Support when considering transactions and mergers

Help for NHS providers navigating their way through a transaction such as a merger or acquisition.

Transactions guidance

This new transactions guidance advises NHS trusts and foundation trusts planning an organisational or non-organisational transaction or investment on our new regulatory assurance process, the approvals required and timescales. It consolidates and supersedes previous transactions guidance issued by Monitor and the Trust Development Authority, and aligns our transaction review process to the integrated support and assurance process.

Our new approach: 

  • is more streamlined with greater focus on early, more detailed engagement with us – the previous strategic and outline business case stages have been combined. This means proposals that are not viable should be identified earlier 
  • updates the risk factors we use to judge the depth of regulatory assurance required
  • sets out the ‘red flags’ that if identified at strategic case stage will require trusts to do further work and/or to provide mitigations

Our guidance also:

  • outlines how trusts should approach funding transactions in the context of ongoing constraints on capital funding
  • shares the key learning points from previous mergers and acquisitions
  • outlines the support we can offer, such as legal guidance and guidance on navigating a Competition and Markets Authority review

If your trust has started a transaction process under the previous guidance from Monitor, we will continue to work with you under this plan.

Guidance on transactions PDF, 1.0 MB

For trusts undertaking transactions, including mergers and acquisitions

Merger benefits guidance

This guidance is for NHS organisations planning a merger.

It also explains how Monitor will assess and provide advice to the Competition and Markets Authority (CMA) on the benefits of mergers involving NHS foundation trusts. It covers:

  • Monitor’s role in relation to merger benefits
  • what is a relevant patient benefit
  • how the CMA will take our advice into account
  • our approach to assessing merger benefits
  • examples of types of merger benefits

Competition review of NHS mergers: a short guide for managers of NHS providers

This short guide seeks to answer the questions merging providers often ask about the UK merger review process. It is designed to highlight important aspects of the process of merger review and provide an overview of the substantive test. It is not intended to be comprehensive.

For further detail please refer to more in-depth guidance that the CMA and Monitor have published.

Consultation response: Monitor’s draft guidance on merger benefits

This describes the healthcare sector’s response to Monitor’s draft guidance and explains the changes made to the final guidance documents.

Is there anything wrong with this page?

Help us improve this website

Do not include any personal, sensitive or confidential information.