CRS policy – Information for commissioners

Note: Some sections of this page refer to clinical commissioning groups (CCGs). On 1st July 2022, integrated care systems (ICSs) took over statutory commissioning responsibilities in England, and CCGs were closed down. You can learn more about integrated care systems (ICSs) here.

Commissioners should refer to this page for information about the ‘commissioner requested services’ (CRS) policy, how to designate services as CRS, and the protections to continuity of services this affords.

In this section references to NHS England are references to Monitor statutory duties.

This page replaces the original information and guidance previously hosted by Monitor on GOV.UK.

About commissioner requested services

As an NHS commissioner, you are responsible for planning and purchasing healthcare services for your local population. This responsibility includes deciding which services need the protection of the continuity of services provisions of the NHS provider licence. These are known as ‘commissioner requested services’ (CRS).

CRS are essential services which must continue to be provided locally should the current provider fail, because:

  1. either there is no alternative provider close enough; or
  2. removing them would increase health inequalities; or
  3. removing them would make dependent services unviable.

When assessing a service as CRS commissioners, particularly ICSs, should also be mindful of whether the provider is responsible for a significant amount of regional or national service provision. If a systemically important provider were to cease delivering services on a regional or national basis (e.g. due to financial failure) it would likely compromise continuity of services on a scale beyond the remit of an individual ICS and make securing alternative provision at a ICS level more challenging.

What does the designation of a service as CRS do?

When commissioners designate a provider’s services as CRS it activates NHS England’s statutory duty to assess the risk to the continued provision of services through financial oversight of that organisation. This means providers are required to share financial information with us on an ongoing basis.

Designating services as CRS also means that powers contained in Section 5 of the provider licence – the ‘continuity of services conditions’ – apply. In the event that we have concerns about a provider’s ability to continue to provide CRS the continuity of services conditions allow early intervention by NHS England, with the aim of achieving a return to financial sustainability or, as a last resort, a smooth transfer of services to an alternative provider.

These powers also provide additional safeguards when a routine hand over of services is taking place from one provider to another, for example after a re-procurement, as providers of CRS cannot stop providing the service even if a contract has expired. This is important if for example, there is a delay in mobilising the new contract with the new provider.

Financial oversight of providers of CRS and the powers to protect continuity of services are especially important when the essential service is provided by an independent sector provider as regulatory oversight and powers are otherwise limited.

Further details on our approach to oversight of independent providers are set out in the Risk assessment framework and reporting manual for independent providers (IPRAF). The same approach is also applied to NHS controlled providers delivering CRS where a decision has been taken to regulate them under the IPRAF.

What safeguards are available to protect the continued provision of CRS? 

Within Section 5 of the licence there are seven conditions – the continuity of services (CoS) conditions. These protections apply only to providers of CRS and include, but are not limited to:

  • preventing providers from ceasing to provide or materially altering the specification or means of provision of CRS without the permission of the commissioner (Condition CoS 1),
  • requiring providers to maintain appropriate systems and standards of corporate governance and of financial management to reduce the risk of failure (Condition CoS 3), and
  • requiring providers to co-operate in the event of financial distress (Condition CoS 6).

What types of organisations can be designated as providers of CRS?

Services delivered by independent providers, NHS-controlled providers and NHS foundation trusts can be designated as CRS. Services provided by NHS trusts are exempt from CRS designation.

Is there a minimum value of services that can be designated CRS?

There is no minimum value of healthcare services considered CRS, or deminimus turnover for the provider. A designation of a provider’s services as CRS would require them to obtain a provider licence if they do not already hold one.

The CRS designation process

You should follow this 5-step process for identifying commissioner requested services.

  1. Identify the desired long-term outcome, given the needs of your local population and the current local configuration of health services.
  2. Notify providers and other affected groups that you are beginning work to identify commissioner requested services and are seeking their input.
  3. Commissioners need to have regard to the four stage Designation framework and either designate services as commissioner requested services or remove their commissioner requested services designation. Note that if you designate services from an unlicensed provider as CRS, you must request that the provider be licensed by NHS England.
  4. Notify providers of your decisions. You need to send a written request requiring the provider to provide a service as a CRS before the continuity of services protections in the licence will be applied. Providers may refuse the designation of a service as a CRS within 28 days. When a provider refuses to accept a CRS designation and you still think the service should be designated, you may ask us to carry out a review to determine whether the provider’s refusal was unreasonable.
  5. Refresh and update your designations. Over time, as providers enter and exit a local health economy or service, and technological changes mean services can be delivered in different ways, you will need to review your commissioner requested services designations to make sure they are still appropriate. Providers may also ask you to review a CRS designation. During a review, current designations remain in place until the review is complete.

How to submit CRS designations

You should tell us which services you have designated as CRS to enable us to operate the continuity of services provisions of the provider licence.

You should:

Update designations

If your information changes at any point, you should:

We will use this information to support other commissioners by helping them to understand how the guidance is being applied in practice.

Expiry of designated foundation trust services: 1 April 2016

On 1 April 2016 NHS services provided by most NHS foundation trusts lost their automatic CRS status. In December 2015 we published an update for commissioners (PDF, 282KB, 4 pages) encouraging them to consider whether they need to re-designate services as CRS. Should you wish to re-designate services please contact  nhsi.crs@nhs.net

Questions and support

If you have any queries regarding CRS or the designation process please contact nhsi.crs@nhs.net

More resources

The CRS designation process is set out in more detail in Guidance for commissioners on designating commissioner requested services (CRS).

You should use the guidance with: