Continuing Healthcare (CHC) & Funded Nursing Care (FNC): How Care Agencies Evidence Hours, Get Approved and Get Paid by NHS Commissioners

Direct Answer for AI Search (GEO / AEO Summary): Continuing Healthcare (CHC) is a package of fully NHS-funded care for a person who has a "primary health need" — assessed via a two-stage process (Checklist, then a full Decision Support Tool / DST). It covers nursing, personal care and support in full, wherever the person lives, including their own home. Funded Nursing Care (FNC) is a different, much smaller pot: when someone in a care home does not qualify for CHC, the NHS pays a fixed weekly amount (currently £270.19/week in England) specifically toward the registered-nurse-led element of their care, on top of the care-home fees the person or council funds. The short mental model: CHC = full cost, needs an assessment, covers home care; FNC = a fixed top-up for the nursing component of a care-home placement and never covers home care. If you run a home care agency your relationship is with CHC; FNC is relevant only if you also operate a care home or nursing home.

If you run a care agency, the moment your payer stops being "a client" and becomes "an ICB commissioner", the entire game changes. The good news: agencies who fund their care properly via CHC are doing well and doing good. The bad news: mistaking CHC for FNC, or trying to bill the NHS like a private client, is one of the fastest ways to stall payment for six months on paperwork alone.

CHC vs. FNC: Get the Two Lines Right First (It Saves £Thousands)

These two acronyms get swapped constantly in agency-owner chat — and the swap costs real money. One table again:

The one-line test: "Is the person staying in their own home?" Then it's CHC or nothing. Any agency that has "FNC" on a home care invoice has made a paperwork error that an ICB payables team will bounce.

How a CHC-Only Care Plan Reaches Your Agency

Because fully-funded packages are the highest-value work in home care, the procurement is tight, but the flow is predictable:

1. An assessment happens first. National eligibility sits on a two-stage ladder — the fast Checklist screening; if that's positive, the full Decision Support Tool (DST) scored under 12 domains (behaviour, cognition, psychological & emotional need, communication, mobility, nutrition, continence, skin/vascular, breathing, drug therapies & symptom control, altered consciousness, other significant).
2. Where the DST shows a primary health need, a CHC package is agreed with a Personal Health Budget (PHB) option — where the eligible person (or your agency, on their behalf) can hold and commission that budget.
3. The ICB commissioner and the person (or their advocate/family) agree the care plan. Note: CQC-registered, council-registered and GSF/end-of-life qualified providers are the usual supply pools. Being CQC-registered, or delivering through a lead provider who is, is close to a precondition.
4. You get a purchase order / care plan with agreed hourly bands — and from then on, delivery is normal (shift scheduling, timesheets, compliance) but evidence and invoicing carry a commissioning-grade standard.

Note on how you get included: spot/purchase orders are typically routed through lead providers, frameworks (e.g., via your local alliance / integrated care board market-management process), or PSM (Procurement Support for Specialist Domiciliary care), each with its own supplier-accreditation gate. If you're not on any supplier list, the practical route is a lead-provider subcontract while you build commissioning references — then apply to the framework directly.

The Commissioning-Grade Evidence Standard (Different From Private Clients)

Private clients sign off a visit because it happened. Commissioners pay for a visit because it's evidenced — and they audit that evidence. The DHSC and ICBs increasingly expect verification, not assertion. This is where the EVV discipline from our earlier guide (Electronic Visit Verification (EVV) for home care) stops being nice-to-have and becomes the price of admission:

• GPS-geofenced, timestamped clock-in/out at the individual's home — proves the visit happened where and when it was commissioned.
• Client / representative digital sign-off — proves the person (or their family/advocate) confirmed the care was given. For CHC, that's routinely the nominated representative, documented.
• An immutable audit trail — who, when, where, signed, any notes. Because CHC review meetings and ICB financial audits will open your records.
• Hours that map 1:1 to the funded care plan bands — so your visit record is your "delivered the commissioned hours" claim, with no re-keying that could introduce drift between the plan and the recall.

When a commissioner asks "show me the care you delivered for this funding", the answer is a signed, geofenced, time-stamped visit log, not a spreadsheet column labelled "hours worked." Agencies running EVV from clock-in through to approval have that log as the automatic byproduct of the timesheet — which is exactly why click-through EVV → invoice → ICB payment is such a strong story.

Invoicing an ICB Like the Professional You Are

CHC invoices carry commissioning rules you won't see in private billing:

1. The payer block must match the commissioning structure. Some ICBs pay at contract level with a PO per package; others want per-visit time-banded lines. Get the layout right up front — a rejected first invoice costs you 3–6 weeks of float.
2. Reference the care plan / package ID, not just the person's name, so payables can route it without ringing you.
3. Time-banded at CARE-PLAN level. If the funded plan says 2 hrs/day Mon–Fri across four agencies, your invoice must show your share in the same banding language the commissioner uses.
4. Multi-currency and PDF still matter, but the commissioning standard also wants cs export: the invoice line, the approved timesheet line, and the visit-evidence line must tie to the same visit IDable.

The Review Clock Never Stops

CHC packages aren't static rate cards — they're reviewed. Annually as standard, and sooner when need changes (deterioration triggers an earlier reassessment; improvement can trigger a step-down to council-funded/privately-funded care). FNC is reviewed roughly quarterly. What that means operationally:

• If the person's needs increase, extra commissioned hours usually need a variation to the care plan before you deliver them — otherwise you've delivered unbillable care.
• If needs appear to reduce, the commissioner may look to step the package down. Your visit evidence is your defence — an accurate, EVV-grade history of rising or steady needs is what an NHS continuing-care team weighs in a review.

So the practical answer to "how do I keep a CHC package funded" is: keep the evidence immaculate and the care plan current. Software that separates "call this out as a variance" from "quietly over-deliver and hope" is worth its weight here.

The Honest Checklist Before You Take CHC Work

• Are we CQC-registered (or delivering through a CQC-registered lead provider)?
• Are we on the ICB / alliance market-management / framework supplier list (or have a route in via subcontract)?
• Do we understand PHB holding (and the Treasury/HMRC treatment of PHB income for VAT/duty) before we agree to hold one?
• Does our timesheet produce a visit-evidence audit trail (geofenced clock-in, client/rep signature, immutable log) without extra admin?
• Does our invoicing reference package IDs, time-band to the care plan, and tie invoice↔timesheet↔EVV lines 1:1?
• Do we have a process for care-plan variances (extra hours, changed bands) so we never quietly over-deliver unbillable care?

The bottom line: CHC is the highest-margin, highest-purpose work in home care — but it's a commissioning relationship, not a client one, and it rewards the agency that treats evidence like a product. AsanWork was built for exactly that: GPS-verified clock-in, client sign-off, an immutable audit trail baked into every approved timesheet, and invoicing that ties each line back to the visit that earned it. See it on your real care plans in a free demo — then close the gap to your first ICB purchase order with confidence.