ltd 08009 549212 www.calmedical.co.uk Calmedical Scotland Ltd 08009 549212 www.calmedical.co.uk Cameron Surgical 01382 530360 www.cameronsurgical.com Capita Translation and Interpreting 08456 367700 www.capitatranslationinterpreting.com Cardiac Services 01625 878999 www.cardiac-services.com Cardiologic Ltd 01845 523132 www.cardiologic.co.uk Cardiosolutions 08006 128020 www.cardiosolutionsinc.com/ Carl Zeiss Ltd 01223 401500 www.zeiss.co.uk Carleton Medical Limited 01633 838081 www.carletonmedical.co.uk Carleton Optical Ltd 01494 775811 www.carletonltd.com CaseMax Ltd 07446 852646 www.casemax.co.uk Catalyst Medtech 07931 932675 - Caterham Surgical Supplies Ltd 02086 831103 www.caterhamsurgical.co.uk/ CD Medical Ltd 01942 816184 www.cdmedical.co.uk CelgenTek Limited +353 614 198 98 www.celgentek.com CellPath Ltd 01686 611333 www.cellpath.co.uk CeloNova BioSciences of Europe B.V 01256 698010 www.celonova.com Central Medical Supplies 01538 399541 www.centralmedical.co.uk/ Cerapedics Inc +1 303 974 6275 www.cerapedics.com CG Surgical 07584 024712 - Chalice Medical 01909 470777 www.chalicemedical.com Charter Kontron Limited 01908 646070 www.charter-kontron.co.uk Chemence Medical Products 01536 402600 www.chemence.com Cipher Surgical Limited 02392 466855 www.ciphersurgical.com CJ Medical 08445 610612 www.cjmedical.com Claret Medical +1 707 528 9300 www.claretmedical.com ClearView Endoscopy Ltd 01702 597707 www.cviewendo.co.uk Clinical Education Consultancy Ltd 07824 386549 - Clinical Innovations Europe 03333 704408 www.clinicalinnovations.com Clinimax 01359 252181 www.clinimax.net CliniMed Ltd 01628 850100 www.clinimed.co.uk Clinisupplies Ltd 02088 634168 www.clinisupplies.co.uk CLS Surgical Ltd 01912 634991 www.cls-surgical.com CME Medical 01253 206662 www.cmemedical.co.uk

Policy on Supplier Representation April 2017 18 | P a g e Cochlear Europe Limited 01932 263400 www.cochlear.com Codan Ltd. 01189 783663 www.codan.de Cogentix Medical 08000 325965 www.cogentixmedical.com Colin Spall Ltd 01527 559010 www.judd-medical.co.uk Coloplast - Wound Care Division 01733 392000 www.coloplast.co.uk Columbus Medical Ltd 01512 853812 - Comeg Medical 01480 477 307 www.comegmedical.com ConforMIS UK Limited 01423 861643 www.conformis.co.uk ConMed UK Ltd 01793 787910 www.conmed.com ConvaTec Ltd 01895 628400 www.convatec.co.uk Cook Medical +353 613 34 440 www.cookmedical.com Insurance Details Cordis – A Cardinal Health Company 01344 864197 www.cardinalhealth.com Core Surgical 01844 213000 www.coresurgical.com Corin Ltd 01285 659866 www.coringroup.com Cortinthian Surgical 08702 408036 www.corinthiansurgical.com/ Corpak MedSystems UK 08001 444480 www.corpakmedsystemsuk.com/ Cosurge Ltd 01423 771657 - Coup Medical 07917 668039 www.coupmedical.co.uk Covidien EVI 01329 224000 www.covidien.com Insurance details Covidien GI Solutions 01329 224000 www.covidien.com Insurance details Covidien Healthcare Economics 01329 224000 www.covidien.com Insurance details Covidien Ireland 01329 224000 www.covidien.com Covidien Medical Care Solutions 01329 224000 www.covidien.com Insurance details Covidien Neurovascular UK 01329 224000 www.covidien.com Insurance details Covidien Surgical 01329 224000 www.covidien.com Insurance details Covidien UK Technical Service 01329 224000 www.covidien.com Insurance details Covidien Vascular 01329 224000 www.covidien.com Insurance details Crawford Healthcare Ltd 07795 528330 www.crawfordhealthcare.com/ Creo Medical Limited 01291 606005 www.creomedical.com CryoLife Europa 01483 441030 www.cryolife.com/ CS Medical Limited 03300 439747 www.csmedical.co.uk CUI Wear 01162 624333 www.cuiwear.com Cyberonics Europe BVBA +32 272 09 593 www.cyberonics.com Cydar Limited 01223 778020 www.cydar.co.uk Daax Ltd 08709 799110 www.daax.co.uk Daiichi Sankyo UK Ltd 08000 285122 www.daiichi-sankyo.co.uk Dansac UK Limited 01480 484300 www.dansac.com DCC Vital +353 12 90 7055 www.DCCVital.com De Smit Medical Systems Ltd 08453 454226 www.desmitmedical.com Delta Surgical Ltd 01782 637009 www.deltasurgical.co.uk Deltex Medical Ltd 08450 850001 www.deltexmedical.com DePuy Synthes 01133 877800 www.depuysynthes.com Derma Sciences Europe Ltd 01628 625916 www.dermasciences.com Device Technologies UK Ltd 01623 862833 www.device-technologies.co.uk DFine +49 0 621 820 905 00 www.DFine.eu Diagmed Healthcare Limited 01845 526660 www.diagmed.co.uk DJO UK Ltd 01483 459659 www.djoglobal.com Dot Medical Ltd 01625 668811 www.dot-medical.com DP Medical Systems Ltd 02083 914455 www.dpmedicalsys.com Draeger Medical UK Ltd 01442 213542 www.draeger.co.uk DTR Medical Ltd 01792 797910 www.dtrmedical.com Duckworth & Kent Ltd. 01462 893254 www.duckworth-and-kent.com Duo Medical Ltd 07545 137300 www.duomedical.co.uk

Policy on Supplier Representation April 2017 19 | P a g e Durbin PLC 02088 696500 www.durbin.co.uk Dutch Ophthalmic Research Center 08000 518377 www.dorc.eu Eakin Healthcare Group 02920 74700 www.eakin.eu EbCo Medical Ltd 01233 770289 - EcoGen Europe 08454 531377 - Ecolab 01132 322480 www.ecolab.com Eden Medical (UK) Ltd 01314 406500 www.edenmedical.co.uk Edge Medical Ltd 01618 832036 www.edgemedical.co.uk/ Edwards Lifesciences Ltd 08706 062040 www.edwards.com Elemental Healthcare 08444 120020 www.elementalhealthcare.co.uk Elite SurgiTech Ltd 01865 236850 www.elitesurgitech.co.uk Ellipse Technologies +1 949 837 3600 www.ellipse-tech.com Emmat Medical 01902 788777 www.emmat.co.uk Endologix +31 088 116 91 32 www.endologix.com Endosurgical Ltd 02890 764960 www.endosurgical.co.uk Entellus Medical 08003 586046 www.entellusmedical.com/uk Erbe Medical UK Ltd 01132 530333 www.erbeuk.net Eschmann 01903 753322 www.eschmann.co.uk Esaote UK 01223 424499 www.esaote.com Espiner Medical Ltd 01275 878801 www.espinermedical.com Ethicon BIOPATCH 01344 864000 www.ethicon360.com/products/ethicon-biopatch-products Ethicon Biosurgery 01344 324600 www.ethicon360emea.com Ethicon Energy 01344 86400 www.ethicon.com/healthcare-professionals/products/energy-devices Ethicon Surgical Care 01344 86400 www.ethicon.com Eurospine Ltd +33 1 46 86 60 07 www.eurospine.com Eurosurgical +353 8724 390 83 www.eurosurgical.ie Eurosurgical Ltd 01483 456007 www.eurosurgical.co.uk/ EUSA Pharma 01438 735747 www.eusapharma.com Exactech UK Ltd 01527 591555 www.exac.co.uk Excel Lasers Limited 01440 783201 www.excellasers.com Eye Spy Products Ltd 01226 292781 - Fairmont Medical Products Ltd 01245 206800 www.fairmontmedical.com.au Fannin Ltd 08002 12827 www.fannin.eu/ Finox Biotech 07919 374816 www.finoxbiotech.com First Clinical and Technical Services Limited +31 413 270 132 www.firstclintech.com Firstkind Ltd 01494 572040 www.gekodevices.com/en-uk Fisher & Paykel Healthcare Limited 01628 626136 www.fphcare.com Fittleworth Medical Ltd 01903 731244 www.fittleworth.com Flexicare Medical 01443 474647 www.flexicare.com Freehand 2010 Ltd 01483 408720 www.freehandsurgeon.com Freelance Surgical Limited 08450 504147 www.freelance-surgical.co.uk Fresenius Kabi Limited 01928 533533 www.fresenius-kabi.co.uk Fresenius Medical Care (U.K.) Ltd 01623 445100 www.fmc-ag.com Frontier Medical Group 01495 235800 www.frontier-group.co.uk Frontiere Medicale (Trading as Frontmed Trading Limited) 02380 676733 www.frontmed.org Fujifilm Sonosite Ltd 01462 341151 www.sonosite.com Full Support Healthcare Ltd 01933 672180 www.fullsupporthealthcare.com G K Wood & Son Ltd T/A Fulbourn Medical 01223 880909 www.fulbournmedical.com GAMA Healthcare Ltd. 02079 930030 www.gamahealthcare.com Gambro 01733 396100 www.gambro.com GBUK Enteral Ltd 01757 282945 www.gbukenteral.com GBUK Healthcare 01757 282945 www.gbukenteral.com GC Aesthetics / Brand Nagor and Eurosilicone 01236 780780 www.gcaesthetics.com

