“Continuing Care for Children” means that part of a package of care which is arranged and funded by a relevant body for a person aged 17 or under to meet needs which have arisen as a result of disability, accident or illness;

“eligible person” means a person for whom a relevant body considers it necessary to arrange the provision of a relevant health service;

“NHS Continuing Healthcare” means a package of care arranged and funded solely by the health service in England for a person aged 18 or over to meet physical or mental health needs which have arisen as a result of disability, accident or illness;

“personal health budget” means an amount of money—which is identified by a relevant body as appropriate for the purpose of securing the provision to a person of all or part of a relevant health service; andthe application of which is planned and agreed between the relevant body and the eligible person or their representative; and

“relevant health service” means—Continuing Care for Children; ... NHS Continuing Healthcare; Section 117 Aftercare; or Wheelchair Services.

“Section 117 After-care” means that part of a package of care which is arranged and funded by a relevant body for a person to whom section 117(1) of the 1983 Act applies; and

“Wheelchair Services” means services which are arranged and funded by a relevant body for a person with a medically recognised long term disability who for their health and wellbeing requires a wheelchair or specialist buggy to carry out normal day-to-day activities.

(2) References in this Part to an eligible person’s representative are to such persons whom, in the opinion of the relevant body, it is appropriate to consult about, and involve in, decisions about the provision of a relevant health service to the eligible person by means of a personal health budget.

Duties of relevant bodies in relation to personal health budgets

32B

(1) A relevant body must ensure that it is able to arrange for the provision of a relevant health service to an eligible person by means of a personal health budget which is managed in accordance with paragraph (2).

(2) A personal health budget must be managed in at least one of the following ways—

(a) the making of a direct payment;

(b) the application of the personal health budget by the relevant body in accordance with the outcome of discussions with the eligible person or that person’s representative as to how best to secure the provision of the relevant health service to the person; or

(c) the transfer of the personal health budget by a relevant body to a person who applies the money in accordance with the outcome of discussions with the eligible person or that person’s representative as to how best, with the agreement of the relevant body, to secure the provision of the relevant health service to the eligible person.

(3) A relevant body must—

(a) publicise and promote the availability of personal health budgets to eligible persons and their representatives; and

(b) provide information, advice and other support to eligible persons and their representatives to assist them in deciding whether to request a personal health budget in respect of a relevant health service.

(4) Where a request is made by or on behalf of an eligible person for a personal health budget, a relevant body must grant that request, save to the extent that it is not appropriate to secure provision of all or any part of the relevant health service by that means in the circumstances of the eligible person’s case.

(4A) Where a relevant body arranges a personal health budget under paragraph (4), it must decide which of the ways mentioned in paragraph (2) would be the most appropriate way in which to manage that personal health budget.

(5) A relevant body must make arrangements for eligible persons for whom a personal health budget has been arranged, and their representatives, to obtain information, advice and other support in connection with the management of the personal health budget.

(6) The duty in paragraph (5) does not apply in relation to any part of a personal health budget to which regulation 9 of the National Health Service (Direct Payments) Regulations 2013 (information, advice and other support) applies.

(7) If a relevant body decides to refuse a request for a personal health budget made by or on behalf of an eligible person in full or in part, it must provide that person and their representatives with the reasons for that decision in writing.

(8) On receipt of—

(a) a decision under paragraph (4A); or

(b) written reasons in accordance with paragraph (7),

an eligible person or a person acting on the eligible person’s behalf may require a relevant body to undertake a review of the decision and may provide evidence or information for the relevant body to consider as part of that review.

(9) A relevant body must inform the eligible person or their representatives in writing of the decision following a review, and state the reasons for the decision.

(10) A relevant body may not be required to undertake more than one review following a decision under paragraph (7) in any six month period.

22A

Atypical haemolytic uraemic syndrome services.

57A

Hand transplantation for adults.

