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Business rules play a critical role in an organization’s daily activities. With the increased use of business rules (solutions) the interest in modelling guidelines that address the manageability of business rules has increased as well. However, current research on modelling guidelines is mainly based on a theoretical view of modifications that can occur to a business rule set. Research on actual modifications that occur in practice is limited. The goal of this study is to identify modifications that can occur to a business rule set and underlying business rules. To accomplish this goal we conducted a grounded theory study on 229 rules set, as applied from March 2006 till June 2014, by the National Health Service. In total 3495 modifications have been analysed from which we defined eleven modification categories that can occur to a business rule set. The classification provides a framework for the analysis and design of business rules management architectures.