Policy on Supplier Representation April 2017 20 | P a g e Gedeon Richter UK Ltd (Women’s Health Division) 02076 048800 www.gedeonrichter.co.uk GE Healthcare 01707 263570 www.gehealthcare.co.uk GE Healthcare Ultrasound – Point of Care 01707 263570 www.gehealthcare.co.uk Genesys Medical Solutions (UK) Ltd 08706 009940 www.genesysmedicalsolutions.com Genesis Medical Ltd 02084 514100 www.genmedhealth.com/ Geratherm Medical AG +49 3620 598 210 www.geratherm.de/en/ Get Orthopaedics 01429 867654 www.getorthopaedics.co.uk/ GHG Software Developments (Trading as Talkingpoint) 01908 565663 www.talkingpoint.uk.com Globus Medical 01420 83999 www.globusmedical.com GlySure Limited 01235 462872 www.glysure.com GN Otometrics UK 01280 730742 www.otometrics.com Grafton Optical Company Ltd 01923 233980 www.graftonoptical.com grbmedical 01977 680232 - Griffiths & Nielsen Ltd 08452 638908 www.gandn.com/medical Grünenthal Ltd 01494 480354 www.grunenthal.co.uk GTA (UK) Ltd 01159 815703 www.gta-uk.co.uk Guardian Spine Limited 01923 819338 www.guardianspine.co.uk Guardian Surgical 01256 339200 www.guardiansurgical.com Guymark UK Ltd. 01384 890600 www.guymark.com/ GVS Filter Technology UK Ltd 01524 847600 www.gvs.com H&R Healthcare 01482 631606 www.hrhealthcare.co.uk H4 Medical 01617 439772 www.h4medical.co.uk Haag Streit UK 01279 414969 www.Haagstreituk.com Haemonetics 08082 344817 www.haemonetics.com Halyard Health Limited 08009 176585 www.halyardhealth.com Hamilton Medical UK 01217 170199 www.hamilton-medical.com Health Tech Solutions Ltd 07808 763926 www.healthtechsolutions.co.uk Healthcare 21 08456 055521 www.healthcare21group.com Healthcare matters 01978 758111 www.healthcare-matters.com Healthline Medical Ltd 02083 355213 www.healthline.co.uk Heidelberg Engineering Limited 01442 345370 www.HeidelbergEngineering.co.uk Helapet Ltd 01582 501982 www.helapet.co.uk Hemodia UK Ltd 02033 765228 www.hemodia.com Henleys Medical Supplies Limited 01707 333164 www.henleysmed.com Heraeus Medical +49 6181 353 399 www.heraeus-medical.com/en/home_15.html Highland Medical Ltd 01932 429287 www.highlandmedical.co.uk Hill Rom 01530 411000 www.hill-rom.com Hitachi Medical Systems Ltd UK 08448 004294 www.hitachi-medical-systems.com Hollister UK Limited 01189 895000 www.hollister.com Hologic Ltd 01619 462263 www.hologic.com/ Hospira UK Ltd 01926 820820 www.hospira.co.uk Hospital Innovations 02920 020858 www.hospitalinnovations.com Hospital Metalcraft Ltd (Bristol Maid) 01258 451338 www.bristolmaid.com Humanmed UK Ltd 01322 611729 www.humanmed.de Huntleigh Diagnostic Products Division /td> 02920 485885 www.huntleigh-diagnostics.com Hupomone Advisors Ltd 02072 217330 - IBG Immucor Ltd (Immucor UK) 03303 338742 www.immucor.com Ideal Med Ltd 08443 183804 www.idealmed.co.uk Ideal Medical Solutions 02087 737844 www.ideal-ms.com IDMED +33 491 118 784 www.idmed.fr Idoman UK 08082 343932 www.Idoman-med.com IGEA UK 01279 874535 www.igeamedical.co.uk Imaging Equipment Limited 01761 417402 www.imagingequipment.co.uk

Policy on Supplier Representation April 2017 21 | P a g e Immucor UK 03303 338742 www.immucor.com Implants International Ltd 01642 769080 www.implantsinternational.com Independence Products Ltd. (incorporating Spirotect) 01159 757254 www.independenceproducts.co.uk/ Inditherm PLC 01709 761000 www.inditherm.com Inomed Health Ltd 01422 399510 www.inomedhealth.com Inspiration Healthcare Ltd 01455 840555 www.inspiration-healthcare.com Inspire MD Ltd +49 302 5555 155 www.inspiremd.com Instinctive Limited 01234 302233 www.instinctiveUK.com Int2Med Ltd 08432 891886 www.int2med.com Integra NeuroSciences Ltd 01264 345781 www.integralife.eu Interacoustics 01698 208254 www.oticonmedical.com InterGlobal Surgical 01242 262680 www.igsurgical.co.uk Interim Pharma Services Ltd 07769 695275 - Intersurgical 01189 656426 www.intersurgical.co.uk Intervene Ltd 01246 828088 www.ivltd.co.uk Intrapharm Laboratories Ltd 01628 771800 www.intrapharmlabs.com Intuitive Surgical +1 408 523 2186 www.intuitivesurgical.com/ Invacare Ltd 01656 776283 www.invacare.co.uk InVen/v Health 01235 448500 www.themedicinescompany.com/ Iskus Health Ltd +353 140 48 38 www.iskushealth.com JD Surgical Ltd 07468 698291 www.jdsurgical.uk Jewel Management Ltd 01380 734990 www.generalmedical.co.uk Jo Anthony Ltd 07768 821737 www.joanthony.com John Weiss and Son Ltd 01908 318017 www.johnweiss.com Johnson and Johnson Medical Ltd 01344 864000 www.jnjgateway.com JOTEC UK Ltd 01386 429421 www.jotec.com JRI Orthopaedics Ltd 01142 573200 www.jri-ltd.co.uk Judd Medical 01527 559010 www.judd-medical.co.uk Jump Start Consulting Limited 01234 888955 www.jump-start-consulting.co.uk June Medical UK Ltd 01628 330010 www.junemedical.com K2 Medical Systems Ltd 01752 397800 www.k2ms.com K2M UK Ltd 02033 265670 www.k2m.com K4 Medical Limited 07595 690010 www.k4medical.co.uk Kapitex Healthcare Ltd 01937 580211 www.kapitex.com KARL STORZ Endoscopy (UK) Ltd 01753 503500 www.karlstorz.com Karomed Limited 01460 66033 www.karomed.com/ KB Spine & Consulting 07792 522338 - Kebomed Ltd 01884 266377 www.kebomed.co.uk/ Keeler Ltd 01753 857177 www.keeler.co.uk Kent Pharmaceuticals Limited 08454 375565 www.kentpharm.co.uk Kestrel Ophthalmics Ltd 01202 658444 www.kestrelophthalmics.co.uk Kimal Plc 08454 379540 www.kimal.co.uk KLS Martin UK Ltd 01189 000570 www.klsmartin.com Kowa Optimed Europe Ltd. 01276 937021 www.kowamedical.com LabLogic Systems Ltd 01142 667267 www.lablogic.com Laborie Medical Technologies Europe Limited 01788 547888 www.laborie.com Laerdal Medical Ltd 01689 876634 www.laerdal.com/gb/ Laprosurge 02089 010281 www.laprosurge.com LaserVision Ltd 01483 209518 www.laservision.co.uk/ Lavender Medical Limited 08456 769733 www.lavendermedical.com Lawmed Ltd 08452 411510 www.lawmed.co.uk/ Leda Orthopaedics 02037 142301 www.ledaortho.com Leica Biosystems 08002 982344 www.leicabiosystems.com/

Policy on Supplier Representation April 2017 22 | P a g e Leica Microsystems (UK) Ltd 01908 353560 www.leica-microsystems.com LeMaitre Vascular GmbH 08702 406640 www.lemaitre.com Lenstec House 01924 382678 www.lenstec.com LiDCO Ltd 02077 491500 www.lidco.com Light Source Supplies 01279 600700 www.LssLamps.com Lima Orthopaedics UK Ltd 08443 320661 www.lima.it Lindare Medical Ltd 01233 822296 www.lindaremedical.co.uk/ Lindsay Surgical Supplies Ltd 01202 521326 www.lindsaysurgical.com Linc-Medical 01572 717515 www.linc-medical.co.uk LINET UK 08442 481833 www.linet.uk.com Litechnica Ltd 02085 772450 www.litechnica.co.uk/ LiteOptics Ltd 01799 542716 www.liteoptics.com LocaMed UK Ltd 01252 413051 www.locamed.com Lockdown Medical Limited 01527 555888 www.lockdown.uk.com Lombard Medical Ltd 01235 750846 www.lombardmedical.com Lumenis UK Ltd 02087 364110 www.lumenis.com Lynton Lasers Ltd 01477 536977 www.lyntonsurgical.co.uk M.I.S.S Ophthalmics Ltd 01536 741139 www.miss-ophth.com M3 Medical +353 128 85 000 www.m3.ie Macmedhealthcare +353 868 36 700 www.macmedhealthcare.ie Macromed 08450 345160 www.macromed.co.uk Mainline Instruments 01214 586800 www.main-line.co.uk Malosa Medical 01422 328940 www.malosa.com Mana-Tech Ltd 01283 538538 www.mana-tech.com Maquet Ltd 01915 196200 www.maquet.co.uk Marquardt-uk Ltd 02087 325579 www.marquardt-uk.com Marshall Airway Products Ltd 08456 128888 www.marshallproducts.co.uk Masimo Europe Limited 01256 479988 www.masimo.co.uk Masson Seeley & Co Ltd 01366 388000 www.masson-seeley.co.uk/ Mathys Orthopaedics Ltd 08450 580938 www.mathysmedical.com MatOrtho Ltd 01372 224200 www.matortho.com Matz Medical Ltd 02036 017572 www.matzmedical.co.uk/ MBA Surgical UK Ltd 01625 838878 www.mba.eu MCA Medical Devices Ltd 07743 909332 - MDM Medical Ltd 02380 259900 www.mdmmedical.com Mecobo Ltd 01613 580350 www.mecobo.com Med Surg Supplies +966 014 647 846 www.medsurgsupplies.com Medacta UK Ltd 01455 613026 www.medacta.com MEDACX Limited 02392 469737 www.medacx.co.uk/ Medartis Ltd 01924 476699 www.medartis.com Medecon Healthcare UK Ltd 02082 424699 www.medecon.co.uk/ Meddikit 07944 690561 www.meddikit.com MED-EL UK Ltd 01226 242919 www.medel.com Med Imaging Healthcare Ltd 03330 069189 www.medimaging.co.uk Medela UK Ltd 01617 760400 www.medela.co.uk Medical Devices Ltd 01704 544944 www.absolutepatientcare.com Medical Imaging Technnologies Ltd 01625 599656 www.medicalimagingtechnologies.com Medical Innovations Group 01702 291878 www.medicalinnovations.co.uk Medical Perspectives UK Limited 08004 714783 www.medicalperspectivesuk.com Medicareplus International Limited 02088 108811 www.medicare-plus.com Medicina 01204 695050 www.medicina.co.uk Medicrea Technologies UK Limited 01223 813725 www.medicrea.com Mediplus Ltd 01494 551200 www.mediplus.co.uk

Policy on Supplier Representation April 2017 23 | P a g e Medisoft Ltd 01133 472020 www.medisoft.co.uk Medistim UK Limited 01159 815703 www.medistim.com Meditech Systems Ltd 01747 821546 www.meditechsystems.co.uk Medline Industries Ltd 08443 345237 www.uk.medline.com/ Medserve Limited 01275 218161 www.medserveltd.com Medstrom Limited 08453 711717 www.medstrom.co.uk Medtronic CardioVascular 01923 212213 www.medtronic.co.uk Insurance details Medtronic CRDM 01923 212213 www.medtronic.co.uk Insurance details Medtronic Diabetes 01923 212213 www.medtronic-diabetes.co.uk Insurance details Medtronic Neurological &ENT 01923 212213 www.medtronic.co.uk Insurance details Medtronic Spine & Pain 01923 212213 www.medtronic.co.uk Insurance details Medtronic Neurological &ENT 01923 212213 www.medtronic.co.uk Insurance details Melyd Medical Ltd 01244 660954 www.melydmedical.com Mentor 01344 864000 www.mentormedical.co.uk Mercian Surgical Supply Co Limited 08448 791133 www.merciansurgical.com Meril Life Sciences +49 228 7100 4000 www.merillife.com Merit Medical 08000 228184 www.merit.com Mermaid Medical Ltd 01704 560493 www.mermaidmedical.dk MGC Lamps Ltd 01473 466300 www.mgc-lighting.com MicroAire/ Morgan Steer Orthopaedics 01162 396424 www.morgansteer.co.uk MicroPort Orthopaedics UK Ltd 01244 572120 www.ortho.microport.com Microscope Service and Sales Ltd 01628 536936 www.microscopy.uk.com Microscopix Limited 01992 469085 www.microscopixlimited.co.uk MicroVention UK Ltd 01912 586777 www.microvention.com Mindray UK Limited 01480 416877 www.mindray.com Mitsubishi Pharma Europe 02070 655000 www.mitsubishi-pharma.eu.com Mobelife NV +32 016 660 444 www.mobelife.be Mobile Health Systems 08443 350737 www.mobilehealth.org.uk/ Modern Aesthetic Solutions Ltd 08448 849966 www.modernaestheticsolutions.com Mölnlycke Health Care 01582 676100 www.molnlycke.com Nagor Limited 01236 780780 www.nagor.com Neomed UK Ltd 01707 663200 www.neomed.co.uk neQis Ltd 01795 842542 www.neqis.co.uk Neotract International Inc. 03300 889549 www.NeoTract.com Nestle Health Science 08006 3785385 www.nestlehealthscience.co.uk Network Medical Products Limited 01765 609555 www.networkmedical.co.uk Neurotechnics Ltd 08454 500590 www.neuro-technics.com NeuroTherm Ltd 02086 604374 www.neurotherm.com Neurologic Europe 01279 874814 www.neurologiceurope.com Nevro Medical UK +1 650 251 0005 www.nevro.com New Med Healthcare Solutions 01323 720357 www.newmedhealthcare.com NEWCO Surgical 01213 866688 www.newcosurgical.com Nine Group International 01726 813979 www.ninegrp.com Nordic Pharma 01189 298241 www.nordicpharmagroup.com NORGINE Pharmaceuticals Ltd 01895 826600 www.norgine.com Nova Biomedical 01928 704040 www.novabiomedical.com Nuada Medical Prostate Care Ltd 02070 378850 www.nuadamedical.com Nutricia 01225 711552 www.nutricia.co.uk NuVasive UK Limited 02082 387850 www.nuvasive.com Occlutech UK 02036 575647 www.occlutech.com Oceana Therapeutics Ltd +35 31 293 0153 www.salix.com O'Flynn Innovation 02030 269859 www.oflynn-innovation.com Olympus Keymed 01702 616333 www.olympus.co.uk

