Guidance

Independent providers of NHS-funded services: apply for an NHS provider licence

Apply for an NHS provider licence as an independent provider of NHS-funded services.

Background

The NHS provider licence is Monitor’s main tool for regulating providers of NHS services.

The licence sets out conditions that healthcare providers must meet to help ensure that the health sector works for the benefit of patients. These conditions give Monitor the power to:

  • set prices for NHS-funded care in partnership with NHS England
  • enable integrated care
  • safeguard patient choice and prevent anti-competitive behaviour that is against the interests of patients
  • support commissioners to protect essential health services for patients if a provider gets into financial difficulties
  • oversee the way NHS foundation trusts are governed

Who needs a licence?

As a provider of healthcare services for the purposes of the NHS, you will need an NHS provider licence from April 2014, unless you are exempt.

These types of providers are exempt:

  • providers that are not required to register with the Care Quality Commission
  • small providers of NHS-funded healthcare services whose annual turnover from providing NHS services is less than £10 million
  • providers of primary medical and dental services
  • providers of NHS continuing healthcare and NHS-funded nursing care
  • NHS trusts (which will only be licensed when they are authorised as NHS foundation trusts)

However, these exemptions don’t apply (apart from the exemption for NHS trusts) if you provide services designated by a commissioner as commissioner requested services. If you provide these, you need a licence.

You can find more details in the regulations on licence exemptions and the Department of Health’s licence exemptions guidance.

Licensing criteria

You will need to meet Monitor’s 2 licensing criteria to be granted a licence:

  • you must be registered with the Care Quality Commission (see CQC care directory for registered providers)
  • your directors or governors must meet Monitor’s fit and proper test

You have to continue to meet these criteria to keep your licence.

The fit and proper test

To be licensed, your directors and governors (or people performing equivalent functions) must be ‘fit and proper’. This is in line with the statutory fitness requirements set out for directors and governors of NHS foundation trusts, and certain requirements on directors of companies.

For example, directors and governors must not:

  • be an undischarged bankrupt
  • have undischarged arrangements with creditors
  • be subject to a moratorium period under a debt relief order
  • have received a prison sentence of 3 months or longer during the previous 5 years
  • be subject to a disqualification order or undertaking

How to apply

You should read Monitor’s Licensing application guidance (PDF, 1.17MB, 45 pages) before you start the online application for an NHS provider licence.

There are 2 stages to the online application process:

1. Pre-authenticate your application

Access the online application form.

Enter your CQC provider ID number and confirm your provider’s:

  • name
  • registered address and contact details
  • company/charity registration number
  • legal status
  • correspondence details of a contact person for the application

If you provide commissioner requested services, you will need to supply additional information at this stage.

Monitor’s licensing team will then send you a PIN (by email) and a passcode (by post).

Once you have received your passcode and PIN, enter these and your CQC provider ID to authenticate your account. You can then set up a user name and password to get access to the whole application form.

2. Complete and submit your application form

You will need to complete and submit the application form, using the Licensing application guidance (PDF, 1.17MB, 45 pages) to help you.

You will normally get a decision on your application within 20 working days of submitting it, unless queries or concerns are raised.

Applying for CQC registration and a Monitor licence at the same time

You can save time by applying for your Care Quality Commission registration and NHS provider licence from Monitor through a single application form.

The streamlined process is only for organisations applying as a new service provider for both the registration and licence.

Don’t use this route if you are:

  • already registered with CQC
  • a partnership or an individual
  • exempt from needing an NHS provider licence

You can find guidance on the joint application process and an application form on the CQC website.

Application fees

There is currently no fee for applying for or maintaining an NHS provider licence.

Once you’re licensed

If you hold a licence, you can log on to the licensing portal to:

  • view your licence
  • manage your user accounts

Conditions of your licence

The types of services you provide determine the conditions you will need to meet as a licensee. Full details of all of the conditions are available in the NHS provider licence document.

There are a number of universal requirements of all licensees:

  • general conditions
  • integrated care condition
  • choice and competition conditions
  • pricing conditions

And additional requirements for:

  • licensees who supply commissioner requested services (continuity of services conditions)

General conditions

The general conditions set out Monitor’s standard requirements and rules. There are 9 general conditions you’ll need to meet, covering areas such as providing and publishing information, paying fees, fit and proper persons requirements, and a requirement for providers to be registered with the Care Quality Commission.

Integrated care condition

This condition allows Monitor to take action if you act in a way that is detrimental to the delivery of integrated care.

Choice and competition conditions

The competition condition aims to prevent anti-competitive behaviour that is not in the interests of patients. The condition prevents you from entering into or maintaining any agreement, or engaging in any other conduct, which prevents, restricts or distorts competition where this is against the interests of healthcare users.

The choice condition requires you to notify patients when they have a right of choice of provider, and to tell them where they can find information about the choices they have. This condition applies wherever patients have a choice of provider under the NHS Constitution or a choice that has been conferred locally by commissioners. It also prohibits you from offering inducements to clinicians, commissioners and other third parties to refer patients or commission services.

Pricing conditions

The pricing conditions of the licence require you to comply with the national tariff and to provide Monitor with information on costing.

Continuity of services conditions

If you provide essential NHS-funded services known as commissioner requested services, the continuity of services conditions require you to meet certain conditions, so that if you get into very serious financial difficulty Monitor can step in and ensure the services can continue to be provided on a sustainable basis.

Monitoring and enforcement

Monitor can take action:

  • if you breach a licence condition or a requirement to provide information
  • if you provide NHS services without holding a licence when you are required to have one

This action can include making sure you put things right and, in certain circumstances, imposing a fine.

Providers of commissioner requested services

If you are an independent provider of commissioner requested services, you’ll be monitored according to the principles set out in Monitor’s Risk assessment framework for independent sector providers of NHS services.

Other providers

If you are a licensed provider but don’t provide commissioner requested services, Monitor will ask you to certify that you are compliant with the licence conditions each year. Monitor will also follow up on relevant information from other sources such as third party reports, market analysis and whistleblowers where appropriate.

Maintaining your licence

There is no requirement to re-register every year. Instead, you will have to complete a simple annual self-certification that confirms your continued eligibility to hold an NHS provider licence.

Contact us

For any general or technical enquiries about the licence application process, please contact our enquiries team on 020 3747 0606 or email enquiries@monitor.gov.uk.