If you have ever received a tender opportunity in the health and social care sector and wondered whether the rules applying to it are the same as the NHS contract you bid for six months ago, the honest answer is: probably not.

 Since January 2024, two separate procurement frameworks have operated in parallel across health and social care in England, and the contract you are looking at right now may fall under either one of them depending on the commissioner, the service type, and the contract value.

Understanding the difference between these two frameworks is no longer optional for providers who want to bid intelligently. The framework that applies to a given contract determines who can bid, when you can bid, whether you will receive advance notice of an opportunity, and in some cases whether a contract can be awarded to a competitor without you ever being invited to participate.

Why Procurement Law Changed

Before January 2024, NHS clinical services were procured under the Public Contracts Regulations 2015 and, before that, the now-repealed Section 75 regulations introduced by the Health and Social Care Act 2012. 

The system was widely criticised for creating unnecessary market competition in areas where competition added no value to patients or commissioners, for generating disproportionate administrative burden, and for failing to support the kind of collaborative, integrated commissioning that NHS England had been promoting through its Long Term Plan.

The Provider Selection Regime was designed to address these criticisms directly. It removed the automatic requirement for competition and gave commissioners genuine discretion over the route to market. The Procurement Act 2023, which governs non-clinical contracts, was meanwhile introduced as part of a wider post-Brexit reform of UK public procurement law, replacing European-derived procurement rules with a domestic framework intended to be simpler, more transparent, and more flexible.

The Provider Selection Regime (PSR)

The Health Care Services (Provider Selection Regime) Regulations 2023 came into force on 1 January 2024. The PSR applies to clinical healthcare services commissioned by NHS bodies, local authorities, and certain combined authorities. It replaced the old NHS procurement rules and fundamentally changed how clinical services can be awarded.

The core principle is that commissioners are not required to run a competitive tender to award a clinical healthcare contract. Instead, they choose between five selection routes:

• Direct Award A applies where a commissioner is extending or varying an existing contract within permitted parameters, including extending duration or expanding scope in defined circumstances.
• Direct Award B applies where only one provider is realistically capable of delivering the service, for example a service that requires unique clinical infrastructure or location-specific delivery.
• Direct Award C applies where the current provider is performing well against a defined set of criteria, and the commissioner concludes there is no discernible benefit to the patient, service user, or taxpayer from running a competition.
• Most Suitable Provider allows a commissioner to select a single provider on the basis of published award criteria without a competitive process, typically used where multiple providers could in principle deliver the service but a competition would be disproportionate.
• Competitive Process is the traditional open tender, used where the commissioner concludes that competition is the most appropriate route to market given the nature of the service, its value, and the available provider market.

The most significant implication for providers is that a contract can be awarded to a competitor without you ever being invited to bid. If a commissioner uses Direct Award C to extend an incumbent’s contract, the award is published with a standstill period during which you can raise representations. 

However, you cannot compel a competition. This makes it more important than ever to be the incumbent, to maintain strong commissioner relationships during the contract period, and to ensure your performance data, quality evidence, and outcome reporting are consistently documented throughout the contract life cycle.

What the PSR Means for Your Bid Strategy

The PSR does not make winning contracts easier or harder in absolute terms. It makes the relationship between performance and new business more direct than it has ever been.

 A provider with a strong CQC rating, low serious incident rates, high staff retention, and a track record of positive commissioner feedback is now in a materially better position under the PSR than under the old competitive model. A provider with gaps in its evidence base is in a materially worse position.

The PSR also introduces a genuine first-mover advantage at the Most Suitable Provider stage. Commissioners using this route must publish selection criteria in advance and assess providers against them. 

Providers who have engaged with the commissioner, understand their priorities, and have positioned themselves against those criteria before the process opens are consistently better placed than those who encounter the criteria for the first time when the opportunity is published. Relationship management is no longer soft strategy. Under the PSR, it is procurement strategy.

