The Provider Selection Regime (PSR) encourages clear thinking, proportionate effort and transparent reasoning.
As organisations apply PSR across a range of services, a common theme is emerging: the strength of the decision record has very little to do with how long it is and everything to do with how relevant it is. This aligns with PSR’s purpose, which is to introduce a flexible and proportionate process for selecting providers of NHS healthcare services.
Clarity of purpose
Good PSR decision records demonstrate a clear understanding of the need, the intended outcomes and the rationale for commissioning. This reflects the statutory requirement for relevant authorities to keep appropriate records and to be able to explain their reasons when making decisions.
How the focus shifts across direct award routes
PSR applies the same principles across all routes, but the emphasis changes depending on the direct award process being used.
Direct Award A: the decision must show why only one provider can reasonably deliver the service.
Direct Award B: the emphasis is on patients having unrestricted choice, where the relevant authority is not limiting the number of providers.
Direct Award C: the reasoning centres on why the existing provider remains suitable, where the provider is meeting its current obligations and the proposed arrangements will not change considerably.
These direct award processes form part of the statutory framework for arranging services under Regulation 4 of the Health Care Services (Provider Selection Regime) Regulations 2023.
Quantity vs quality
Panels and reviewers do not assess PSR decisions by the number of pages. A decision record may be concise or detailed. What matters is whether the content is relevant and supports the reasoning behind the chosen route. This reflects PSR’s flexible and proportionate approach and the statutory guidance’s emphasis on clear and accessible documentation.
Justification must always be complete and directly address the PSR criteria for the chosen route, but relevance matters more than volume, especially where it is repetitive.
Relevant evidence
Building on this, the evidence included in a PSR decision record should directly support the assessment being made. Useful material may include activity baselines, risk considerations, funding assumptions and equality or quality impacts, but only where these are relevant to the service and the route being applied.
Under Regulation 5, authorities must consider the five key criteria where they apply, which means the evidence should speak to those criteria rather than repeat the same point across each section. Clear, relevant evidence provides a stronger basis for demonstrating how the criteria have been assessed.
Thinking ahead
A helpful discipline is shaping a decision record so it stands up at approval, audit and future review. NHS England’s updated statutory guidance emphasises clearer navigation and comprehension, reinforcing the value of records that are structured so others can understand the reasoning easily.
As PSR continues to embed across the system, these touchpoints are helping teams produce decision records that are clearer, more proportionate and more resilient to scrutiny.
PSR pitfalls: A quick guide
- Misunderstanding what Regulation 4 requires: selecting a process without demonstrating why it is justified.
- Repetition across Regulation 5 key criteria: weakening the decision by not evidencing each criterion independently.
- Using irrelevant or generic examples: giving an appearance of completeness without meeting PSR requirements.
- Insufficient reasoning for Direct Award A, B or C: failing to demonstrate why the chosen route applies.
- Evidence not linked to the criteria: a common theme in PSR Panel findings.
- Weak documentation trail: lacking a clear ‘need → options → evidence → decision’ flow.
- Not showing how risks, equality or quality considerations were assessed: required where applicable under Regulation 5.
- Over- or under-working the process: excessive volume or insufficient detail both weaken clarity of reasoning.
Get in touch
If you’re working through challenges related to PSR and need some support, don’t hesitate to get in touch: [email protected].