A summary of NHS England’s Fit and Proper Person Test Framework

NHS Employers has worked with legal firm Capsticks to create a briefing which will help organisations to prepare for the new requirements.

1 September 2023

NHS England published a revised Fit and Proper Person Test (FPPT) Framework in response to the recommendations made by Tom Kark KC in his 2019 Review of the FPPT as it applies under Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The review highlighted areas that needed improvement to strengthen the existing regime.


The Framework is effective from 30 September 2023 and NHS organisations 1  are expected to use it for all new board level appointments or promotions and for annual assessments for all board members going forward from that date. It should be read alongside the NHS Constitution, NHS People Plan, People Promise and forthcoming NHS Leadership Competency Framework.  

The Framework will introduce a requirement for and means of retaining certain information relating to testing the requirements of the FPPT for board members, a set of core elements for the FPPT assessment  of all board members, and a new way of completing references.


The purpose of the new Framework is to strengthen individual accountability and transparency for board members, thereby enhancing the quality of leadership within the NHS.

It is a core element of a broader programme of board development, effective appraisals and values-based (as well as competency-based) appointments – all of which are part of the good practice required to build a ‘healthy’ board.

The Framework will help board members build a portfolio to support and provide assurance that they are fit and proper, while demonstrably unfit board members will be prevented from moving between NHS organisations.


The Framework applies to executive and non-executive directors of integrated care boards (ICBs), NHS trusts and foundation trusts, NHS England and the CQC, interim as well as permanent appointments where greater than six weeks and those who are called “directors” within Regulation 5. If they wish, trusts can extend the framework to cover other senior managerial positions for example, to those individuals who may regularly attend board meetings or otherwise have significant influence on board decisions. The annual submission requirement is, however, limited to board members only.

What’s new?

  • Updates in the NHS Electronic Staff Record (ESR) to record the testing of relevant information about board members’ qualifications and career history.
  • A new standard board member reference template for references for all new appointments. For board members who leave their position, organisations must complete and retain locally the new board member reference, whether or not a reference has been requested by a prospective employer.
  • An NHS Leadership Competency Framework will provide guidance for the competence categories against which a board member should be appointed, developed and appraised.
  • The annual assessment needs to be in line with the FPPT checklist which is set out at appendix 7 of the framework so organisations should ensure they are familiar with this document.
  • The duty to store information relevant to the annual assessment (as set out in the checklist) will apply to existing directors (as they will have to comply with the assessment each year) and not only new appointees/promotions.
  • NHS organisations must be able to demonstrate, annually, that they have carried out a formal assessment of the FPPT for each board member and should consider carrying out the assessment alongside the appraisal cycle.

    The chair of an NHS organisation is responsible for ensuring that their organisation is adhering to the Framework. As there is a requirement to record information on ESR, it is likely they will need to seek support from their HRD/CPO to do this.  The Framework (section 3.6) outlines the responsibilities of the chair. Chairs will be subject to the same FPPT requirement. 

    Section 3.1 of the Framework contains three flowcharts on suggested approaches to the assessment, including the board member reference process.

    FPPT assessment

    A documented, full FPPT assessment will need to be completed by NHS organisations from 30 September 2023, against the core elements (outlined below) in the following circumstances:

    • New appointments in board member roles, whether permanent or temporary, where greater than six weeks, this covers:
      • new appointments that have been promoted within an NHS organisation.
      • temporary appointments (including secondments) involving acting up into a board role on a non-permanent basis.
      • existing board members at one NHS organisation who move to another NHS organisation in the role of a board member.
      • individuals who join an NHS organisation in the role of board member for the first time from within or outside the NHS.
    • When an individual board member changes role and remains on the board within their current NHS organisation.
    • Within a 12-month period of the date of the previous FPPT.

    Every board member will need to complete an annual self-attestation (see section 3.3 of the Framework), to confirm that they comply with the FPPT requirements. Self-attestations will be a necessary step that forms a part of the full FPPT assessment.

    Section 3.5 of the Framework contains information on additional considerations when applying the FPPT for joint appointments across NHS organisations, shared roles within the same NHS organisation and periods of temporary absence.

    Section 3.6 of the Framework has information on dispute resolution in relation to the data and information held about board member and where a board member disagrees with the outcome of the FPPT assessment.

    It is good practice for an organisation to report on its high level outcomes of the FPPT assessment in its annual report and/or on its website.

    Core elements

    NHS organisations should assess board members against three core elements when considering whether they are a fit and proper person to perform a board role:

    • Good character (see section 3.7.1 of The Framework)
    • Qualifications, competence, skills required and experience (see section 3.7.2 of The Framework)
    • Financial soundness (see section 3.7.3 of The Framework).

