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.

For more information about Monitor’s role read the updated publication ‘About Monitor: an introduction to our role.’

Contact Monitor

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

  1. NHS procurement, choice and competition: ask a question or make a complaint

    • 2 May 2014
    • Detailed guide


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

  1. Procurement, patient choice and competition regulations: guidance

    • 19 December 2013
    • Statutory guidance
  2. NHS healthcare providers: working with choice and competition

    • 12 September 2014
    • Guidance
  3. Choice and competition: hypothetical scenarios for NHS healthcare providers

    • 12 September 2014
    • Guidance

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.

  1. Case: Investigation into the commissioning of complex adult community services in East Devon

    • 25 February 2015
    • Notice
  2. Case: Investigation into the commissioning of elective services in Blackpool, Fylde and Wyre

    • 25 September 2014
    • Notice
  3. Case: Investigation into the commissioning of radiosurgery services in Yorkshire and Humber

    • 4 April 2014
    • Decision
  4. Case: Investigation into the commissioning of cancer services in Manchester

    • 31 January 2014
    • Decision


Information on projects carried out by Monitor.

  1. NHS adult hearing loss services in England: exploring how choice is working for patients

    • 8 July 2014
    • Closed consultation
  2. NHS walk-in centre services in England: review

    • 19 February 2014
    • Research and analysis
  3. General practice services: research project

    • 3 December 2014
    • Closed consultation


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

    • 31 July 2014
    • Guidance
  2. Supporting NHS foundation trusts considering a merger: proposed approach

    • 12 May 2014
    • Consultation outcome
  3. Assessing public hospital mergers

    • 17 October 2013
    • Guidance
  4. Merger rules: how they affect pathology service reconfigurations

    • 3 June 2013
    • Guidance
  5. Merger benefits for NHS foundation trusts: Monitor's draft guidance

    • 27 March 2013
    • Consultation outcome
  6. Reviewing mergers involving NHS trusts and NHS foundation trusts

    • 22 March 2013
    • 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

    • 29 August 2014
    • Guidance
  8. Merger of pathology services of Southport and Ormskirk Hospital and St Helens and Knowsley Teaching Hospitals

    • 11 July 2014
    • Notice
  9. Heatherwood and Wexham Park Hospitals NHS Foundation Trust: advice on proposed merger

    • 4 June 2014
    • Guidance
  10. Case: Proposed merger of University Hospitals Bristol and North Bristol NHS Trust

    • 20 September 2013
    • Decision
  11. Case: Proposed merger of Royal Free and Barnet and Chase Farm Hospitals

    • 13 August 2013
    • Decision
  12. Neurosurgery at the Royal Free and UCLH: advice on transfer of services

    • 6 March 2013
    • Guidance
  13. Brighton and Sussex and Surrey and Sussex pathology services: advice on proposed merger

    • 12 March 2014
    • Guidance