Saving and transitional provision in relation to certain services for rare and very rare conditions

11A

(1) A relevant contract in relation to transferring services is not terminated or modified by virtue of the omission of those transferring services from Schedule 4 with effect from the transfer date and continues in force as it did immediately before the transfer date.

(2) NHS England retains the duty under regulations 7(2)(c), 10(1)(c) and 11 which it held in relation to those transferring services immediately before the transfer date for so long as a relevant contract for the provision of those services continues to have effect in relation to those transferring services but only to the extent of the provision which is made in that relevant contract for such services.

(3) In this regulation—

(a) a “relevant contract” is a contract having effect as between NHS England and another person for the provision as part of the health service of transferring services where that contract has effect immediately before the transfer date;

(b) “the transfer date” means—

(i) in relation to transferring services referred to in paragraph (c)(i) (wheelchair services), 1st April 2015; and

(ii) in relation to transferring services referred to in paragraph (c)(ii) (specialist morbid obesity services), 1st April 2016;

(i) wheelchair services as included within the service specified in paragraph 135 of Schedule 4 immediately prior to the transfer date;

(ii) specialist morbid obesity services as specified in paragraph 118 of that Schedule immediately prior to the transfer date.

Assessment, diagnostic, elective and minor elective care services provided by Independent Sector Treatment Centres

Fixated threat assessment services

3A

Adult highly specialist oesophageal gastric services in the form of gastro-electrical stimulation for patients with intractable gastroparesis.

59A

Highly specialist adult urological surgery services for men.

107A

Specialist colorectal surgery services.

116A

Specialist immunology services for children with deficient immune systems.

116B

Specialist maternity care for women diagnosed with abnormally invasive placenta.

140A

Surgery for complex obesity in children.

140B

Uterine transplantation services.

36A

Clinical genomic services.

140AA

Termination services for expectant mothers with significant comorbidities that require either or both critical care and medical support.

20A

Alpha 1 antitrypsin services.

57ZA

Gonadal tissue cryopreservation services for children and young people at high risk of gonadal failure due to treatment or disease.

92A

Psychological medicine inpatient services for severe and complex presentations of medically unexplained physical symptoms.

104A

Specialist adult haematology services.

Terms and conditions to be drafted by NHS England

Consultation by NHS England

NHS England's duty: reviewing decisions

Patient choice: primary medical services

42A

(1) NHS England must not restrict the ability of a person—

(a) to apply for inclusion in the list of patients of the practice of the person’s choice;

(b) to express a preference to receive services from—

(i) the practice in whose list of patients the person is included, or

(ii) a particular performer or class of performer,

either generally or in relation to any particular condition.

(2) Paragraph (1) does not apply to the inclusion in a contractor’s contract of any term which provides for the contractor to refuse an application for inclusion in its list of patients, or not to agree to any preference expressed to receive services from a particular performer or class of performer, in accordance with—

(a) Part 2 of Schedule 3 to the National Health Service (General Medical Services Contracts) Regulations 2015 (other contractual terms - patients: general),

(b) Part 2 of Schedule 2 to the National Health Service (Personal Medical Services Agreements) Regulations 2015 (other required terms - patients: general), or

(c) arrangements for the provision of primary medical services made under section 83(2) of the 2006 Act (primary medical services).

(3) In this regulation—

“contract” means, as the case may be—an arrangement for the provision of primary medical services made under section 83(2) of the 2006 Act, including any arrangements which are made in reliance on a combination of that provision and any other powers to arrange for the provision of health care services for the purposes of the NHS,a general medical services contract made under section 84(1) of the 2006 Act (general medical services contracts), oran agreement made in accordance with section 92 of the 2006 Act (arrangements by the Board for the provision of primary medical services);

“contractor” means a person who has entered into a contract with NHS England;

“the NHS” means the comprehensive health service continued under section 1(1) of the 2006 Act, except the part of it that is provided in pursuance of the public health functions (within the meaning of that Act) of the Secretary of State or local authorities;

“performer” means a medical practitioner included in a list maintained in accordance with regulations made under section 91(1) of the 2006 Act (persons performing primary medical services);

“practice” means the business operated by a contractor for the purposes of delivering primary medical services under Part 4 of the 2006 Act under a contract for the provision of such services.

