Who pays? determining responsibility for payments to providers

Document type
Guidance
Corporate author(s)
NHS England. Commissioning Development Directorate
Publisher
NHS
Date of publication
29 August 2013
Subject(s)
Health Services
Collection
Social welfare
Material type
Reports

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This document sets out the framework for establishing responsibility for commissioning an individual's care within the NHS and determining who pays for this care. 

The Health and Social Care Act 2012 amended the NHS Act 2006 to establish the legal framework for the new commissioning architecture for the NHS in England, including the responsibilities of NHS England and clinical commissioning groups (CCGs). The Act sets out that a CCG has responsibility for all people who are provided with primary medical services by GP practices who are members of the CCG, or usually resident in the area covered by the CCG and not provided with primary medical services by a member of any CCG. Regulations make further provision for these commissioning responsibilities, including the responsibility to commission urgent and emergency care services for everyone present in their geographic area. 

In general, CCGs are responsible for commissioning health services to meet all the reasonable requirements of their patients, with the exception of certain services commissioned directly by NHS England (primary care, high secure psychiatric services, specialised services, the majority of health services for prisoners/those detained in ‘other prescribed accommodation’, and members of the armed forces and some of their families who are registered with Defence Medical Services GP practices), health improvement services commissioned by local authorities, and health protection and promotion services provided by Public Health England.

These commissioning responsibilities include planning services based on assessing the needs of the CCG’s local population, securing services that meet those needs, and monitoring the quality of care provided. In most cases when commissioning health services, CCGs are responsible for meeting the cost of the services provided. This document establishes certain important exceptions to this rule.

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