Consultation for changes to the NHS provider licence

Closed 9 Dec 2022

Opened 28 Oct 2022

Results updated 24 Jul 2023

In early 2023, NHS England consulted on proposals for updating the risk assessment framework for independent sector providers of NHS services.

This follows amendments we made to the NHS Provider Licence Continuity of Services conditions to make specific quality governance requirements.

If we are satisfied that an independent sector provider has inadequate processes in place to safeguard quality, the new licence conditions give us the power, in extremis, to require the provider to take the necessary steps to address this.

This complements the existing Care Quality Commission (CQC) oversight/inspection regime by giving the NHS the flexibility to require the necessary actions to address failings highlighted by the CQC.

We received 19 responses to the consultation from licensed independent providers, licensed independent providers of commissioner requested services (CRS), other regulators and other stakeholders.

Responses demonstrated broad support for the proposed updates. 

See the consultation response report for more details: Consultation on risk assessment framework for independent sector providers of NHS services


NHS England is proposing changes to the NHS provider licence to support effective system working and the delivery of high-quality sustainable care.

The NHS provider licence sets out the conditions that healthcare providers must meet to help ensure that the health sector works for the benefit of patients, now and in the future. All providers that deliver healthcare services for the NHS are required to hold a licence, unless exempt. Exempted organisations include those:

  • that only provide primary medical or dental services 
  • that only provide continuing healthcare or NHS-funded nursing care
  • whose annual turnover from providing NHS services is under £10 million
  • that are not required to register with the Care Quality Commission (CQC).

The licence forms part of the oversight arrangements for NHS providers, serves as the legal mechanism for regulatory intervention, and underpins mandated support at our most challenged providers. Specific principles of oversight, including key metrics and factors considered when determining support needs are described in the NHS oversight framework for NHS trusts and foundation trusts. The Risk assessment framework and reporting manual for independent sector providers of NHS services sets out similar principles for independent providers.

Details of our approach to enforcement are provided in the Enforcement Guidance.

Why your views are important

The proposals to change the NHS provider licence are subject to a statutory requirement to consult existing licence holders, the Secretary of State, integrated care boards and the CQC and its Healthwatch England Committee. We are also interested to hear from NHS trusts who will be issued a licence following changes introduced by the 2022 Act, and from other bodies with an interest in the provision of NHS healthcare in England. 

Your feedback will be used to shape the final version of the licence. We welcome comments on each of the proposed changes, including feedback on both the policy intent underlying the changes as well as the specific wording proposed for the licence itself.  We also welcome evidence into the potential impact of these changes, including how they may impact health inequalities and on protected characteristic groups.

The proposed changes are described in detail in the statutory notice of consultation Part A. This is accompanied by a draft new provider licence (Part B)  and an assessment of the anticipated impact of these changes (Part C).

Note on the application of licence changes

We expect to issue licences to all existing and new licence holders (including NHS trusts) once the licence is finalised post consultation, with an effective date based on when all licences will have been issued. The estimated timeline will be communicated as part of the publication of the consultation response. Existing arrangements will be maintained until such time as the new licences take effect, including the shadow licence approach currently used with NHS trusts.

Proposed amendments reflect existing expectations set out in legislation and national policy. We remain committed to a proportionate enforcement response and recognise that meeting these expectations may also require new systems and processes to be established.


  • All interested stakeholders


  • Integrated care