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Understanding the “Primary Health Need” Test for NHS Continuing Healthcare
The Primary Health Need test is at the heart of NHS Continuing Healthcare (CHC) eligibility, and it is something every nurse involved in CHC assessments needs to understand clearly.
The CHC Agency Nurses Network brings together experienced CHC nurses, agency nurses and other healthcare professionals to share knowledge, support each other and develop confidence in applying the national CHC Framework and the Primary Health Need test in practice.
About the CHC Agency Nurses Network
The CHC Agency Nurses Network is a professional community and support hub for nurses working in, or aspiring to work in, NHS Continuing Healthcare and complex care.
Our network is a place to:
- Connect with over 500 CHC agency nursing professionals across the UK.
- Share real-world CHC assessment experience and case discussions 24/7/365 in confidential, invite-only social media groups.
- Relax, debrief and talk with other nurses who truly understand the workload, pressures and emotional impact of CHC work.
- Attend regular online and in-person events focused on CHC practice, including the Primary Health Need test and DST.
- Develop your professional profile and career in CHC, complex care and nurse consultancy.
Many members in our community become long-term friends, building supportive professional networks that extend far beyond a single workplace or contract.
Introduction to the Primary Health Need Test
Within the NHS Continuing Healthcare (CHC) framework in England, the Primary Health Need test is the core legal test used to decide whether an adult’s needs are primarily for healthcare rather than social care.
For nurses contributing to or leading CHC assessments, understanding how this test works in practice is essential to ensuring fair, lawful and person-centred decisions about eligibility.
Through the CHC Agency Nurses Network, members can discuss challenging cases, ask questions and share best practice on applying the Primary Health Need test consistently.
What Is a Primary Health Need?
Definition of a Primary Health Need
A Primary Health Need exists where the nature, intensity, complexity or unpredictability of an individual’s needs means that the care they require is more than a local authority could be expected to provide under social care legislation.
In simple terms, if a person’s needs are mainly about ongoing healthcare and clinical management, rather than everyday social care support, they may have a Primary Health Need and therefore be eligible for fully funded NHS Continuing Healthcare.
Why It Is Important in CHC
The Primary Health Need test is the decisive factor in determining whether the NHS or the local authority is responsible for funding a person’s ongoing care package.
Accurate, well-documented decision-making ensures that:
- Individuals with significant, complex or unpredictable needs receive the correct level of NHS funding.
- Care packages are legally robust and defensible at review, local resolution or independent review panels.
- Healthcare organisations and commissioners remain compliant with the National Framework for NHS Continuing Healthcare.
Nurses in our network regularly discuss real-life examples of Primary Health Need decisions, helping one another to refine clinical reasoning and documentation.
Criteria for Assessing a Primary Health Need
Key Considerations in the Assessment
The Primary Health Need test is based on four key characteristics, which should be considered together, not in isolation:
Nature
This looks at the type of needs (physical, mental health, behavioural, cognitive etc.), their overall effect on the individual and the type of intervention required by skilled staff.
Intensity
Intensity refers to the quantity and severity of needs, including how much care is required, how often, and whether constant monitoring, supervision or interventions are necessary.
Complexity
Complexity covers how multiple needs interact with one another, the skill required to manage them safely, and the level of clinical judgement involved in planning and delivering care.
Unpredictability
Unpredictability considers how unstable or changeable the person’s condition is, the risk of sudden deterioration, and whether highly responsive, skilled care is required.
In the CHC Agency Nurses Network, these four characteristics are a frequent topic of discussion, as experienced nurses share examples of how they applied Nature, Intensity, Complexity and Unpredictability (NICU) in real assessments.
The CHC Assessment Process and the Primary Health Need Test
Step-by-Step Overview
Determining a Primary Health Need is not about a single score or diagnosis; it is about a multidisciplinary, evidence-based process.
Typically this includes:
- Gathering comprehensive clinical and social information from nursing records, medical notes, therapy reports and risk assessments.
- Completing a Checklist (where appropriate) to identify whether a full CHC assessment is required.
- Holding a multidisciplinary team (MDT) meeting with health and social care professionals familiar with the person’s needs.
- Completing the Decision Support Tool (DST) to summarise needs across 12 care domains, supported by clear evidence.
- Using the four key characteristics to apply the Primary Health Need test and recommend eligibility for CHC.
Nurses in our network share tips on MDT preparation, effective evidence gathering and how to clearly articulate Primary Health Need reasoning within DST recommendations.
Tools and Guidelines Used
The main tools and frameworks used in assessing a Primary Health Need include:
- The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.
- The CHC Checklist tool (for screening).
- The Decision Support Tool (DST) to structure the full multidisciplinary assessment.
- Local ICB (Integrated Care Board) policies and procedures, which must align with the National Framework.
