Standard operating procedure: choice provider qualification complaints process


NHS England is committed to strengthening its existing choice oversight process.

One element of this relates to complaints from providers about the qualification of providers by integrated care boards (ICBs), for services where the legal rights to choice; and related obligations, apply under the NHS Standing Rules.

To this end, a choice provider qualification complaints panel has been established to proactively review and support the timely resolution of these complaints.

This standard operating procedure (SOP) explains the end-to-end steps which will be taken by NHS England’s National Choice Team (NCT); and where appropriate, the choice provider qualification complaints panel, to facilitate a resolution between the provider and ICB.

The timeline outlined in this process is indicative and contingent on the engagement and timely responses of providers and ICBs.

A brief illustrative diagram of this process is included in Appendix 1 of this document.

A brief illustrative diagram of the overarching NCT Casework process is also included in Appendix 2 of this document for context.

Provider complaint submitted to National Choice Team (NCT)

Providers can raise a complaint with the NCT using the single point of contact:

Within one working day of the complaint being received the duty Case Manager will triage the complaint and send the Provider a link to the complaint proforma to complete, which includes requests for supporting evidence, consent to contact the ICB about the complaint, and availability for a follow-up discussion.

All correspondence will be filed, and records stored securely in line with corporate records management and information governance policies.

NCT assign case manager and contact the provider

On receipt of the completed complaint proforma, the NCT will establish if there is sufficient information to proceed:

  • Where there is insufficient information to proceed the case manager will advise the provider and offer support as required.
  • Where there is sufficient information to proceed an allocated case manager will:
    • arrange a meeting with the provider to establish the background, key facts, and a timeline of events (to take place within 5-10 working days).
    • provide a summary of issues to the ICB and request a discussion to take place within 5-15 working days.

Case manager meetings with provider and integrated care board (ICB)

At the meetings with the provider and ICB, the case manager will explain NHS England’s regulatory roles and responsibilities and approach to managing complaints, including the remit of the choice provider qualification complaints panel.

The case manager will also provide a clear explanation of the different sets of rules governing patient choice (described in NHS Standing Rules) and requirements on ICBs in relation to the qualification of providers.

Following each meeting the case manager will send participants a summary of the meeting outcomes and agreed next steps and will continue to collaborate with the provider and ICB to reach resolution (days 15-25).

If the complaint has not been resolved within 25 days of the complaint proforma being received, the case manager will:

  • finalise the complaint summary with recommendations
  • update the senior responsible officer on the status of the complaint and request clearance to escalate to panel or to dismiss the complaint*
    • *the provider may only appeal the SRO’s decision to dismiss if they can demonstrate that the outlined process has not been followed by the NCT.
  • write to the provider and ICB explaining outcome and next steps
  • request the choice provider qualification complaints panel secretariat to include the complaint on the agenda for the next panel meeting, if required.

Choice provider qualification complaints panel

  • If the NCT are unable to resolve the complaint, it will be escalated to the choice provider qualification complaints panel.
  • The panel will meet monthly to undertake a comprehensive review of complaint/s received and agree to one or more of the outcomes.
  • The choice provider qualification complaints panel secretariat will communicate meeting outcome/s to the ICB and provider; and action next steps, within five working days.

Appendix 1: Choice provider qualification complaint process

Appendix 2: National Choice team – casework overview

Publication reference number: PRN00679