Policy on Supplier Representation April 2017 24 | P a g e Omega surgical instruments 01932 260844 www.omegasurgicalinstruments.com/ Omnimed Limited 01962 626364 www.omnimed.ltd.uk Onbone Oy +35 8504664642 www.woodcast.fi/en/frontpage Oped UK Ltd 01380 722177 www.opeduk.co.uk Operating Room Systems Ltd 02844 832947 www.operatingroomsystems.com Opsens Inc +1 418 682 9996 www.opsensmedical.com Optima Medical 02030 580850 www.optimamedical.com/ Optimus Medical Limited 08456 860305 www.optimus-medical.com/ Origin Healthcare Europe Ltd 01423 866857 www.origin-healthcare.com Orspine UK Ltd 07899 873905 - Orthimo 01618 711990 www.orthimo.com Ortho Solutions 01621 843599 www.orthosol.com OrthoCoach Ltd - - Orthofix Ltd 01628 594500 www.orthofix.co.uk OrthoLink (Scotland) Ltd 07834 632721 www.ortholink.co.uk Osiris Therapeutics Inc +1 443 5451800 www.osiris.com Osteotech Ltd 01202 487885 www.osteotec.co.uk Oticon 01698 208206 www.oticonnhs.co.uk Oticon Medical 01698 283363 www.oticonmedical.com Otodynamics Ltd 01707 267540 www.otodynamics.com/ Owen Mumford Ltd 01608 645555 www.owenmumford.com P3 Medical Ltd 01179 728888 www.p3-medical.com Pajunk UK Medical Products Ltd 01912 647333 www.pajunk.co.uk Pall Europe Limited 02392 338000 www.pall.com Paramount Medical Solutions Ltd 03331 110002 www.paramountmedical.com Parity Medical 01513 430500 www.paritymedical.com/ Park House Healthcare 08453 442615 www.parkhouse-hc.com Patterson Medical 08448 730035 www.pattersonmedical.co.uk Paul Hartmann Ltd 01706 363200 www.hartmann.co.uk Pelican Healthcare Ltd 02920 747000 www.pelicanhealthcare.co.uk Pennine Healthcare 01332 794880 www.penninehealthcare.co.uk PENTAX Medical 01753 798180 www.pentaxmedical.com Pentland Medical 01314 675764 www.pentlandmedical.co.uk Penumbra Europe GmbH +49 30 2005 67 60 www.penumbrainc.com/ pfm medical UK Limited 01625 875388 www.pfmmedical.com/uk Phagenesis Ltd 01618 204525 www.phagenesis.com Phoenix Surgical Instruments Ltd 01992 479444 www.phoenixsurgical.co.uk/ Physio-Control 08082 580094 www.physio-control.com Pierson Surgical Ltd 01225 766632 www.piersonsurgical.com Pioneer Medical Europe Ltd 08081 469234 www.pioneermedicaleurope.co.uk Platform-14 08452 571014 www.platform-14.com PNN Medical +45 491 391 13 www.pnnmedical.com PORGES - a Coloplast division 01733 392000 www.coloplast.co.uk Precision Surgical Ltd 01142 701000 www.precisionsurgical.co.uk/ Premia Spine +972 544 626 602 www.premiaspine.com Premier Endoscopy Ltd 01904 786888 www.premierendoscopy.co.uk PROACT Medical Ltd 01536 461981 www.proactmedical.co.uk Promed Limited 01487 842842 www.promedltd.com Promedics Orthopaedic Ltd 01475 746400 www.promedics.co.uk Proplink Medical (Europe) Ltd 01952 613803 www.proplinkmedical.co.uk/ ProStrakan 01896 664000 www.prostrakan.com/ Pulmonx UK Ltd 08082 340376 www.pulmonx.com Pure Healthcare Ltd 01327 317846 www.pure-healthcare.com

Policy on Supplier Representation April 2017 25 | P a g e Purple Surgical UK Ltd 01923 839333 www.purplesurgical.com Pyms Consultancy 01529 469596 www.pymsconsultancy.co.uk Q Medical Technologies Ltd 01539 561807 www.qtechnologiesgroup.co.uk QED Scientific Ltd. 01663 735494 www.qedscientific.com QIAGEN – Sample and Assay Technologies 08082 343665 www.qiagen.com QSPINE LTD 01536 267515 www.qspine.co.uk Quintiles 01184 508000 www.quintiles.com/locations/europe/united-kingdom/ R&J Medical Ltd 02890 865523 www.randjmedical.com Radiometer 01293 517599 www.radiometer.co.uk Rayner Intraocular Lenses Ltd 01273 205401 www.rayner.com RB Medical Engineering Ltd 01989 563958 www.rbmedical.co.uk Ream Surgical Limited 01322 220600 www.reamsurgical.co.uk Reed Medical Ltd 01254 503333 www.reedmedical.co.uk Regenerys Ltd 01142 220983 www.regenerys.com Renishaw Plc 01453 524524 www.renishaw.com ResMed UK Ltd 01256 862997 www.resmed.com Respond Healthcare Ltd 08002 20300 www.respond.co.uk Richard Wolf UK Ltd 02089 447447 www.richard-wolf.uk Richardson Healthcare 08001 701126 www.richardsonhealthcare.com Ricoh UK Ltd 01604 814900 www.ricoh.co.uk RMS Innovations 02089 537781 www.rmsbio.net Rocamed SAM +377 979 84243 www.rocamed-urology.com Rocialle 01433 471359 www.rocialle.com Rontis Hellas S.A. +30 210 61 09 090 www.rontis.gr Roberts Surgical Healthcare Limited 01562 865110 www.robertssurgical.co.uk Rocket Medical plc 01914 196988 www.rocketmedical.com Rostra Medical Ltd 01226 286665 www.rostrauk.com S&E CareTrade 02894 462233 www.caretrade.co Sagentia Ltd 01223 875200 www.sagentia.com Sage Products +1 800 323 22 20 www.sageproducts.com Salts Healthcare Ltd 01213 332000 www.salts.co.uk SCA Hygiene Products UK Ltd 01582 677400 www.sca.com/uk/ SCM Healthcare Solutions - - Scotmed Ltd 01418 877074 www.scotmed.com Schülke & Mayr UK Ltd - Hygiene International (Hospital Division) 01142 543500 www.schulke.co.uk SD Healthcare 01617 767626 www.sdhealthcare.com Sebbin UK Ltd 01494 590416 www.sebbin.com Sela Medical UK Ltd 01159 440141 www.selamedical.co.uk Semperit UK Ltd +43 179 777 208 www.semperitgroup.com/en/ Sentra Medical Ltd 08447 365799 www.sentramedical.co.uk Sequana Medical AG +41 44 03 55 62 www.alfapump.com Serchem Ltd 01952 223130 www.serchem.co.uk Serve Medical Ltd 01952 290280 www.servemedical.co.uk Sharpsmart Ltd 01388 810310 www.sharpsmart.co.uk Sheffmed Ltd 01142 617161 www.sheffmed.com SI-BONE +39 0331 156 1179 www.SI-BONE.com SI-Bone UK Ltd 01423 860025 www.si-bone.com Sigmacon (UK) Ltd 02089 509501 www.sigmacon.co.uk Silvalea Limited 01626 331655 www.silvalealtd.co.uk Silony Medical 01279 874147 www.silony-medical.com Single use surgical 01236 732333 www.susl.co.uk SJM Technical Media Ltd 01275 371107 www.sjmbiomed.com SLE Ltd 02086 811414 www.sle.co.uk

Policy on Supplier Representation April 2017 26 | P a g e S-Med Ltd 01214 466953 www.s-med.co.uk Smith & Nephew Plc 01482 222200 www.smith-nephew.com Smiths-Medical 08458 500445 www.smiths-medical.com SOL Dental Technologies 01162 537679 www.soldental.co.uk Solus Medical Ltd 08453 058098 www.solusmedical.com Sorin Group (UK) Ltd 01452 638500 www.sorin.com Sovereign Medical Ltd 01279 816167 www.sovereignmedical.co.uk Spacelabs Healthcare 01992 507700 www.spacelabs.com Spectranetics International BV +31 33 43 47 050 www.spectranetics.com Spinal Cord Monitoring Ltd 07801 413273 www.spinalcordmonitoring.co.uk Spinal Modulation NV +32 2 719 04 44 www.spinalmodulation.com Spine App 07956 106705 - Spirit Healthcare 01162 865000 http://spirit-healthcare.co.uk/ SPorter Medical Ltd 07922 951416 - Squadron Medical Ltd 01246 822822 www.squadronmedical.co.uk/ SRA Developments Ltd 01364 652426 www.lotusultrasonicscalpel.com St Jude Medical 01789 207600 www.sjm.com Stamford Products Ltd 01613 305577 www.stamford-products.co.uk Stanmore Implants 02082 386500 www.stanmoreimplants.com Stanningley Pharma Limited 01159 124253 www.stanningleypharma.com/ Starkstrom 02088 683732 www.starkstrom.com/ Stat One Services Ltd 01213 548829 www.statone.co.uk STOK UK 03303 007865 www.stokuk.com STORZ Medical (UK) Ltd 02089 650004 www.storzmedical.com Straub Medical AG +41 81 720 04 60 www.straubmedical.com Strawberry Medical Ltd 01525 229900 www.strawberrymedical.com Stryker UK Ltd 01635 262400 www.stryker.co.uk Sulis Healthcare Products Ltd 01604 890939 www.Sulishealthcare.com Summit Medical Ltd and Orthodynamics Ltd 01451 810900 www.summit-medical.co.uk Sunflower Medical Ltd 01274 684004 www.sunflowermedical.co.uk/ Supermax Healthcare Limited 01733 615215 www.supermax.co.uk Supra Medical Ltd 01953 488837 www.supramedical.co.uk Surgical Holdings 01702 602050 www.surgicalholdings.co.uk Surgical Innovations 01132 307597 www.surginno.com Surgical Instrument group Holdings Ltd 02086 831103 www.sighltd.co.uk Surgix Ltd 07952 344921 www.surgix.co.uk Swann-Morton Ltd 01142 344231 www.swann-morton.com Sword Medical +353 182 42 700 www.swordmedical.ie Symbios UK Ltd 01392 365884 www.symbiosorthopaedics.co.uk Symetis sa +41 21 651 0160 www.symetis.com Symprove Limited 01252 413600 www.symprove.com Synapse Medical +353 186 24 600 www.synapsemedical.ie/ Synergy Health Plc 01772 299990 www.synergyhealthplc.com Synergy Medical Technologies Limited 01273 961992 www.synergymedtech.com Syner-Med (Pharmaceutical Products) Limited 02086 556380 www.syner-med.com Talarmade Limited 01246 268456 www.talarmade.com/ Taphon Ltd 01268 530066 www.taphon.co.uk TCB Training Services LTD 01522 788142 www.tcbfirstaidtraining.co.uk Teasdale Hospital Equipment Ltd 01614 805779 www.teasdalehealthcare.com Technopath +353 613 35 844 www.techno-path.com/ Teleflex 01494 532761 www.teleflex.com TEM UK Ltd. 01429 871517 www.rotem.de Terumo UK Ltd 01784 476200 www.terumo-europe.com

