The Commissioner’s Guide to Spot Purchase Agreements for Complex Care

When it comes to commissioning complex care, there is no one-size-fits-all solution. Individuals with complex needs often require personalised, community-based support that does not fit neatly into a block or framework contract. In these situations, spot purchase agreements offer commissioners a vital route to ensure timely and tailored support is in place.

At Gray Healthcare, we specialise in clinically informed, person-centred support for people with complex mental health needs, learning disabilities, autism, and other challenges. We work closely with local authorities, NHS partners and families to deliver high-quality supported living services tailored to each individual.

In this guide, we explore what spot purchase agreements are, when and how to use them, and what commissioners need to know to make them work. We also reflect on our own experience as a trusted partner in this process, delivering meaningful clinical outcomes for people with complex needs.

The Role of Spot Purchase in Complex Care Referrals

Most people we support are referred to us by their local Integrated Care Board (ICB) or Local Authority (LA) through a preferred provider framework and tender process. However, when an individual requires a bespoke package that sits outside of the existing government procurement agreement, commissioners can instead make a spot purchase placement.

Creating Flexible Pathways for Individuals Outside Standard Provision

Spot purchasing allows us to respond quickly, flexibly and effectively to those who might otherwise be left behind by standard processes. However, before exploring spot purchase placements in detail, it is important to understand how they fit into the wider referral landscape, and how they complement standard commissioning routes such as Dynamic Purchasing Systems (DPS) or framework agreements.

Understanding Spot Purchase in Complex Care

Spot purchasing refers to the commissioning of individual care packages outside of existing block contracts or framework agreements. It is typically used when a specific, urgent, or highly personalised support need arises that cannot be met by providers already within the local framework.

A Vital Alternative for Urgent and Specialist Support

Commissioning for people with complex needs requires creativity, flexibility and speed. While most care packages are commissioned through structured systems, these don’t always offer the flexibility or specialist expertise needed for complex cases.

Spot purchase agreements offer commissioners a critical alternative when:

• Urgent or crisis placements are required.
• An individual has specific behavioural or clinical needs.
• Highly specialist support is needed for individuals with complex or co-occurring needs.
• Existing providers lack capacity or cannot meet specific requirements.
• There is an urgent need to avoid breakdown of care or readmission to hospital.
• A bespoke service needs to be co-designed with family and professionals.
• When suitable care isn’t available locally or requires an out‑of‑area specialist provider.

In such cases, spot purchasing can facilitate the development of tailored packages that reflect the person’s strengths, history, goals and aspirations.

Flexible Commissioning for Complex Transitions

At Gray Healthcare, we are frequently commissioned via spot purchase to design and deliver personalised packages that enable individuals to live safely and independently in their own homes.

This approach is particularly effective when working with:

• Young people transitioning from children’s to adult services.
• Adults with a history of failed placements or restrictive settings.
• People subject to the Mental Health Act or with forensic backgrounds.

What is a Dynamic Purchasing System (DPS)

A Dynamic Purchasing Systems (DPS) is a framework where providers can join continuously. It allows for greater flexibility than a fixed framework, but still doesn’t always cover highly tailored care for complex needs. When a Dynamic Purchasing System (DPS) cannot meet an individual’s specific requirements, a spot purchase agreement provides an essential alternative – still operating within established public procurement regulations.

Spot Purchase vs. Framework / DPS Procurement

Unlike bulk or recurrent procurement routes, spot purchasing is a case-by-case solution. For example, if a person is clinically ready to step down from hospital but no suitable supported living provision exists within the framework, a spot purchase agreement allows commissioners to commission bespoke care without delay.

Feature	Framework / DPS	Spot Purchase
Pre‑qualified suppliers	✔ Yes	Generally providers who are already on the approved provider list (not always)
Fixed rates / pricing	✔ Usually	More variable
Predictability & competition	✔ Higher	Lower
Flexibility to respond to unique needs	Limited	High
Procurement overhead	Lower (planned)	Higher (reactive)

The Strategic Role of Spot Purchasing

While spot purchase agreements should not replace structured commissioning processes, they remain an essential tool for commissioners when traditional routes cannot deliver the right support services for individuals with complex needs.

