Content and expertise verified in partnership with Holly Ward at Oxtavia
The 16–18 month NHS sales cycle: what actually happens in those months and how to survive them
Every healthtech founder is told that NHS sales cycles are long. Very few are told what happens during those 16–18 months from first meaningful conversation to purchase order — or how to stay alive financially while you wait.
Months 1–4
Relationships, not sales — listen to the trust’s problems, don’t pitch your product
You’re meeting clinical champions, attending trust innovation events, getting warm introductions through AHSNs. Nothing is being procured yet. The trust is deciding whether you’re credible and whether the clinical need is real. The mistake most founders make here: they pitch the product. The smart move: listen to the trust’s problems. The sales conversation starts when they tell you what they need, not when you tell them what you’ve built. Finding the right decision-maker often takes the most time in this phase — and most founders underestimate how long it takes.
Months 5–10
Pilot and evaluation — paid engagement with agreed success criteria, or a free trial nobody evaluates
If you’ve structured this well, it’s a paid or resource-committed engagement with agreed success criteria. If you’ve structured it badly, it’s a free trial that nobody is evaluating. The critical question to answer before the pilot starts: who will make the purchasing decision based on these results, and what specifically do they need to see?
Months 10–14
Evidence, business case, and infosec — where most deals quietly die
Your pilot results need to become a procurement-ready evidence package: cost savings quantified, clinical outcomes documented, integration requirements scoped, and DTAC and security assessments completed. This is where most deals stall — not because the evidence is bad, but because nobody on the startup side knows how to write a business case that an NHS finance director can take to their board. And information security is a hurdle that catches a lot of companies off guard at exactly this stage: every trust will send you an infosec questionnaire, and if you can’t demonstrate DTAC, GDPR compliance, and ideally progress toward ISO 27001, the deal stalls regardless of your clinical evidence.
Months 14–18
Procurement — framework agreements, legal review, and stakeholders you’ve never met
Framework agreements, purchase orders, legal review, data processing agreements. This phase has its own timeline and its own stakeholders, most of whom haven’t been involved until now.
The single biggest mistake: not having the right decision-makers in the room from the start. A lot of founders assume a doctor or consultant will be the person who signs off the purchase. They usually aren’t. Get the right people — the budget holder, the procurement lead, the finance director — engaged early. Show them the problem, the solution, and the value. If you wait until month 14 to discover that the person with signing authority has never heard of your product, you’ve lost 14 months.
Survival Strategies
Eighteen months is a long time for a startup with 12 months of runway
The founders who make it through either have diversified revenue (private healthcare, international sales, consulting engagements), grant funding timed to bridge the gap, or patient investors who understand the NHS sales cycle. Ideally, all three. A lot of the companies I’ve seen pivot to the US market during NHS cycles because the sales cycle is significantly quicker.
On grant funding as a bridge: apply, but never rely. Grant competition has intensified significantly, and even when you win, the money typically arrives in instalments aligned with a project start date that can be months away. One often-overlooked alternative: look at charities that offer non-dilutive funding in your specific disease or clinical area. A lot of charities fund innovation in their space, and because fewer companies know about these routes, competition is often much lower.
And one hard truth about non-renewal. If a hospital doesn’t renew your product, it’s almost never just “budget cuts.” That’s the polite answer. If a product is truly valued and embedded, they will find the money. If they haven’t, it usually means they haven’t seen enough value. That’s a difficult thing to hear, but it’s the problem you need to solve quickly — because if one trust isn’t renewing, others are thinking the same thing.
The worst strategy: betting everything on a single NHS deal with no alternative revenue and no grant bridge. The best strategy: running 3–4 NHS conversations in parallel while generating revenue from other sources, so that 16–18 months is the timeline for your first NHS sale — not the timeline for your company’s survival.