The NHS Standard Contract is the contractual basis on which Integrated Care Boards (ICBs) contract for all healthcare services other than primary care.

Below, we've summarised the key changes affecting providers of Continuing Healthcare Services, Community Services, Mental Health, and Learning Disability Services, which are funded wholly or partly by the NHS.

Payments

The 2025/26 NHS Payment Scheme will be updated for services paid on an activity basis. The NHS Standard Contract has been amended in anticipation of those changes and confirms that:

• commissioners can apply notified payment limits, which act as budgetary limits  for services where activity-based payments are likely to exceed £100,000 p/a;
• providers must still accept referrals even where the provider has met or exceeded the notified payment limit; and
• commissioners will not be obliged to pay over the notified payment limit.

This presents a significant risk where indicative activity plans fail to adequately predict demand and/or where providers are obliged to accept referrals[1]. Stakeholders wishing to comment on the proposals around payment for elective activity should do so via the NHS Payment Scheme consultation which runs until 28 February 2025.

Commissioners will have more flexibility when aggregating payments across a range of services or commissioners, meaning that undisputed payments should be settled more quickly.

Workforce

Covid-19 vaccinations are no longer mandatory for staff, but NHS England continues to recommend that providers promote staff uptake of Covid-19 vaccination. Providers are only required to promote staff vaccination where and as indicated in periodic national guidance issued by NHS England/DHSC/JCVI/the Green Book.

NHS trusts have new contractual duties to promote high staff attendance and retention, to have regard to national policy documents relating to sexual safety and improving the lives of resident doctors. Whilst these changes don’t directly apply to health care providers, they demonstrate a renewed focus on staff wellbeing.

The duty to have due regard to the Armed Forces Covenant will now apply to both the short-form as well as the long-form NHS Standard Contract.

ESG factors

The DHSC has proposed health service-specific regulations and statutory guidance to tackle modern slavery in NHS procurement. Once published, NHS trusts will have a duty to comply with the regulations and have due regard to the guidance – increasing scrutiny on their supply chains. Providers will need to prepare for enhanced scrutiny of their employment practices and be ready to evidence the steps they are taking to combat modern slavery.

As part of their duty to minimise adverse environmental impacts and help deliver net-zero, providers must now have clear, detailed plans to reduce piped nitrous oxide and nitrous oxide and oxygen mixture waste.

Whilst providers are already required to seek and act on feedback from stakeholders as part of their regulatory obligations, they must now:

• have regard to the statutory guidance on working in partnership with people and communities;
• take account of stakeholders’ ‘health literacy’ when communicating with individuals; and
• when reasonably requested by the co-ordinating commissioner, provide evidence of stakeholder involvement to show how the views of those involved have been taken account of in the relevant developments to and redesign of services.

Those providers that have already invested heavily in stakeholder engagement and evidencing value-for-money will find this easier to demonstrate than those that do not have a regular programme for seeking feedback.

Medicines                                

Providers must now use all reasonable endeavours to assist NHS England to optimise its use of medicines and deliver efficiencies when starting, substituting, tapering and stopping medicines. 

Providers are already subject to significant scrutiny when it comes to medicine management and will have plenty of suggestions as to how medicines can be used cost-effectively. NHS England has already identified sixteen medicines optimisation opportunities and providers are more likely to benefit from commissioner engagement where they can link their processes to one of those optimisation opportunities. 

Patient choice, referrals and non-attendance

Changes to the NHS Standard Contract confirm that a responsible commissioner shall be entitled to withhold payment for services delivered, where there is no written NHS Service Contract is in place. This is often referred to as non-contract activity. To unlock payment, providers will need to deliver a complete, up to date and unredacted copy of the NHS Particulars to the responsible commissioner.

Providers of acute, community and mental health services must have in place a Local Access Policy to describe how the provider will manage situations where a patient does not attend an appointment. The NHS Standard Contract has been updated to reflect that non-attendance must never be used as a reason for discharge from care for people with severe and relapsing mental illness.

Changes are being made to the short-form NHS Standard Contract, to include provisions relating to prior approval schemes. Prior approval schemes require a clinician to confirm that the patient's clinical presentation meets the locally agreed eligibility criteria for treatment, as listed in the local commissioning policies. These changes will allow commissioners to enforce their local commissioning policies across a wider range of services.

Child safety and information sharing              

The Child Protection Information Sharing Service (CP-IS) relates to children and young people who are known to social care because they are either looked after or have a child protection plan. CP-IS helps health and social care workers share information securely to better protect children and young people who are known to social care.

Previously, CP-IS was only mandated for certain care settings but has now been extended to:

• General practice (in hours)
• Child and Adolescent Mental Health Services (CAMHS) (all four tiers)
• Sexual Health: Sexual Assault Referral Centres (SARCS)
• Sexual Health: Termination of Pregnancy Services (ToPS)
• 0-19 Services: School Nursing and Health Visitors
• Community Paediatrics
• Dentistry (appointment-based dentistry, including emergency dental care)

Providers must ensure that relevant staff have access to and make appropriate use of CP-IS.

When updating, developing or procuring any information technology system or software, providers must have regard to the NHS digital architecture principles. This largely streamlines previous obligations and technical requirements will become clearer once new regulations are published in respect of new information standards for health and adult social care in England.

Other changes to note

New wording has been included to make it clearer that providers must rectify the cause of a Suspension Event before suspension will be lifted. Previously, suspension could be lifted where the provider demonstrated it was able to provide the suspended service to the required standard, without requiring the provider to rectify the issue that gave rise to the suspension.

Previous references to NICE guidance on self-harm has been replaced by NG225 (Self-harm: assessment, management and preventing recurrence).

Reference to NICE guidance on suspected sepsis has been removed but providers are still required to have regard to NG51 (Suspected sepsis: recognition, diagnosis and early management).

Comments on the draft NHS Standard Contract 2025/26 should be submitted by 25 February 2025 via the NHS England consultation hub. Once the consultation has concluded, the new terms will apply to the 2025/26 financial year for all new contracts and will automatically apply to any existing contracts that continue into the 2025/26 financial year. 

For more information 

For more information and a walk through the NHS Standard Contract 2025/26, please sign up for our webinar on 11th March or contact me directly.

[1] the obligation to accept referrals does not apply to Continuing Healthcare Services.