Spot purchasing is appropriate when:

• No framework provider has the specialist expertise required.
• Specialist provision is needed that aligns with a co-produced care plan.
• Procurement timelines would delay urgent access to essential services.

Balancing Flexibility with Accountability in Commissioning

In these situations, spot purchasing must be used carefully and responsibly. Commissioners are encouraged to:

• Clearly document the rationale for each placement.
• Demonstrate value for money.
• Plan for how the provision can be integrated into longer-term commissioning strategies.

When used appropriately, spot purchasing enables access to tailored support services for people whose complex needs fall outside standard frameworks, ensuring individuals receive timely, personalised care that promotes stability and independence.

Demonstrating the Impact: Why Spot Purchasing Matters

When used thoughtfully, spot purchase placements can play a critical role in delivering high-quality support services for people with complex needs. Far from being a fallback, they offer a strategic solution for ensuring personalised, community-based care when standard frameworks fall short.

Key Benefits of Spot Purchase Agreements

• Faster access to specialist support services.
• Improved outcomes for individuals with complex needs.
• Reduced reliance on inpatient or restrictive settings.
• Closer alignment with co-produced care and support planning.
• Better integration of housing, support and clinical input.

At Gray Healthcare, we have seen the impact of spot-purchased care, time and again, through our bespoke supported living model. Our 2024/25 Outcomes Report demonstrates this clearly:

✅ 97% of the people we support did not need any form of physical intervention
✅ 81% showed improvements in key functional skills, such as communication, emotional regulation, and daily living abilities.

These outcomes highlight how spot purchasing, when backed by clinical oversight, strong partnerships, and a person-centred approach, can unlock long-term stability, greater independence and real quality of life for the people we support.

Addressing Common Concerns Around Spot Purchasing

While spot purchase agreements for complex care offer critical flexibility, some Integrated Care Boards (ICBs) and local authorities remain hesitant to use them. Common concerns include:

• Concerns about cost efficiency compared to standard framework rates.
• Challenges in maintaining consistent oversight and quality assurance.
• Questions about how to balance individualised care with equity and market consistency.

While some of these concerns around spot purchasing might be valid, these challenges can be effectively addressed through robust commissioning practices, such as:

1. Ensuring Good Governance While Meeting Urgent Needs

• Implementing clear contract management protocols to ensure quality and accountability.
• Using outcome-based metrics to measure the impact and value of the support provided.
• Planning ahead to integrate spot-purchased services into longer-term commissioning strategies where appropriate.

Importantly, commissioners should also take the opportunity to review whether existing frameworks reflect the full spectrum of complex needs within the population. In some cases, innovation and personalised care may be unintentionally limited by overly rigid procurement models.

2. Time Limits and Review Mechanisms

Spot purchase agreements should never become open-ended by default. To safeguard commissioning integrity and ensure ongoing relevance, commissioners should:

• Define a clear minimum duration for each placement, with appropriate review checkpoints and exit clauses.
• Include regular contract performance audits and individual outcome reviews.
• Avoid letting short-term solutions drift into long-term arrangements without reassessment.

3. Managing Costs and Outcomes

Because spot placements often fall outside fixed framework rates, commissioners must be proactive in managing cost and value by:

• Conducting value-for-money assessments, and benchmark against similar support services.
• Collaborating with providers to agree fair, transparent costs at the outset.
• Explore risk-sharing arrangements that balance accountability with flexibility.

4. Governance and Oversight

To uphold transparency and strategic alignment across the system, commissioners need to:

• Ensure spot placement decisions are subject to review by a care governance panel or commissioning board.
• Establish standardised approval processes, documentation protocols, and performance reporting procedures.
• Embed oversight into broader commissioning strategies to reduce fragmented decision-making.

Legal and Procurement Considerations

While spot purchase agreements offer flexibility, they must still operate within the boundaries of public procurement law and local governance requirements.

