Who Pays?

Determining which NHS commissioner is responsible for commissioning healthcare services and making payments to providers

Who Pays? sets out the framework for establishing which NHS commissioner will be responsible for commissioning and paying for an individual’s NHS care.

Who Pays? – March 2024

This version of Who Pays? came into effect on 1 April 2024.

It provides clarification in relation to responsibility for funding NHS services for overseas visitors, sets out a new rule on determining which ICB is to be responsible for paying a Trust to provide diagnostic services at designated Community Diagnostic Centre sites and provides updated guidance which reflects the changes being made in specialised commissioning arrangements from 1 April 2024.

It also clarifies that the Supreme Court judgement on the Worcestershire case does not affect the operation of the rules relating to establishing the responsible NHS commissioner for detention and aftercare under the Mental Health Act 1983.

Who Pays? – legacy documents

Previous versions of Who Pays? can be accessed below:

Who Pays? June 2022: This version of the Who Pays? guidance came into effect from 1 July 2022.  It reflected a number of changes brought about by the Health and Care Act 2022 and associated regulations. It set rules for determining the group of people for whom each integrated care board (ICB) has core responsibility, it introduced a change in the rules around detention and aftercare under the Mental Health Act and it introduced a change in relation to transition to adult continuing care.

Who Pays? August 2020: This version of the Who Pays? guidance came into effect from 1 September 2020. The structure of this version of Who Pays? guidance was broadly similar to the 2013 version and the core rule remained that the commissioner responsible for payment will be the clinical commissioning group of which the patient’s GP practice is a member, with some exceptions to this core rule which are described.

There were important changes in paragraph 13 on stays in hospital, in paragraph 14 on discharge from hospital and continuing care and in paragraph 18 on detention and Section 117 aftercare under the Mental Health Act.

There were also new, mandatory arrangements for dispute resolution described in Appendix 1 and in Appendix 4, which was published separately.

Who Pays? August 2013: The 2013 version of Who Pays? guidance was amended in 2016 through the publication of an addendum on the ADASS website which made changes to paragraphs 33 and 34.