Patient Choice Framework

The Patient Choice Framework operates on a fundamentally different principle from standard public procurement. Rather than a contracting authority selecting a single winning provider through competitive tender, the framework establishes a set of qualifying criteria that any willing provider must meet. Patients are then offered a choice among qualified providers, and NHS funding follows the patient. This Any Qualified Provider (AQP) model has been part of NHS policy in England since 2012 and remains a significant route to market for certain elective and community services.

What is the Patient Choice Framework?

The Patient Choice Framework is the NHS England policy that governs how patient choice operates for elective NHS services. Under the framework, NHS commissioners (now Integrated Care Boards) identify services suitable for patient choice and publish a set of qualification criteria. Any provider that meets those criteria, regardless of type (NHS trust, independent sector, or voluntary sector), may be listed as a choice option for patients referred by GPs or other primary care clinicians.

Key features of the framework include the following.

Qualification rather than selection. Providers do not compete against each other for a fixed contract. Instead, they demonstrate that they meet quality, safety, regulatory, and capacity requirements. Meeting the bar means joining the list; failing to meet it means exclusion.

National tariff payment. Listed providers are paid at the nationally set NHS payment schedule rate for the relevant procedure. There is no price competition among providers. Competition occurs on quality, access, and patient experience.

Patient information. The framework requires that patients are given clear, comparable information about available providers, including quality indicators such as outcomes data and waiting times, to support an informed choice.

Scope of services. The framework applies to a defined set of services including certain diagnostic tests, outpatient consultations, and elective procedures. It does not apply to emergency services, highly specialised services, or services where patient choice is clinically inappropriate.

The framework interacts with the Provider Selection Regime. Where patient choice applies, the PSR Route 1 or Route 2 direct award routes are generally not used; the qualification and listing process substitutes for competitive procurement.

Why it matters for bidders

For independent sector and voluntary sector providers, the Patient Choice Framework is a significant market access route that does not require winning a competitive tender. A provider that obtains qualification status and CQC registration can begin receiving patients without going through a procurement exercise. This is particularly valuable for smaller or specialist providers who may struggle to compete on price in a conventional tender.

Understanding the qualification criteria and maintaining compliance with NHS quality standards is therefore the central commercial challenge, not bid writing. Providers must also manage referral pathway relationships with GPs and primary care networks to ensure patients are directed to them.

Example

A physiotherapy company wishes to provide NHS-funded musculoskeletal services in a region where patient choice applies. It applies for qualification under the local ICB's Any Qualified Provider scheme, demonstrating CQC registration, qualified staff, accessible premises, and capacity to accept NHS referrals. Once listed, it receives patients whose GPs offer them a choice of physiotherapy provider. Payment is received at the national tariff rate per completed course of treatment.

Frequently Asked Questions

Is the Patient Choice Framework the same as Any Qualified Provider (AQP)?

The Patient Choice Framework is the current policy name; Any Qualified Provider was the earlier terminology. The underlying mechanism, qualifying providers rather than selecting one through competition, is substantially the same. The current framework has been refined to place more emphasis on quality information and to align with ICB commissioning responsibilities.

Does patient choice apply across the whole of Europe?

No. Patient choice in healthcare procurement is primarily a UK NHS concept. EU member states have their own approaches to service user choice within health systems, but these are governed by national health system legislation rather than EU procurement directives. Directive 2014/24/EU permits flexible procurement approaches for health services under the light-touch regime but does not mandate patient choice mechanisms.

Can patients be directed to a non-NHS provider under the framework?

Yes. Independent sector and voluntary sector providers that meet qualification criteria are listed alongside NHS providers. Patients choose based on the information provided to them, not on whether the provider is NHS or independent. This has enabled a range of voluntary sector organisations to participate in NHS-funded service delivery without needing to win a traditional contract.