Policy on Supplier Representation April 2017 27 | P a g e THD (UK) LTD 01905 747883 www.thdlab.co.uk The Boat Genie Ltd 07495 923395 www.theboatgenie.co.uk The Diabetic Boot Company 01296 678596 www.pulse-flow.com The Durham Clinic 0191 3787844 www.thedurhamclinic.com The Glanville Partnership Ltd 01480 496913 - The Helping Hand Company 01531 635678 www.helpinghand.co.uk The Laser Shop 01843 297110 www.thelasershopuk.co.uk The Magstim Company Limited 01994 240798 www.magstim.com The Medical Room Ltd 01582 696023 www.themedicalroom.com The Tree Concept Ltd 07806 612616 - Thea Pharmaceutical’s Ltd. 0845 521 1290 www.spectrum-thea.co.uk Thermo Fisher Scientific (Phadia Ltd) +46 18 16 50 00 www.thermoscientific.com/phadia Tiger Medical Supplies Ltd 01634 712 428 www.tigermedicalsupplies.co.uk/ Timesco Healthcare Ltd 01268 297722 www.timesco.com TMS Medical Limited 01782 479605 www.tmsmedical.co.uk Tobinjaffry Ltd 01422 208657 www.tobinjaffry.co.uk Toffeln 03455 004433 www.toffeln.com Topcon (GB) Ltd 01625 567024 www.topcon.co.uk Tornier UK Ltd 01753 464850 www.tornier.com/ Toshiba Medical Visualization Systems Europe, Ltd 01314 724792 www.tmvse.com Total Containment Solutions 01942 679600 www.totalcontainmentsolutions.co.uk Tristel Solutions Limited 01638 721500 www.tristel.com Trumpf Medical 01530 411000 www.trumpf-med.com UK Medical Supplies Ltd 07545 566016 www.ukmedicalsupplies.com Uniplex UK Ltd 01142 413410 www.uniplexuk.com Unisurge International Limited 08455 213111 www.unisurge.com Urgo Medical 01509 502051 www.urgo.co.uk VacSax Limited 01752 337000 www.vacsax.com Validair Monitoring Solutions Ltd 01684 576452 www.validair.com Vascular Perspectives Ltd. 01614 910585 www.vascularperspectives.com Vascutek Ltd. 01418 125555 www.vascutek.com Veni Vidi (Ophth) Ltd 01422 254064 www.veni-vidi.co.uk Ventmed Ltd 01732 884091 www.ventmed.com Verathon Medical 01494 682650 www.verathon.co.uk Vernacare Ltd 01204 529494 www.vernacare.com Veritek Global Ltd 01323 500200 www.veritekglobal.com/ Viamed Ltd 01535 634542 www.viamed.co.uk Vifor Fresenius Medical Care Renal Pharma UK Ltd 01276 853600 www.viforpharma.com/en/ Vision Pharmaceuticals t/a Spectrum Ltd 01625 618816 www.spectrum-uk.co.uk Vision Matrix Ltd 01423 705058 www.visionmatrix.co.uk VisionScope Technologies 01223 440239 www.vst.org.uk Vitaflo International Ltd 01517 099020 www.vitaflo.co.uk Volcano Europe SPRL/BVBA +32 267 91 076 www.eu.volcanocorp.com/ Vygon (UK) Limited 01793 748800 www.vygon.co.uk W L Gore & Associates (UK) Ltd 01506 460123 www.gore.com Warwick SASCo Ltd 01926 422427 www.sasco.co.uk Waveney Medical Ltd 07980 743372 - Welch Allyn 01296 689900 www.welchallyn.co.uk Win Health Medical Ltd 01835 864866 www.win-health.com Winsor Medical 01444 882210 www.winsormedical.co.uk/ Wright Medical 01244 572120 www.wmt.com Wymedical 01480 211505 www.wymedical.com Xaviourmed LLP - www.xaviourmed.com

Policy on Supplier Representation April 2017 28 | P a g e X-Bolt Orthopaedics 01172 300632 www.x-bolt.com/ Xiros 01132 387202 www.Xiros.eu.com York Medical Technologies Ltd 01430 803113 www.ymt.co.uk/ Ypsomed Ltd 03448 567820 www.mylife-diabetescare.co.uk Zethon Ltd 01296 634090 www.remltd.co.uk Zilico Ltd 01618 267840 www.zilico.co.uk Zimmer Ltd 01793 584500 www.zimmer.co.uk Zimmer Biomet 01656 655221 www.biomet.co.uk ZOLL Medical UK 01928 595160 www.zoll.com

Participating trusts/boards The following trusts/boards are participating in the scheme. Aintree University Hospitals NHS Foundation Trust Aneurin Bevan University Health Board - Nevill Hall Hospital Ashford & St Peter's Hospitals NHS Foundation Trust Barking, Havering and Redbridge University Hospitals NHS Trust - Queens Hospital - King Georges Hospital Barts Health NHS Trust - The Royal London Hospital - Mile End Hospital - Newham University Hospital - St Bartholomew's Hospital - Whipps Cross University Hospital - Barkantine Birth Centre - Barking Birth Centre - The Dental Hospital Bedford Hospital NHS Trust Birmingham Children's Hospital NHS Foundation Trust Cambridge University Hospitals NHS Foundation Trust - Addenbrooke's Hospital - Princess of Wales Hospital - The Rosie Hospital Central Manchester University Hospitals NHS Foundation Trust - Royal Manchester Children's Hospital - University Dental Hospital of Manchester - Manchester Royal Eye Hospital - Manchester Royal Infirmary - Saint Mary's Hospital - Trafford Hospitals Colchester Hospital University NHS Foundation Trust Dorset County Hospital NHS Foundation Trust East Kent Hospitals University NHS Foundation Trust - Queen Elizabeth The Queen Mother Hospital - Kent & Canterbury Hospital - William Harvey Hospital George Eliot Hospital NHS Trust Gloucestershire Hospitals NHS Foundation Trust - Cheltenham General Hospital - Gloucester Royal Hospital Great Ormond Street Hospital for Children NHS Foundation Trust Great Western Hospitals NHS Foundation Trust

Policy on Supplier Representation April 2017 29 | P a g e Heart of England NHS Foundation Trust - Heartlands Hospital - Solihull Hospital - Good Hope Hospital - Birmingham Chest Clinic - Castle Vale Renal Unit - Runcorn Road Renal Unit Hinchingbrooke Health Care NHS Trust Imperial College Healthcare NHS Trust - Charing Cross Hospital - Hammersmith Hospital - Queen Charlotte and Chelsea Hospital - St Mary's Hospital - Western Eye Hospital Kettering General Hospital NHS Foundation Trust Kingston Hospital NHS Foundation Trust Lewisham and Greenwich NHS Trust - Lewisham Hospital - Queen Elizabeth Hospital - Burgess Park - Downham Health and Leisure Centre - Primary Care Centre - Honor Oak Health Centre - Ivy House - Kaleidoscope - Jenner Health Centre - Lee Health Centre - Marvels Lane Health Centre - South Lewisham Health Centre - Sydenham Green Health Centre - Waldron Health Centre Liverpool Women`s NHS Foundation Trust London North West Healthcare NHS Trust - Central Middlesex Hospital - Ealing Hospital - Northwick Park and St Mark's Hospitals Maidstone and Tunbridge Wells NHS Foundation Trust Milton Keynes University Hospital NHS Foundation Trust National Services Scotland NHS Grampian - Royal Infirmary - Matthew Hay Building - Royal Aberdeen Children's Hospital - Aberdeen Maternity Hospital - - - - City Hospital - - Dr Gray's Hospital - The Oaks Palliative Care Day Centre - -