Requests for NHS Standard Contract assessment

42B

(1) This regulation applies in relation to a decision by a relevant body as to whether it should offer an NHS Standard Contract to a provider where the service being offered by the provider is one which the relevant body arranges or intends to arrange for the persons for whom it has responsibility and in respect of which (if that provider held such a contract) a patient would be permitted to choose that provider as a provider—

(a) in accordance with regulation 39, or

(b) otherwise than in accordance with regulation 39 where the relevant body has not restricted the number of providers from which patients may choose.

(2) A provider may express an interest to a relevant body at any time in being assessed for the award of an NHS Standard Contract under this regulation.

(3) Where a provider expresses an interest under paragraph (2), the relevant body must make available to that provider any local terms and conditions for inclusion in any supporting schedules of an NHS Standard Contract it proposes to award as a result of an assessment under this regulation.

(4) Following the provision of any local terms and conditions under paragraph (3) (or confirmation from the relevant body that no such terms and conditions are to be included), a provider may request a relevant body to assess it against the criteria in regulation 42C for the purposes of—

(a) the award of an NHS Standard Contract where the provider does not have an existing NHS Standard Contract with the relevant body, or

(b) the award of a further NHS Standard Contract where the provider already has an existing NHS Standard Contract with the relevant body, but wishes to be assessed in relation to—

(i) the provision of new services,

(ii) the provision of existing services from a location other than that specified in the existing NHS Standard Contract, or

(iii) a change to the criteria specified in that contract which determine the means by which a service will be accessible to patients.

(5) The relevant body must assess a provider who has made a request under paragraph (4) against the criteria in regulation 42C as soon as reasonably practicable but in any event before expiry of a period of six weeks beginning with the day on which the provider has requested to be assessed against those criteria.

(6) Where the criteria in regulation 42C are met, the provider must be offered an NHS Standard Contract, which must include any local terms and conditions referred to in paragraph (3).

Qualification of providers: criteria

42C

The criteria referred to in regulation 42B(4) to (6) are that—

(a) the provider must be registered with the Care Quality Commission under Chapter 2 of Part 1 of the Health and Social Care Act 2008 in respect of the regulated activities which are relevant to the services to be provided;

(b) the provider must, unless exempt, hold a provider licence issued by NHS England under Chapter 3 of Part 3 of the 2012 Act;

(c) the provider must demonstrate to the satisfaction of the relevant body that it will be able to comply with the terms and conditions of the NHS Standard Contract, including those in any supporting schedules, in respect of the services to be provided and in relation to the location from which those services will be provided;

(d) the provider must demonstrate that it—

(i) is a member of an NHS Clinical Negligence Scheme under the National Health Service (Clinical Negligence Scheme) Regulations 2015 or the National Health Service (Clinical Negligence Scheme for General Practice) Regulations 2019,

(ii) has undertaken to join such a scheme, or

(iii) has put in place equivalent alternative indemnity arrangements to the satisfaction of the relevant body.

Modification of existing NHS Standard Contract

42D

(1) Regulation 42B(1) to (3) and (5) also applies to the assessment of a provider in respect of a proposed modification of an existing NHS Standard Contract held by that provider, and—

(a) references to the offering or awarding of an NHS Standard Contract to a provider are to be read respectively as references to the offering to modify or the modifying of an existing NHS Standard Contract held by a provider;

(b) the reference in regulation 42B(5) to “paragraph (4)” is to be read as a reference to paragraph (2) of this regulation;

(c) in the application of regulation 42C pursuant to regulation 42B(4) as modified by this regulation, the reference in regulation 42C to “regulation 42B(4) to (6)” is to be read as a reference to paragraphs (2), (3) and (5) of this regulation.

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