System design, governance & accountability

Provider Selection Regime: understanding experiences of Integrated Care Systems

Procuring health care services under the Provider Selection Regime

Ariel view of crowd
March 2025 - February 2026

Background

A new set of rules called the Provider Selection Regime (PSR) came into effect on 1st January 2024, replacing the previous regulations for how NHS and local authorities in England choose healthcare service providers. The PSR was introduced because the old rules encouraged competition as a preferred way of selecting service providers, which often conflicted with the goal of fostering collaboration and integrated care. The principle of collaboration became increasingly important since the establishment of the Integrated Care Systems (ICSs) - geographical areas consisting of local commissioning and providing  organisations responsible for the delivery of health care services in a given area. The tension between principles of provider competition and provider collaboration when selecting the providers became particularly evident with the introduction of Integrated Care Boards (ICBs) - new statutory bodies tasked with commissioning health services within the ICSs. 

The PSR aims to: 

  • Provide more flexibility in the process of choosing healthcare providers
  • Reduce the use of competitive tendering
  • Support collaboration between providers 
  • Improve transparency of procurement processes and reduce bureaucracy. 

Under the PSTR, healthcare authorities have five options for selecting providers: three types of Direct Awards, Most Suitable Provider, and a Competitive Process. The authorities must document their decisions, publish transparency notices, and handle complaints, including via a new independent panel.

  • This study aims to understand how the new PSR rules are being applied by the ICBs. Among other things, it will examine how decisions are made about which procurement route to use, and whether the PSR supports collaborations within the ICSs and reduces administrative burdens. 

    Research Questions 

    1. What do ICBs and providers think about the new PSR? 
    2. How are decisions made about which procurement route to use, and does this vary by service type? 
    3. How does the PDR compare to the old system in terms of flexibility, risk of disputes, and provider sustainability? 
    4.  How well does the PSR align with the national goal of increasing collaboration? 

  • The research will focus on three ICS areas and involve interviews with the senior staff from ICBs. NHS providers and independent providers. Around 15 interviews will be conducted across the three ICS areas, targeting individuals involved in procurement decisions. The interviews will explore how procurement decisions are made, which routes are used, and the perceived impact of the PSR. 

    Limitations 

    As the study focused on only three ICSs, the findings will not be nationally representative. However, three ICS case studies will provide valuable insights into how the PSR is being implemented in real-world settings, which cannot be captured through surveys or administrative data alone. 

  • The findings will help national policymakers in the Department of Health and Social Care (DHSC) and NHS England understand how the PSR is working in practice. The study will also benefit local healthcare leaders by shedding light on how the new rules impact collaboration and service delivery. Overall, this research will provide early evidence to guide improvements in healthcare procurement processes and support the goal of delivering more integrated, efficient, and collaborative care.