Members of the CHC Agency Nurses Network regularly share updates, policy changes and practice alerts, helping one another keep up to date with national and local CHC requirements.
Common Challenges in Determining a Primary Health Need
Complex or Multiple Conditions
Many CHC cases involve people with multiple long-term conditions, frailty, dementia or complex mental health needs, making it difficult to see the “big picture” of overall need.
Within our confidential groups, nurses openly discuss anonymised scenarios to explore how to distinguish between primary and secondary needs and how to document complex presentations effectively.
Balancing Health and Social Care Needs
Another challenge is separating what is primarily a healthcare need from what could legally be met by a local authority as social care.
Our network enables nurses to test their thinking with peers, check their interpretation of the National Framework and learn from colleagues’ experience with local authority and ICB boundaries.
Subjectivity and Professional Judgement
CHC assessments inevitably involve professional judgement, and different MDTs can reach different conclusions if evidence is weak or poorly presented.
By sharing good practice examples, panel feedback and learning from appeals, the CHC Agency Nurses Network helps nurses refine their clinical reasoning and reduce unwarranted variation in Primary Health Need decisions.
How the CHC Agency Nurses Network Supports Nurses and Assessors
Professional Networking and Peer Support
We provide a safe, informal space where nurses can talk openly about CHC practice, ask for advice and debrief after challenging cases or panels.
Our invite-only social media groups operate 24/7, meaning you can connect with peers whenever you need support or want to share a learning point.
Events, Webinars and Learning Sessions
The CHC Agency Nurses Network runs regular online and in-person events focused on topics such as:
- Understanding and applying the Primary Health Need test.
- Best practice in DST completion and MDT documentation.
- Preparing for appeals, local resolution and independent review panels.
- Case law updates and implications for CHC practice.
These sessions are designed to build confidence, share practical tools and help you stay aligned with current CHC guidance.
Career Development in NHS Continuing Healthcare
Whether you are new to CHC or an experienced CHC nurse assessor, our network can help you to:
- Explore agency and contract opportunities in CHC and complex care.
- Build a visible professional profile within the CHC community.
- Learn from peers who have progressed into senior assessor, clinical lead or consultancy roles.
By joining the CHC Agency Nurses Network, you gain access to a community that actively supports your ongoing learning and career progression in this specialist area of practice.
Joining the CHC Agency Nurses Network
We welcome new members who are:
- Registered nurses working in NHS Continuing Healthcare or interested in moving into CHC roles.
- Agency nurses who want to develop skills in CHC assessments, DST and complex care coordination.
- Other healthcare professionals with a strong interest in CHC eligibility and Primary Health Need assessments.
When you join, you will be invited to our private social media groups, given access to events and introduced to a friendly community of CHC professionals who understand the realities of the work.
Conclusion: Confident, Consistent Primary Health Need Decisions
Accurately applying the Primary Health Need test is essential to ensuring people with complex health needs receive fair, lawful NHS Continuing Healthcare funding.
Through the CHC Agency Nurses Network, nurses and other professionals can share knowledge, reflect on complex cases and strengthen their CHC practice in a supportive environment.
If you want to improve your understanding of the Primary Health Need test, develop your CHC skills and connect with like-minded professionals, the CHC Agency Nurses Network is here to support you.
Frequently Asked Questions (FAQs)
- What is the Primary Health Need in NHS Continuing Healthcare?
The Primary Health Need is the test used to decide whether a person’s care needs are mainly health-related and therefore eligible for fully funded NHS Continuing Healthcare. - Why is the Primary Health Need test so important?
It determines whether the NHS or the local authority is legally responsible for funding a person’s ongoing care package. - Who carries out the Primary Health Need assessment?
A multidisciplinary team (MDT) of health and social care professionals uses the DST and national guidance to assess whether a Primary Health Need exists. - What tools are used in CHC and Primary Health Need assessments?
The main tools are the CHC Checklist, the Decision Support Tool (DST) and the National Framework for NHS Continuing Healthcare. - How does the CHC Agency Nurses Network help with CHC assessments?
We provide peer support, events, discussions and shared resources to help nurses apply the Primary Health Need test and CHC guidance confidently. - Is the Primary Health Need test based on diagnosis?
No, eligibility is based on the nature, intensity, complexity and unpredictability of needs, not just on a particular diagnosis. - Can social care needs still be present if someone has a Primary Health Need?
Yes, people can have both health and social care needs, but eligibility depends on whether the primary need is for healthcare. - Do I need CHC experience to join the CHC Agency Nurses Network?
No, we welcome both experienced CHC nurses and those who are new to or interested in moving into CHC practice. - How can I join the CHC Agency Nurses Network?
You can contact us via our website or social media channels to request an invitation to our private groups and events. - Is the CHC Agency Nurses Network only for NHS staff?
No, our community includes agency nurses, independent practitioners and NHS staff who are involved or interested in CHC work.
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