A different rulebook for NHS clinical work
NHS Tenders and the Provider Selection Regime
If you provide healthcare services to the NHS in England, the Procurement Act 2023 is mostly NOT your rulebook. Since January 2024, NHS bodies (and councils buying healthcare) select providers of clinical services under the Provider Selection Regime (PSR) - a deliberately different system that often involves no open competition at all.
Understanding which regime you are in - and how PSR decisions are actually made - is the difference between chasing tenders that were never really open and positioning for the decisions that matter.
When PSR applies (and when it does not)
PSR covers arrangements for "relevant healthcare services" delivered to patients - clinical and care services - commissioned by NHS England, integrated care boards, NHS trusts, and local authorities, at ANY value. There is no threshold: a £5,000 clinical contract is PSR.
It does NOT cover goods, medicines, equipment, estates, cleaning, catering, IT or other non-clinical services - those follow the Procurement Act like everyone else. Mixed contracts follow the main subject matter. If you sell maintenance to an NHS trust, you are a Procurement Act bidder; if you provide community physiotherapy, you are in PSR.
The three PSR routes
PSR gives commissioners three lawful ways to select a provider, and most NHS clinical spend flows through the first two - without an open tender:
- Direct award (processes A and B): continuing with the existing provider where the service is satisfactory and not changing considerably, or where patients choose between providers - no competition
- Most suitable provider (process C): the commissioner identifies the best-placed provider against published key criteria, without running a full competition - but must publish an intention notice first
- Competitive process: a structured competition with published criteria - used where the choice is genuinely open or contested
How a provider wins under PSR
Because so much PSR activity is non-competitive, the levers shift from bid-writing to positioning. Watch for intention notices (published before most-suitable-provider and direct awards) - they are your early warning and, where you believe you are a credible alternative, your window to make representations during the standstill-like period before the decision is confirmed.
Build the evidence base commissioners must assess: PSR decisions are made against published key criteria including quality, integration, collaboration, service sustainability and social value. A provider with documented outcomes data, CQC standing and local relationships is the "most suitable provider" analysis half-written. Incumbency is powerful under PSR - which makes performance on your current contracts your strongest commercial asset.
Frequently asked questions
Does PSR apply to dental, pharmacy or GP contracts?
Most primary care contracts have their own statutory schemes, but PSR governs much of the commissioned clinical landscape around them. Check the service type - and remember any non-clinical NHS contract follows the Procurement Act instead.
Can I challenge a PSR direct award?
PSR has its own representation process rather than the Procurement Act's court remedies: after an intention notice, aggrieved providers can make representations the commissioner must consider before confirming. The window is short - monitoring notices is essential.
Do social value rules apply to NHS PSR contracts?
Social value features within the PSR key criteria, and the NHS net-zero requirements apply to suppliers - so a quantified social value and sustainability story still matters.
We tell you which regime you're actually in
BidSquirrel classifies every opportunity's regime automatically - PSR, Procurement Act, light-touch or devolved - so you read each tender with the right rulebook in mind.