Policy on Supplier Representation April 2017 30 | P a g e - Insch War Memorial Hospital - Jubilee Hospital - Peterhead Community Hospital - - Chalmers Hospital - Glen O' Dee Hospital - - Kincardine Community Hospital - Turriff Hospital - - Stephen Hospital - Fleming Hospital - - - Aberdeen Community Health and Care Village Northampton General Hospital NHS Trust Northern Devon Healthcare NHS Trust - Axminster Hospital - Barnstaple Health Centre - Bideford Community Hospital - Budleigh Salterton Hospital - Crediton Hospital - Exeter Community Hospital - Exmouth Hospital - Holsworthy Community Hospital - Honiton Hospital - Lynton Resource Centre - Moretonhampstead Hospital - North Devon District Hospital - Okehampton Community Hospital - Ottery St Mary Hospital - Seaton Community Hospital - Sidmouth Hospital - South Molton Community Hospital - Tiverton and District Hospital - Torrington Community Hospital - Tyrrell Hospital Northumbria Healthcare NHS Trust Oxford University Hospitals NHS Trust - Churchill Hospital - Horton General Hospital - John Radcliffe Hospital - Nuffield Orthopaedic Centre Queen Elizabeth Hospital King's Lynn NHS Foundation Trust Royal Cornwall Hospitals NHS Trust - Royal Cornwall Hospital - St Michael's Hospital - West Cornwall Hospital Royal Devon & Exeter NHS Foundation Trust - Wonford Hospital - Heavitree Hospital Sandwell and West Birmingham Hospitals NHS Trust Southend University Hospital NHS Foundation Trust

Policy on Supplier Representation April 2017 31 | P a g e Spire Cambridge Lea Hospital Spire Gatwick Park Hospital Spire Leicester Hospital Spire Montefiore Hospital St Helens and Knowsley Teaching Hospitals NHS Trust - St Helens Hospital - Whiston Hospital Taunton and Somerset NHS Foundation Trust The Wellington Hospital The Pennine Acute Hospitals NHS Trust - The Royal Oldham Hospital - North Manchester General Hospital - Fairfield General Hospital - Rochdale Infirmary - Floyd Unit University College London Hospitals NHS Foundation Trust - University College Hospital - Royal National Throat, Nose and Ear Hospital - Royal London Hospital for Integrated Medicine - National Hospital for Neurology and Neurosurgery - UCH at Westmoreland Street - Eastman Dental Hospital University Hospital of South Manchester NHS Foundation Trust - Withington Community Hospital - Wythenshawe Hospital University Hospitals Coventry and Warwickshire NHS Trust - University Hospital Coventry - Hospital of St Cross Rugby University Hospitals of North Midlands NHS Trust - Royal Stoke University Hospital - County Hospital University Hospital Southampton NHS Foundation Trust - Southampton General Hospital - Princess Anne Hospital - New Forest Birth Centre Walsall Healthcare NHS Trust Walton Centre NHS Foundation Trust Warrington and Halton Hospitals NHS Foundation Trust Yeovil District Hospital NHS Foundation Trust

Participating organisations The following industry and professional organisations are supporting the MIA scheme. The industry associations are promoting best practice within the sector. The professional organisations encourage healthcare providers to ensure that representatives from outside organisations are appropriately trained to attend in the critical or acute care environment. Details of the individual organisations can be found by clicking through to their websites. Company name Phone number Web address ABHI 020 7960 4360 www.abhi.org.uk AfPP 01423 881 300 www.afpp.org.uk ASGBI 0207 973 0300 www.asgbi.org.uk

Policy on Supplier Representation April 2017 32 | P a g e Barema 020 3318 0836 www.barema.org.uk Health Care Skills 0141 951 5646 www.healthcareskills.com Optic UK 01962 870 850 www.opticuk.org About us Cookie policy Terms and conditions Visit ABHI main site Copyright 2016 ABHI/JMH Publishing SDMA 01246 568 175 www.dressings.org.uk

Policy on Supplier Representation April 2017 33 | P a g e Appendix C – MIA Publicity Poster for the ROH (note roll out in fact brought forward to 9th May 2016)

Policy on Supplier Representation April 2017 34 | P a g e Appendix D – Draft Section from the Theatre Guidelines Relating To Access Restriction and Attire

Professional Culture

The ROH has set out in its Values and its Vision to be “the first choice in Orthopaedic Care."

The Theatre Guidelines have been produced to support consistent delivery of the Trust's strategic aims:

 Delivering exceptional patient experience and world class outcomes  Developing services to meet changing needs, through partnership where appropriate  At the cutting edge of knowledge, education, research and innovation  With safe, efficient processes that are patient centred  Delivered by highly motivated, skilled and inspiring colleagues

It also reflects our values:

 Respect and listen to everyone  Have compassion for all  Work together and deliver excellence  Have pride in and contribute fully to patient care  Be open, honest and challenge ourselves to deliver the best  Learn, innovate and improve to continually develop orthopaedic care

All staff are encouraged and required to promote a culture of honesty, openness and transparency. Staff must feel able to, and indeed are required to speak up if they are concerned about any aspect of patient safety. In doing so, they should have confidence that their views will be respected, heard and, where needed, acted upon.

This type of culture extends to incident reporting, measuring our achievements against performance indicators and against agreed standards in audit. Such activities must be viewed positively as the basis of individual and organisational learning and improvement.

Likewise, staff must report near misses when they occur and not just actual harm. This is so that the risks can be fully assessed and lessons learned to improve our service provision.

Where necessary, and if the act of stopping activity does not compromise patient care in itself, any member of staff who has immediate concerns for patient safety must feel able to “stop the line” and halt activity while senior advice is sought.

Teamwork

Teamwork is fundamental to the safe delivery of care throughout all patient pathways. The Theatre Clinical Service Manager and Matron will ensure as far as possible that procedural teams are consistent.

Multidisciplinary teams that work together should train together, with a focus on human factors, effective communication and openness.

All members of the team, regardless of pay banding, perceived ability, status or role are worthy of the same level of respect, consideration and politeness. Staff should address members of the theatre team by their appropriate title, unless invited to do otherwise, especially in front of patients who are awake.

Policy on Supplier Representation April 2017 35 | P a g e

The same level of respect applies for visitors and the greatest respect at all times is given to patient themselves, without exception.

Putting the Patient First

The patient is the most important member of the team.

Patients and patient groups will be involved in the development and monitoring of theatres. At a minimum, a representative of the Theatre User Group and Divisional Management Board Group will attend the Patient Council twice a year to update on developments and seek feedback on progress.

In theatres, the patient must be actively involved in the individual safety steps wherever possible. For example, a patient with capacity can participate in the handover to the procedure team from the ward or admission area, in addition to the sign in. If the procedure is performed under regional or local anaesthesia without sedation, the patient must be regarded as the key member of the team and invited participate in the time out, sign out and other handovers within the patient pathway.

Patients should always be addressed by “Mr” or “Mrs/Ms/Miss” (except for paediatric patients) unless they have given prior consent to be address by their given name. Details of preferred form of address should be indicated on the theatre checklist.

Preparing For Work in The Operating Theatres

Staff Attire

All staff working within the theatre environment should present a professional appearance and conduct themselves in a professional manner at all times. The clothes that staff wear should enable good practice and minimise any risk to patients. Patients and the wider public should have complete confidence in the cleanliness and hygiene of their healthcare environment. The way staff dress is an important influence on people’s overall perceptions of the standards of care they experience. When staff are in the theatre environment, Trust ID Badges must be kept on the individual at all times. If the ID badge is held on a lanyard it is important that it does not compromise the sterile field and therefore be kept inside the theatre top. Otherwise, when moving about the hospital the Hospital ID badge must be on show. Lanyards should be washed regularly.

Staff Uniforms

Uniforms and name badges assist in the recognition and identification of staff. Uniforms should be clean at all times, and professional in appearance. They should not impede effective hand hygiene nor should they be able to come into contact with patients during direct patient care activity. It is good practice for staff either to change at work or to cover their uniforms as they travel to and from workplaces. As far as possible, subject to the above overriding requirements of patient safety and public confidence, staff should feel comfortable in their uniforms. This includes being able to dress in accordance with their cultural practices. For example, although exposure of the forearm is a necessary part of hand and wrist hygiene during direct patient care activity, the uniform code should allow for covering of the forearm at other times.

