NHS Procurement
"NHS procurement" is not one regime but two. Clinical healthcare services in England have been bought under the Provider Selection Regime since 1 January 2024, outside the main procurement rules. Everything else the NHS buys — medicines, devices, equipment, IT, facilities, agency staffing, consultancy — is bought under the Procurement Act 2023 like any other public contract. Which set of rules applies determines where the opportunity is advertised and how it is awarded.
The split that governs everything
The single most common mistake suppliers make about the NHS is treating it as one market with one rulebook. In England there are two, and they behave very differently.
Clinical healthcare services fall under the Provider Selection Regime (PSR), established by the Health Care Services (Provider Selection Regime) Regulations 2023 under the National Health Service Act 2006 as amended by the Health and Care Act 2022. The PSR came into force on 1 January 2024 and sits outside the Procurement Act 2023 entirely.
Everything else — goods, non-healthcare services, and works — is procured under the Procurement Act 2023, in force since 24 February 2025, with notices published on Find a Tender.
What the Provider Selection Regime covers
The PSR applies to relevant authorities: NHS England, integrated care boards, NHS trusts and NHS foundation trusts, local authorities and combined authorities.
In scope are services provided as part of the health service that consist of healthcare provision to individuals or groups, within the CPV codes listed in the regulations. That means hospital services, community health, mental health, primary care, palliative care, ambulance services, and local authority public health services such as substance misuse, sexual and reproductive health and health visiting.
Explicitly out of scope, in NHS England's own words:
> Goods (for example, medicines and medical equipment), social care services, patient transport services that do not require CQC registration, non-healthcare services or health-adjacent services that do not provide healthcare to an individual.
Community pharmacy essential services, capital works, catering and public health marketing campaigns are also excluded. For mixed contracts, the PSR applies only where the main subject matter is in-scope healthcare services and the authority takes the view that the out-of-scope elements could not reasonably be supplied under a separate contract.
How PSR awards work
The PSR moved deliberately away from an expectation of competitive tendering. There are five provider selection processes:
- Direct Award A — an existing sole provider where there is no realistic alternative
- Direct Award B — services where patients exercise unrestricted choice of provider
- Direct Award C — an existing provider is doing the job satisfactorily and the proposed changes are not material
- Most Suitable Provider — the authority identifies the most suitable provider without running a competition
- Competitive Process — full competition
Transparency requirements differ by route. For Direct Awards A and B, the authority publishes a confirmation of award notice within 30 days of award and there is no standstill. For Direct Award C, most suitable provider and competitive processes, the authority publishes an intention notice, observes an eight working day standstill, and publishes confirmation of award within 30 days.
The practical consequence for suppliers is uncomfortable but important: a large share of in-scope clinical services will never be advertised as an open competition. Watching a portal for clinical opportunities will miss most of them. What generates work is being a credible known provider to the ICBs and trusts in a geography, and reading intention notices closely, since an intention notice is the only formal warning before an award and the standstill is the only window in which to challenge.
Non-clinical NHS buying
This is the larger and more conventional market. Medicines and medical equipment, diagnostics, consumables, IT systems, estates and facilities management, agency and temporary staffing, transport, catering, waste, professional services — all bought under the Procurement Act 2023, with the same notice types, thresholds, assessment summaries and standstill periods as any other public contract.
Much of it flows through aggregation. NHS Supply Chain procures common goods centrally for trusts across England. NHS Shared Business Services and regional collaboratives run further framework portfolios, and trusts also use Government Commercial Agency agreements and other public sector frameworks. Getting on to the relevant framework is usually the precondition for supplying at scale, and framework award competitions are advertised on Find a Tender.
The structural change in progress
NHS England is being abolished, with its functions moving into the Department of Health and Social Care. The Health Bill giving effect to this was introduced in the House of Commons on 14 May 2026 and had its second reading on 1 June 2026; legal abolition is targeted for April 2027. NHS England therefore still exists in law today and remains a relevant authority under the PSR.
Related reorganisation is already under way: specialised commissioning transferred to seven integrated care board hubs from April 2026, and ICB mergers mean that in some areas the body that awarded a contract is not the body that now holds it — contracts, staff and liabilities pass to the successor ICB under a transfer scheme.
For suppliers this means checking who your counterparty actually is before assuming a renewal conversation is with the same organisation, and expecting a period in which commissioning responsibilities move.