    This is in addition to local recruitment and selection processes and the NHS Employment Check Standards. The checks that underpin the core elements reflect the assessment criteria in Regulation 5 and Schedule 4 of the Regulations.

  • A standardised board member reference is being introduced to ensure greater transparency, robustness and consistency of approach when appointing board members within the NHS. The template is based on the standard NHS reference and includes additional requests for information (relevant to the FPPT). The six competency domains outlined in the forthcoming NHS Leadership Competency Framework should be considered when the board member reference is written.

    Board member references will apply as part of the FPPT assessment:

    • When there are new board member appointments, either internal to a particular NHS organisation, internal to the NHS, or external to the NHS. NHS organisations should obtain references before the start of the board member’s appointment, in writing (either via hardcopy or email) and organisations will need to satisfy themselves that both the referee and the organisation are bona fide.
    • When any board member leaves an organisation for any reason. NHS organisations should use the board member reference template and maintain the accuracy of the reference where the board member departs, irrespective of whether there has been a request from another NHS employer for the reference. The completed reference should be retained locally in an accessible archive.

    A future development in ESR will enable the reference to be retained in ESR (at a local level) on a career long basis and up to the age of 75 for the individual in question.

    Obtaining references

    Under the Framework, the board member  reference is required to validate a period of six consecutive years of employment immediately prior to the application for a reference being made.

    Where the individual is from outside the NHS, or from within the NHS but moving into the board role for the first time: The new employing organisation should make every effort to obtain a reference which fulfils the requirements of the board member reference. A minimum of two references using the board member reference template should be obtained from different employers, where possible.

    Where an individual moves from one NHS board role to another NHS board role, across NHS organisations: Where possible one reference from a separate organisation in addition to the board member reference for the current board role will suffice. This is because their board member reference template should be completed in line with the requirements of the framework so that NHS organisations can maintain accurate references when a board member departs.

    Where references from previous employers are unattainable for the previous six years, additional character or personal references should be sought. Character and personal references should be sought from personal acquaintances who are not related to the applicant, and who do not hold any financial arrangements with that individual.

    Where an NHS organisation is unable to fully evidence that the incoming board member is fit and proper because of gaps in the board member reference, they may continue to hire the individual but should clearly document within ESR the gaps in relation to the board member reference, any mitigation for this, and the reasons for being comfortable with employing/appointing the board member.

  • New data fields in ESR will hold individual FPPT information for all board members operating in the NHS and will be used to support recruitment referencing and ongoing development of board members. The FPPT information within ESR is only accessible within the board member’s own organisation and there is no public register.

    The chair will be accountable for ensuring that the information in ESR is up to date for their organisation. As a minimum, it is expected that each NHS organisation conducts an annual review to verify that ESR is appropriately maintained. 

    The ESR FPPT data fields will retain records of completed tests to support the FPPT assessments. All supporting documents/records in relation to the FPPT will be held locally by each individual NHS organisation in compliance with GDPR and the NHS Records Management Code of Practice.

    There should be limited access to the FPPT fields of ESR but it is reasonably expected that the following will have access:

    • chair
    • chief executive officer
    • senior independent direction
    • deputy chair
    • company secretary
    • human resources directioe/chief people officer.
  • Every three years, organisations should undertake an internal audit to assess the processes, controls and compliance supporting the FPPT assessments.

    External quality assurance checks will be conducted by the CQC, NHS England and an external/independent review. The Care Quality Comission's (CQC’s) role is to ensure NHS organisations have robust processes in place to adequately perform the FPPT assessments, and to adhere to the requirements of Regulation 5 of the Regulations. NHS England has oversight through receipt and review of the annual FPPT submissions to the relevant NHS England regional director from NHS organisations.

Next steps

  • Visit NHS England’s website for supporting information, templates and guidance.
  • Work with your chair to let your board directors know about the new FPPT requirements and data points being added to ESR to record the testing of relevant information about board members’ qualifications and career history.
  • From 30 September 2023, use the new board member reference template for references for all new board appointments and complete and retain locally the new board member reference for any board member who leaves their position.
  • NHS England is finalising the new NHS Leadership Competency Framework for board level roles, due by September 2023 so that you can implement this alongside the FPPT Framework.
  • A new board appraisal framework will also be published, incorporating the Leadership Competency Framework, by March 2024. NHS England will ask you to use this for all future annual appraisals of board directors from this point.
  • Consider local policies, contract and settlement agreement templates which may require amendment to enable compliance with the Framework.


  1. 1. In this summary ‘NHS organisations’ refers to all institutions the Framework applies to which is listed in the Framework as including NHS trusts, NHS foundation trusts, integrated care boards, the Care Quality Commission and NHS England.