Policy on Supplier Representation April 2017 36 | P a g e Staff Personal Adornment

Nothing should be worn that could compromise patient or staff safety during care, for example:

 false nails  bulky rings  earrings other than small studs  necklaces

A smooth plain band wedding ring is allowed. Small studs in the earlobe are allowed. Facial piercings are not permitted. No visible body jewellery to be worn. This includes ear jewellery not worn in the ear lobe, nose rings, tongue studs and other visible piercings. Perfume and after shave may be worn but these should be light as many patients and staff are affected by strong perfumes. Minimal make-up may be worn in the operating theatre

Changing Facilities

Changing rooms are provided with wash and shower facilities. The changing areas must be kept clean, tidy and dry. Maintaining a clean and tidy changing environment is the responsibility of all staff. Unlabelled or single footwear may be regarded as having no current owner so it is sensible to clip shoes and wellingtons together and label them clearly. It is not acceptable to leave items on the floor, other than outside footwear. Similarly, newspapers, cups pens, elastoplast etc should be returned to their correct place and not left on top of lockers.

Theatre Clothing

Theatre personnel who enter the red restricted or amber semi-restricted zones of the operating department must don the attire intended for use within the surgical environment. Theatre clothes consist of a two-piece trouser suit.

Technique to don theatre attire:

 Remove outer clothing and jewellery.  Wash hands.  Place cap/hood over hair.  Don the freshly laundered scrub suit.  Put on clean theatre footwear  Hands must be washed before and after donning theatre attire.

Removal of theatre attire:

 Theatre attire must be removed when it becomes wet or soiled, and placed into containers specially designed for contaminated laundry, to reduce the risk of cross contamination.  Theatre attire must be removed, before leaving the theatre environment, and placed into clear plastic clinical laundry bag.

Cover gowns / jackets

All staff must change into their outdoor clothes before leaving the theatre environment, particularly to go Policy on Supplier Representation April 2017 37 | P a g e to the canteen, or public places. Used theatre attire must not be stored in lockers for further use; fresh theatre clothing must be donned on return to the theatre department. Staff are permitted to wear theatre attire in urgent and emergency situations, for example when required to travel to an emergency on the ward. In such cases, their theatre attire should be fully covered by clean cover gown/jacket, fully fastened up.

Laundering of Theatre Attire

These clothes are provided freshly laundered and should be checked that they are in good condition. Home laundering of theatre attire is not permitted. All theatre attire must be sent to the laundry to ensure laundering of clothing is in accordance with relevant standards. Clean theatre clothing should be protected from contamination during transfer and storage.

Headwear

All head and facial hair should be covered completely by a head cover/cap. Disposable headwear is single- use, surgical headwear. Its function is to securely contain the hair and thereby prevent hair and skin particles from contaminating the patient. It can be a surgical hood or theatre cap - elastic or tied. Headwear should be donned prior to donning the scrub suit. Headwear should be changed daily, unless it becomes soiled, when it should be changed immediately. Headwear should always be worn in laminar flow theatres during open Orthopaedic operations.

Finger Nails

Fingernails must be clean, short and free from nail varnish. False finger nails, including acrylic or gel coated or fibreglass must not be worn, as these have been shown to harbour micro-organisms such as fungi and gram negative bacteria even after hand washing; they can also inhibit hand washing

Footwear

Autoclavable anti-static footwear is provided and is available to all personnel. It must be well fitting, supportive, fully enclose the foot or have retaining straps behind the ankle. It is each individual health worker’s responsibility to ensure that their footwear is decontaminated. Footwear should not be left in a contaminated state or on changing room floors.

Masks

Facemasks must be always be worn by the surgical team during sterile procedures. During open Orthopaedic operations, all staff within the operating theatre will wear facemasks. Protective face shields must be worn by staff whenever activities place personnel at risk of splashes or aerosol contamination. Masks must cover the nose and mouth, fitting the contour of the face and must be tied securely. Masks must be changed between patients. The mask should not be touched once applied. A used mask must be handled by the tapes only. Used masks must be discarded into a yellow clinical waste bag for disposal after each case, or if soiled. Masks must not be worn around the neck or put into pockets for future use. Hands should be washed following mask removal.

Policy on Supplier Representation April 2017 38 | P a g e Personal Hygiene

Personal hygiene should be of a high standard. Showers and towels are provided, for staff accidentally contaminated with body fluids whilst on duty.

Patient Attire

Patients in preparation for surgery must wear suitable clothing. Patients will be supplied with disposable underwear to maintain privacy and dignity. Patient gowns should be correctly fitting to enable them to be securely closed at the rear to maintain privacy and dignity. Patients who walk to theatre must be allowed to wear their own dressing gown over the patient gown and if they do not have their own gown they must be provided with a disposable gown to cover the patient gown during the transfer. Patients must wear appropriate footwear during walking transfers to theatre to maintain safety. Patients undergoing procedures which do not require them to change out of their own clothes (e.g some day case procedures) must have their own clothing protected during the procedure.

Visitors to the theatre environment

Staff/visitors, supplier representatives and other healthcare professionals must be made aware of the Trust’s policies and procedures with respect to dress. Relative supporting patients in the anaesthetic rooms or recovery can enter the department without changing. They may be asked to wear cover jackets and overshoes. Students (from all health professions) must comply with Trust policies on uniform in the operating department Visiting professionals (surgeons etc) must comply with Trust policies on uniform in the operating department and have an appropriate honorary contract in place. Access will be denied if this is not in place, except in an emergency situation where the Theatre Clinical Service Manager/Matron or Divisional General Manager should be contacted for advice. Allied health professionals (lab technicians, maintenance workers etc) must comply with Trust policies on uniform in the operating department. Medical supplier representatives must comply with Trust policies and standards on uniform in the operating department if entering the clinical area – see Red Line Policy.

Policy on Supplier Representation April 2017 39 | P a g e Red Line Policy - Restricting Access within the Theatre Complex

Restriction of access within theatres is necessary for many reasons including:

 Patient safety  Patient privacy and dignity  General security  Infection control  Efficiency

The Trust has identified three levels of access that apply within the theatre environment:

 Unrestricted (Green Zones) o Normal security and normal staff uniform and dress code applies.  Semi Restricted (Amber Zones) o Traffic is limited to authorised, correctly attired personnel and patients.  Restricted (Red Zones) o Traffic is very limited and personnel must be correctly attired. This includes the operating theatres.

The zones are subject to variation, particularly during building and development work. A current version will be visible near theatre reception and available through the Theatre Clinical Service Manager and Matron.

An example is included below:

Policy on Supplier Representation April 2017 40 | P a g e Appendix E

Indicative Map of Theatre Complex Showing Red and Amber Zones RED AREAS ARE STRICTLY FOR STAFF IN THEATRE SCRUBS ORANGE / AMBER AREAS ESSENTIAL STAFF ONLY PERMITTED IN TRA

RED AREAS ARE STRICTLY FOR STAFF IN THEATRE SCRUBS ORANGE / AMBER AREAS ESSENTIAL STAFF ONLY PERMITTED IN TRANSIT

Policy on Supplier Representation April 2017 41 | P a g e Access Doors

At all times theatre department access is restricted by swipe card. Theatre entrance doors must remain closed at all times when access / egress are not being undertaken.

To support delivery of the red line arrangements, access is restricted through a number of entrances to the minimum necessary personnel. Again, this is subject to change and access will be supervised by the Clinical Service Manager and Matron responsible for Theatres.

Supplier Representatives As part of the red line arrangements, there will be a new charter with company representatives based on the National Medical Industry Accredited (MIA) Scheme. We rely heavily on their expertise to assist in delivering the best of care for our patients. However, they will be asked in future to identify a named individual with whom they are working and in the theatre environment. This will either be assisting a surgical team, or assisting the logistics team with stock. There is no other reason for supplier representatives to be present in Theatre. Sales meetings are not appropriate in the theatre environment. However, we are planning to ensure that there are mutually beneficial opportunities to meet with companies, and remain up to date via a new education programme. Please do not put company reps in a difficult position by agreeing to have sales meetings in theatres. Please also make it clear that any new implants have to be approved by both the Medical Devices Committee for clinical safety, and the appropriate budget holders.

Theatre Traffic Within the Red (Restricted) Zone and Operating Theatres Themselves

Only the number of personnel required to manage the proposed clinical procedure safely should be present in the operating theatre. There should be the minimum amount movement and talking within the operating theatre. All doors to the operating theatre must remain closed, to ensure effective ventilation of the area, and proper function of the laminar flow. As far as possible all potential equipment and supplies for the proposed clinical procedure and/or list should be available in theatre prior to a clinical procedure commencing. This will then reduce the traffic in and out of theatre, and therefore maximise the efficiency of the ventilation system.

Theatre Etiquette | Behaviour

All staff are expected to be changed and ready for duty at their allocated start time. All members of the team are expected to be punctual for the theatre team brief, as this is a key element of improving the safety culture.

