What Is a Primary Health Need?
The concept of a Primary Health Need is central to eligibility for NHS Continuing Healthcare (CHC).
It is not defined in primary legislation. Instead, it is explained within the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care (2018)
The National Framework states that the concept was developed to help distinguish between:
-
Health services the NHS must provide under the NHS Act, and
-
Care and support a local authority may provide under the Care Act 2014
Where a person is assessed as having a Primary Health Need, they are eligible for NHS Continuing Healthcare and the NHS becomes responsible for meeting all assessed health and associated social care needs, including accommodation where required
Our NHS Continuing Healthcare work involves detailed analysis of the National Framework and Decision Support Tool across assessment and review stages. Understanding how the Primary Health Need concept is applied in practice is central to determining eligibility.
How Is a Primary Health Need Determined?
Determining whether someone has a Primary Health Need involves:
-
An assessment by a multidisciplinary team (MDT)
-
Completion of the national Decision Support Tool (DST)
-
Consideration of the totality of needs
The Framework explains that a person has a Primary Health Need if, having taken account of all needs, it can be said that the main aspects or majority part of the care required is focused on addressing and/or preventing health needs
Importantly:
-
It is not about diagnosis
-
It is not about why care is required
-
It is not about where care is delivered
It is about the level and type of day-to-day care needs taken as a whole
The Four Key Characteristics
The National Framework explains that certain characteristics of need may help determine whether the care required is beyond the limits of a local authority’s responsibilities
Nature
The characteristics of the needs and the type of interventions required to meet them
This includes:
-
The overall effect of needs
-
The “quality” of interventions required
-
Whether specific clinical skill or judgement is necessary
Intensity
The extent, severity and continuity of needs
This includes:
-
Frequency of interventions
-
Degree of support required
-
Ongoing and sustained care needs
Complexity
How needs present and interact
This may include:
-
Multiple interacting conditions
-
Compounding risks
-
Increased skill required to manage symptoms
Unpredictability
The degree to which needs fluctuate and create risk
This includes:
-
Instability
-
Rapid deterioration
-
Risk to health if timely care is not provided
What Should Not Influence the Decision
The National Framework is explicit that eligibility decisions must not be based on:
-
Diagnosis
-
Setting of care
-
Whether needs are well managed
-
Use of specialist staff
-
Financial considerations
CHC is not means-tested
Can CHC Be Backdated?
Although the Framework provides structured guidance, applying the Primary Health Need concept requires careful analysis of:
-
The interaction between domains
-
The impact of needs when taken together
-
The distinction between health care and social care responsibilities
This is why detailed reasoning in the Decision Support Tool is essential.
The decision must explain how the totality of needs has been considered and how the four characteristics have been applied.
If You Are Reviewing a CHC Decision
Where CHC funding has been refused, it may be helpful to examine:
-
Whether the four characteristics were properly considered
-
Whether the totality of needs was assessed
-
Whether reasoning aligns with the National Framework
Understanding how the Primary Health Need concept operates under NHS guidance is often central to reviewing eligibility decisions.
Need Clarity?
Or explore our full Continuing Healthcare Funding Support Service.
This guidance page has been prepared by Nellie Supports’ solicitor-led Continuing Healthcare team, drawing on the NHS National Framework and Decision Support Tool guidance. Last reviewed: [February, 2026]