Provider Selection Regime · 2 of 4
The Three Direct Award Processes (A, B and C)
The PSR allows three direct award processes. Process A applies where patients have no choice of provider and only one is capable. Process B applies where the existing provider is the only realistic option. Process C allows an authority to continue with an existing provider that is delivering well where the service is not changing considerably.
What we do
- Read the transparency notice properly and establish which process the authority actually used, because the three carry very different justification burdens and very different openings for a challenger.
- For incumbents, build the process C position deliberately: the evidence that the service is being delivered to a sufficient standard and that the proposed contract is not changing considerably, which is what the continuation rests on.
- For challengers, identify where the authority's justification is weakest, usually the claim that no other provider could deliver, and set out the counter-evidence in a representation during standstill.
- Establish the contract expiry and review dates across your patch so you are visible to the authority well before the next continuation decision rather than after it.
- Where a direct award is genuinely unassailable, say so, and redirect effort onto the opportunities that are not. That is usually the more valuable answer.
The mistake that costs the most
Assuming a direct award is final and unchallengeable, and doing nothing. The standstill period exists precisely so that providers can test the authority's reasoning, and authorities do revisit decisions where a representation shows the justification does not hold. The opposite trap is equally expensive: challenging every direct award reflexively, which burns the commissioner relationship you need for the next decision.
Why this matters
A large share of NHS contract value moves through direct awards, and process C continuations in particular can keep a service with the same provider for many years without any competition ever taking place. If you are the incumbent, that is your most valuable asset and it should be actively protected. If you are not, it is the wall you need to understand before you plan around it.
Common questions
What are the three direct award processes?
Process A applies where patients have no choice of provider and only one provider is capable of delivering. Process B applies where the existing provider is the only provider that can deliver. Process C allows continuation with an existing provider where it is satisfying the existing contract sufficiently well and the service is not changing considerably.
Can an authority keep using direct awards indefinitely?
Process C requires the authority to keep reviewing whether continuation remains appropriate and to consider whether the service should change. In practice a well-performing incumbent can hold a service for a long time, but the authority still has to be able to justify each decision and publish a notice.
How do I find out a direct award has happened?
Transparency notices. Authorities must publish their decisions, including the process used and the reasoning. Monitoring those notices across your patch is how providers learn where services are being placed, and it is far more informative than watching for open competitions.
What is considered a considerable change to a service?
NHS England guidance addresses this rather than the regulations setting a fixed numeric test, and authorities apply judgement to factors such as scope, service model, value and the population served. A material change tends to push an authority off process C and towards the most suitable provider or competitive process.
Is it worth making representations against a direct award?
It is worth assessing, case by case. Where the authority's justification is thin, particularly a claim that no other provider is capable when you demonstrably are, a representation has substance. Where the justification holds, a reflexive challenge costs you the commissioner relationship and gains nothing.
Reviewed 14 September 2026. This page explains the Health Care Services (Provider Selection Regime) Regulations 2023 and the accompanying NHS England guidance. It is not legal advice, and a decision you intend to challenge should be reviewed by your own advisers inside the standstill period.
The rest of the regime
Start at the Provider Selection Regime overview, check what you need in place at NHS supplier eligibility, or see how this plays out in dental and patient transport.
Facing a PSR decision?
Tell us the service, the authority and where you are in the process. A specialist will give you a straight read on the route and what is realistically available to you.
The Three Direct Award Processes (A, B and C)
Which service, which authority, and what stage are you at?