The Procurement Act 2023

The Procurement Act 2023 came into force on 24 February 2025. It governs contracts that fall outside the PSR, including non-clinical care contracts above the relevant thresholds. In practice for care providers, this means many supported living contracts, some domiciliary care frameworks, and care home block contracts commissioned by local authorities or ICBs where the service is not classified as a clinical healthcare service.

Key changes introduced by the Act include:

• Stronger transparency obligations, requiring commissioners to publish more information about contracts, award decisions, performance data, and contract modifications.
• A new open framework structure that allows providers to join frameworks at multiple points during their lifetime rather than only at the outset, removing a significant barrier that prevented newer or growing providers from accessing public sector markets.
• A reformed supplier debarment regime, including a central debarment list and clearer rules on when a provider can be excluded from public procurement on grounds of past performance, financial standing, or regulatory compliance.
• Clearer rules on mid-contract variations, which matters directly when commissioners seek to change service scope, volumes, or pricing during a contract period without returning to the market.
• A new competitive flexible procedure that gives commissioners more discretion in how they design and run competitive processes, potentially allowing for dialogue, negotiation, and staged assessment in ways the old restricted and open procedures did not.

For providers, the most immediate practical implication is the need to maintain an active, up-to-date presence on the Find a Tender service and to monitor Contracts Finder for non-NHS contract opportunities. Providers who were previously reliant on call-off under existing frameworks should also review whether those frameworks have been or will be retendered under the new rules, as open framework provisions may change the timing and structure of opportunities they rely on for revenue continuity.

Better Care Fund and Where the Money Flows

The Better Care Fund for 2025/26 allocates a minimum of £5,621 million from the NHS and £2,640 million through the Local Authority Better Care Grant. These are the commissioning budgets from which health and social care contracts are awarded, and they reflect the continued political and financial commitment to integrated care despite the broader fiscal environment.

Understanding how BCF money flows through an Integrated Care System, and specifically how your service type is positioned within local joint commissioning plans, is essential context for any provider developing a pipeline strategy.

Commissioners commissioning services funded through the BCF are increasingly expected to demonstrate outcomes alignment across health and social care, reduced avoidable hospital admissions, faster hospital discharge, and sustained independence at home. Providers who can evidence contribution to these system-level outcomes in their tender responses are consistently better positioned than those whose bids focus solely on the service they deliver in isolation.

What Commissioners Are Looking For

Across both frameworks, what distinguishes winning bids has not changed as dramatically as the procurement rules themselves. Commissioners look for evidence of quality, safety, value, workforce stability, and a demonstrable track record of delivering the specific type of service being procured. Generic responses that could apply to any contract in any part of the country routinely score poorly against method statements that are specific to the commissioner’s stated priorities, the local population, and the challenges the service is designed to address.

Key things commissioners expect to see in a bid:

• Specific knowledge of the local population, area need, demographic profile, and the commissioner’s published strategic priorities.
• Clear workforce evidence: staffing ratios, training records, vacancy and turnover rates, and a credible plan for workforce sustainability.
• A track record of CQC ratings, contract performance, and measurable outcomes, referenced to the specific service type being tendered.
• Evidence of financial sustainability and organisational stability, including audited accounts and a demonstrated ability to mobilise services on time and within budget.
• Understanding of which procurement route applies, why the commissioner has chosen it, and what that signals about their priorities and risk appetite.
• References or case studies from commissioners in comparable service areas, ideally within the same ICB footprint or local authority area.

See also: Understanding Tender Scoring Matrices and Supported Living Tenders in 2026

AssuredBID helps care providers navigate both the PSR and the Procurement Act to win the contracts that matter. Whether you are tracking a Direct Award C opportunity, preparing for a competitive process, building your pipeline across local authority and ICB frameworks, or positioning for a Most Suitable Provider selection, we provide end-to-end bid management, gap analysis, and method statement drafting.