Talking outside of the anaesthetic rooms and theatres must be kept to a minimum to avoid disruption.

If it is necessary to speak to a member of the surgical team during an operation, it is essential that this is initiated through the scrub person. To prevent disruption of air flows and minimise the risk of cross infection, staff must restrict their movement in and out of each theatre environment.

The use of mobile phones is restricted to minimal use within the theatre complex.

No drinks or food are to be brought in to the theatres or the anaesthetic rooms. These are to be consumed in the allocated rest areas during breaks.

Staff must be familiar with and adhere all Trust Policies and Operating Theatre Standards and Policies, Policy on Supplier Representation April 2017 42 | P a g e which are evolving over time. Staff must be familiar with the Trust values and demonstrate behaviour that is consistent with these.

Any member of staff demonstrating behaviour that is not consistent with the Trust values will be challenged, and action taken if behaviour is not subsequently changed.

Smoking is not allowed in any part of the Theatre suite. Staff wishing to smoke during their allocated break times must change and leave the suite. These staff must ensure that they do not return late from break times, as this is discourteous to colleagues. Help and support is available from Occupational Health for staff members who wish to give up smoking.

Staff must ensure that entitlement to lunch and breaks is not exceeded. The morning coffee break will be granted by the team leader and is for fifteen minutes. Lunch breaks are not to exceed 30 minutes, unless permitted by the team leader in mitigating circumstances. The afternoon tea break is discretionary, and will be granted, when possible, by the theatre team leader.

Policy on Supplier Representation April 2017 43 | P a g e APPENDIX F

EQUALITY IMPACT ASSESSMENT TEMPLATES

Equality Impact Assessment

Initial Assessment form

The Initial Equality Impact Assessment (EIA) is a quick and easy screening process. It should:

1. Identify those policies which require a full EIA by looking at:

. Negative, positive or no impact on any of the protected characteristics. . Opportunity to promote equality for the protected characteristics. . Data/feedback to prioritise if and when a full EIA should be completed

2. Justify reasons why a full EIA is not going to be completed

Division or Corporate area: Division 2

Specialty/Service Area Theatres

Executive Lead (enter name and Jonathan Lofthouse designation):

Title of Policy: Staff attire and preparation for working within the theatre environment

Q1) What is the aim of your Policy?

To improve controls on staff and visitor movement within theatres

Q2) State to which Trust strategic objective this Policy relates:

Culture and Safety

Q3) Who benefits from your Policy?

All, especialy patient

Q4) Do you have any feedback data that influences, affects or shapes this Policy?

Policy on Supplier Representation April 2017 44 | P a g e Yes No   Please complete below. Please go to question 5

What is your source of feedback?  Monitoring Data  Previous EIAs  National Reports  Internal Audits  Patient Surveys Yes Complaints / Incidents / Claims / Litigation  Focus Groups  Equality & Diversity Training  Other (please state) Divisional management reviews

What does this source of feedback reveal?

Improvement in management of restricted areas.

Q5) Thinking about each group below does or could the Policy have a negative impact on members of the protected characteristics below?

Protected Characteristic Yes No Unclear

Age  

Disability  

Race  

Sex  

Gender Reassignment  

Sexual Orientation  

Religion or belief  

Pregnancy & Maternity  

Marriage & Civil Partnership  

Other socially excluded groups  

If the answer is “yes” or “Unclear” please complete a full EIA

Q6) Who was involved in the EIA and how?

Policy on Supplier Representation April 2017 45 | P a g e

Who – please specify. Divisional management team and Theatre Management Team

How were they involved?

 Surveys  Team Meeting Y Group Review  Other Please specify:

Q7) Have you identified a negative/potential negative impact (direct /indirect discrimination)?

No yes 

Q7a) If ‘No’ Explain why you have made this decision?

There may be some work to fully integrate and operationalize this but we foresee no long term hazards from this initiative which is for mutual benefit.

Q7b) If ‘yes’ explain the negative impact – you may need to complete a full EIA

If a negative impact has been identified please continue to undertaking a full impact assessment. If no negative impact has been identified please submit your Initial Equality Impact Assessment to roh- [email protected]

Justification Statement: As member of ROH staff carrying out a review of an existing or proposal for a new service, policy or function you are required to complete this EIA by law. By stating that you have not identified a negative impact, you are agreeing that the organisation has not discriminated against any of the protected characteristics. Please ensure that you have the evidence to support this decision as the Trust will be liable for any breaches in the Equality Legislation.

Completed by: Name: Matthew Revell Designation: Associate Medical Director

Policy on Supplier Representation April 2017 46 | P a g e Date: 06/05/16 Contact number: 0121 685 4000

This EIA has been approved: Name: Designation: Date: Contact number:

Equality Impact Assessment

Full Assessment Form

Having completed the Initial EIA Screening Form (Appendix A) which identified a negative or potential negative impact, you are required to complete this Full Equality Impact Assessment form. This will involve you questioning aspects of a proposed/existing policy, guideline or strategy and forecasting the likely effect on different groups.

Step 1) What is the impact?

1) Why have you carried out this Full Equality Impact Assessment?

Please mention any additional impacts in the box below. This could include contributing factors or conflicting impacts/priorities (e.g. environment, privacy and dignity, transport, access, signage, local demography) that has resulted in indirect discrimination or anyone else who will be impacted on by your policy, guideline or strategy.

Policy on Supplier Representation April 2017 47 | P a g e

Step 2) What are the differences?

2a) Identify the Equality group(s) that will be affected by the impact and state what the differences are:

Protected Negative / Positive / How is the Equality group identified affected in a Characteristic Potential Potential different way to others as a result of the policy, Negative Positive guideline or strategy? Impact Impact

Age  

Disability  

Race  

Sex  

Gender   Reassignment

Sexual   Orientation

Religion or Belief  

Pregnancy &   Maternity

Marriage & Civil   Partnership

Other socially   excluded groups

2b) If this EIA indicates that there is insufficient evidence to judge whether there is differential impact please state why below.

Policy on Supplier Representation April 2017 48 | P a g e Step 3) Consultation

3a) With whom have you consulted on your policy and when did the consultation take place?

3b) As a result of the consultation are there any further changes to the policy needed?

Policy on Supplier Representation April 2017 49 | P a g e

Step 4) Plan to address negative impact

4a) Please complete your action plan using the table below. Detail how you are going to address the negative impact, stating the timescales involved.

Protected Negative Action Required Cost Expected Lead Timescale Characteristic Impact Implications Outcome (name and job (specify title) dates)

Completed by: Name: Designation: Date: Contact number:

This EIA has been approved by: Name: Designation: Date: Contact number:

Policy on Supplier Representation April 2017 50 | P a g e

APPENDIX G – POLICY IMPLEMENTATION PLAN

POLICY IMPLEMENTATION PLAN

POLICY TITLE: Policy on Supplier Representation ACCOUNTABLE EXECUTIVE LEAD: Director of Operations POLICY AUTHOR: Matthew Revell / Associate Medical Director Patient Support Services APPROVED BY: Trust Management Committee DATE OF APPROVAL: April 2016

An implementation plan must be developed for all policies. This will ensure that a systematic approach is taken to the introduction of policies in order to secure effective working practices.

The following template provides a list of activities to consider as a starting point for thinking about implementation in a systematic manner.

Policy on Supplier Representation April 2017 51 | P a g e

IMPLEMENTATION PLAN OWNER: ______M Revell______

IF NO, PLANNED

ACTION RESPONSIBLE COMPLETED? COMPLETION EVIDENCE REFERENCE STATUS (YES/NO) DATE 1 Communications and engagement a Letter and announcement to clinical MPR Yes Letter of 28/4/16 body b Letter to suppliers to be distributed MPR Yes by MIA c Poster campaign MPR No w/c 9/5/16 Posters approved and in transit from MIA d Secure delegation of duties for Matt Payne In progress implementation – theatre front desk Julie Romano and logistics 2 Training a MIA to visit 11th May to commence Matt Payne No 11/5/16 and confirm programme Julie Romano b c d 3 Resources a No financial commitment required b Time to train and implement c d 4 Monitoring Effectiveness & Evaluation a Theatre Management Team to audit Fraz Hussain no Planned TUG minutes and monitor b

[Policy Name] Page 52 of 53

IF NO, PLANNED

ACTION RESPONSIBLE COMPLETED? COMPLETION EVIDENCE REFERENCE STATUS (YES/NO) DATE c d

Final date when plan is expected to be fully implemented: _____1st June 2016______

Status key: Green Fully on Amber Some slippage but expected to meet Red Significantly off target date or failed Blue Completed target timescale to complete

[Policy Name] Page 53 of 53