Procurement, choice and competition in the NHS: documents and guidance

Guidance and information about NHS procurement, choice and competition for healthcare providers and commissioners.

The rules that govern procurement, choice and competition in the NHS are set out in:

Monitor’s role is to make sure that procurement, choice and competition operate in the best interests of patients and to step in if anti-competitive behaviour by NHS commissioners or providers goes against patients’ interests.

Further information on NHS choice and competition can be found on our blog.

Contact Monitor

Find out how to contact Monitor for informal advice or to make a formal complaint.


The following documents include rules and guidance relating to procurement, choice and competition and Monitor’s approach to enforcing them.

Formal investigations

This is a list of current and closed investigations undertaken by Monitor under the procurement, choice and competition regulations.

For formal investigations undertaken by the Co-operation and Competition Panel (from 2009 to 2013) please visit the National Archives’ website.


Information on projects carried out by Monitor.

  1. Making choice work well in NHS adult hearing services: resources for commissioners

    • Guidance
  2. Improving GP services: commissioners and patient choice

    • Research and analysis
  3. Exploring how choice is working in NHS adult hearing services

    • Consultation outcome
  4. NHS walk-in centre services in England: review

    • Research and analysis
  5. General practice services: research project

    • Consultation outcome
  6. Improving community services

    • Research and analysis


Advice and guidance on mergers.

For merger cases conducted by the Co-operation and Competition Panel (from 2009 to 2013) please visit the National Archives’ website.

  1. Supporting NHS providers considering transactions and mergers

    • Guidance
  2. Supporting NHS foundation trusts considering a merger: proposed approach

    • Consultation outcome
  3. Assessing public hospital mergers

    • Guidance
  4. Merger rules: how they affect pathology service reconfigurations

    • Guidance
  5. Merger benefits for NHS foundation trusts: Monitor's draft guidance

    • Consultation outcome
  6. Reviewing mergers involving NHS trusts and NHS foundation trusts

    • Guidance
  7. Advice to the Competition and Markets Authority (CMA) on the relevant customer benefits of an anticipated pathology joint venture in south east England

    • Guidance
  8. Merger of pathology services of Southport and Ormskirk Hospital and St Helens and Knowsley Teaching Hospitals

    • Notice
  9. Heatherwood and Wexham Park Hospitals NHS Foundation Trust: advice on proposed merger

    • Guidance
  10. Case: Proposed merger of University Hospitals Bristol and North Bristol NHS Trust

    • Decision
  11. Case: Proposed merger of Royal Free and Barnet and Chase Farm Hospitals

    • Decision
  12. Neurosurgery at the Royal Free and UCLH: advice on transfer of services

    • Guidance
  13. Brighton and Sussex and Surrey and Sussex pathology services: advice on proposed merger

    • Guidance
Published 22 May 2014
Last updated 13 November 2015 + show all updates
  1. Added resources for commissioners on making choice work well in NHS adult hearing services.
  2. Link to Improving community services project page added
  3. We've added new guidance on mergers and transactions to the collection.
  4. First published.