Monitoring and enforcement

This page contains information on our regulatory oversight of independent providers and NHS-controlled providers, including our powers to take regulatory action. This page replaces the original information and guidance previously hosted by Monitor on GOV.UK.

Content

Overview
Oversight of independent providers
Oversight of NHS-controlled providers
Enforcement guidance


Overview

NHS Improvement has a statutory duty to issue licences for providers of NHS services and has enforcement powers to require providers to remedy licence breaches where there is evidence that this has occurred.

Independent providers are overseen under the ‘risk assessment framework and reporting manual for independent sector providers of NHS services’.

NHS controlled providers are overseen either under the ‘NHS oversight framework’ for NHS trusts and foundation trusts, or successor framework, or the ‘risk assessment framework and reporting manual for independent sector providers of NHS services’.

Further details of these approaches are set out below.

 

Oversight of independent providers

Independent providers are overseen under the risk assessment framework and reporting manual for independent sector providers of NHS services. This covers:

  • NHS Improvement’s oversight responsibilities in respect of independent providers
  • how independent providers of essential ‘commissioner requested services’ are monitored, how risk to the continued provision of these services is assessed, and when action may be taken to safeguard continuity of services for patients.
  • the annual reporting and self-certification requirements for all independent sector licensees
  • how NHS Improvement keeps licensees’ business sensitive information confidential

It supersedes the Risk assessment framework for independent sector providers that was published in April 2014, and incorporates a number of updates which were subject to consultation  in February 2020.

Related content

Consultation response: updates to the risk assessment framework for independent sector providers (IPRAF) of NHS services – published Dec-2020

Consultation on updates to the risk assessment framework for independent sector providers of NHS services – published Feb-2020

 

Oversight of NHS-controlled providers

NHS-controlled providers are providers that:

  • are not themselves NHS trusts or NHS foundation trusts
  • hold a provider licence
  • are ultimately controlled by one or more NHS trusts and/or foundation trusts, where ‘control’ is defined on the basis of IFRS 10

A new licence condition was introduced for NHS-controlled providers in April 2018 as new care models and joint ventures started to become more common.

NHS-controlled providers are overseen either under the ‘NHS oversight framework’ for NHS trusts and foundation trusts, or successor framework, or the ‘risk assessment framework and reporting manual for independent sector providers of NHS services’ . This will depend on factors such as the scope of the services provided, size of turnover, and whether the provider is a wholly owned subsidiary or is jointly owned by a number of providers.

Further details can be found in the oversight of NHS controlled providers guidance.

Related content

If you think you meet the criteria set out above or control an organisation in a way that meets the criteria, please email nhsi.licensing@nhs.net as you will need to apply for the NHS-controlled provider licence.

Enforcement guidance

Providers should refer to this section for information on how action can be taken against healthcare providers who hold an NHS provider licence.

NHS Improvement can take action against healthcare providers who hold an NHS provider licence if there has been a breach, or suspected breach, of licence conditions that has been confirmed via an investigation.

This guidance explains:

  • when we may investigate
  • how we may investigate
  • who we may investigate – including NHS foundation trusts and other providers of NHS services

It also outlines the penalties we can impose if we find a provider has breached their licence.

Enforcement guidance

Related content

Register of licensed health care providers

Regulatory action taken against licensed healthcare providers