To ensure compliance and accountability, commissioners must consider the following:

1. Regulatory Frameworks

• Public Contracts Regulations 2015 and broader government procurement policy require that all awards (spot purchases included) are conducted with fairness, transparency and a clear demonstration of value for money.
• For contracts above the relevant threshold, a direct award must be legally justified or formally tendered, unless a valid emergency exception applies.

2. Documentation and Audit Trail

Every spot purchase should be accompanied by a comprehensive and auditable procurement record, including:

• A reference number and all necessary administrative metadata.
• Clear procurement documentation, including specifications, evaluation criteria and award rationale.
• Any annexes detailing bespoke terms or variations from standard templates.
• Full records of participation, financial assessments, award decisions, time limits, and any deviations from standard processes.

3. Contract Terms: Spot Agreements vs. IPAs

Many contracting authorities utilise Individual Placement Agreements (IPAs), which are often adapted from broader residential or supported living templates, as the basis for spot-purchased care.

These agreements:

• Provide the flexibility needed to tailor care to the individual, while still aligning with standardised terms, outcomes and review mechanisms.
• Enable consistency across spot purchase placements, particularly when time-sensitive or bespoke support packages are required.

Designing Quality Spot Contracts for Complex Care

Spot purchasing presents a valuable opportunity to commission highly personalised, clinically informed support services for individuals with complex needs. To ensure consistency, accountability and long-term outcomes, contracts must be designed with precision and compassion from the outset.

1. Co-Production: The Foundation of Personalised Care

Effective spot purchase placements begin with co-production – a collaborative approach involving the individual, their family, clinicians, and commissioners from the start. At Gray Healthcare, we embed co-production into every support plan, ensuring services reflect the person’s unique life story, goals and risks.

Key elements of co-produced spot contracts include:

• Multi-disciplinary team (MDT) involvement in assessment and planning.
• Behavioural frameworks such as PROACT-SCIPr-UK® or Positive Behaviour Support (PBS) to guide interventions.
• Flexible, person-led care designed around individual needs.

2. Embedding Clinical Oversight and Positive Risk-Taking

Individuals with complex mental health conditions, learning disabilities, a diagnosis of autism or forensic backgrounds often require dynamic and responsive support. Therefore, spot contracts should embed:

• Ongoing clinical oversight to adapt care as needs evolve.
• A commitment to positive risk-taking, enabling greater independence and dignity.
• Clear safeguarding procedures, escalation protocols, and risk review mechanisms that avoid locking providers into rigid schedules.

At Gray Healthcare, our clinical team remains actively involved throughout the placement of each individual, ensuring that care remains safe, therapeutic and proportionate.

3. Defining Outcomes that Matter

Unlike traditional block contracts, spot placements allow for bespoke outcome measurement aligned to the individual’s goals. Well-designed spot contracts should include key performance indicators (KPIs) such as:

• Reduction in restrictive interventions.
• Improvements in functional skills such as communication, emotional regulation and daily living.
• Tenancy sustainment and community inclusion.
• Reduced hospital admissions or readmissions.

 

4. Planning for Transition and Sustainability

Although spot purchasing is often used to respond to urgent or unmet need, it must form part of a longer-term strategy.

Each contract, where appropriate, should include:

• A clear exit plan or integration strategy outlining how the individual will transition to mainstream commissioning routes, when ready.
• A plan for embedding successful support models into broader commissioning frameworks.
• A focus on sustainability, avoiding dependency or drift into indefinite placements.

At Gray Healthcare, our goal is always to stabilise, enable, and eventually transition individuals to greater independence or long-term commissioning pathways, where appropriate.

Case Study: Meet Adam

Adam’s journey is a powerful example of how spot-purchased, clinically informed community care can transform even the most complex lives.

From Long-Term Hospitalisation to Safe, Independent Living

Adam spent over 15 years in secure hospital environments under various sections of the Mental Health Act. His experience was marked by significant trauma, repeated failed discharges, and high levels of assessed risk, particularly from forensic services. On multiple occasions, transitions back into the community had failed – sometimes within 24 hours – leading to immediate readmission.

A Bespoke Solution Through Spot Purchasing

Recognising that traditional commissioning pathways had not met Adam’s needs, commissioners approached our team at Gray Healthcare to co-produce a new model of support.

Through a spot purchase agreement, we designed a bespoke community-based package centred on:

• Clinical oversight and risk management.
• Positive risk-taking to support gradual independence.
• Relationship-based care to build trust and stability.
• Flexible staffing, tailored to Adam’s routines and preferences.

“We were able to establish strong relationships and a consistent routine. Over time, Adam began to make positive choices, engage with his team, and move towards independence.”

Stability, Safety and Progress

Adam has now remained in his own home in the community for several years. His package of care has been safely reduced over time, and he continues to make meaningful progress toward his personal goals. His story demonstrates the long-term value of co-produced, person-led care, which was made possible through spot purchasing when no framework provider could meet his complex needs.

Read Adam’s Story and his Package of Care →

The Opportunities and Challenges of Spot Purchasing

Understanding the advantages and challenges of spot purchasing helps commissioners balance flexibility with accountability in complex care.

Benefits for Commissioners:

• Fills gaps without delay.
• Enables more preventative, community services.
• Reduces reliance on inpatient care.
• Allows testing of innovative models.
• Supports dignity and choice for the individual.

Key Risks to Mitigate:

• Higher costs if placements aren’t subject to strong quality and value-for-money controls.
• Inconsistent service quality in the absence of robust contract terms and monitoring.
• Over-reliance on spot purchasing, which may indicate gaps in long-term commissioning strategies.
• Provider strain, where organisations accept spot placements beyond their capacity or expertise.
• Lack of continuity or planning, leading to drift or breakdown in care over time.

To reduce these risks, commissioners should establish clear criteria for when spot purchasing is appropriate and regularly review overall spend, outcomes and placement trends to ensure alignment with strategic goals.

Moving Beyond Crisis Response

Too often, spot purchasing is seen as a last resort; a reactive measure for urgent or complex cases that don’t fit existing frameworks. However, when commissioned strategically, spot purchasing becomes a vital lever for personalised, outcomes-focused care.

It allows commissioners to meet unique needs, respond flexibly and test new models of support.

Spot Purchasing as a Strategic Tool, Not a Last Resort

When designed and governed well, spot purchasing is not a short-term fix but a powerful commissioning tool for unlocking personalised, community-based support for individuals with complex needs.

It should be:

• Used thoughtfully and transparently, with a clear rationale and audit trail.
• Underpinned by robust contract terms, outcomes monitoring and exit planning.
• Seen as a learning opportunity, to inform gaps in existing frameworks and service design.
• Delivered in partnership with experienced providers, ensuring that safety, dignity and clinically informed care remain central.

From Reactive Use to Strategic Integration

While spot purchasing often responds to urgent need, it also provides insight that can shape longer-term commissioning strategies. Commissioners can:

• Analyse spot purchase placements to identify unmet needs.
• Use data to inform future frameworks and hybrid models.
• Balance flexibility with equity and consistency, particularly in under-served areas.

Maintaining Flexibility While Promoting Consistency and Equity

At Gray Healthcare, we’re proud to be at the forefront of this work. When designed well, spot purchasing offers more than a stopgap; it unlocks personalised, community-based support that standard frameworks often struggle to deliver.

Our supported living referral pathway is designed to maintain stability, promote recovery and reduce the need for restrictive interventions. We pride ourselves on our ability to support people with the most complex needs to live well, safely and independently within their community. Through carefully designed, clinically informed spot placements, we have helped individuals move from long-term hospital stays to stable, supported lives in their own homes.

Get in Touch Today

To discuss a potential referral, request advice, or learn more about how we support local authorities with spot purchase agreements for complex care, contact us today.

We are here to support commissioners, providers, and families in delivering community-based services that truly work for people with complex needs.