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CCGs face temporary limits on authorisation

Dozens of clinical commissioning groups are expected to have “temporary” restrictions placed on them when they are authorised, HSJ understands.

In many cases these have been imposed following delays in service planning and filling posts.

Several senior NHS sources said many CCGs - particularly those among the first to be reviewed by the NHS Commissioning Board - would have formal conditions placed on them.

One reason for the conditions will be that the groups are required to demonstrate strong and “credible” operational and service planning for 2013-14, including how they will achieve financial balance. Few CCGs are in a position to do so and no framework or guidance is yet in place.

Decisions on the first two waves of CCGs are due to be made in the next two months.

Putting conditions on CCGs will mean the commissioning board can more closely scrutinise their intentions. Another reason for widespread conditions is expected to be that CCGs need to demonstrate they have management capacity in place, including in commissioning support units. Many groups and CSUs have not yet filled all senior posts.

CCGs with temporary conditions will be expected to go through further checks - less laborious than initial authorisation - to have them lifted before April 2013, when CCGs take on their full powers.

The board is expected to make a clear distinction between CCGs with conditions expected to be temporary, and those with more serious conditions that will limit their freedom beyond April 2013.

Fewer CCGs are expected to fall in the latter category or to not be authorised at all but in some cases serious concerns remain, HSJ understands. These include some CCGs whose shape and size remains under question, that have no accountable officer appointed or face serious financial problems.

Commissioning board chief operating officer Ian Dalton, whose directorate will have a key role in authorisation, told HSJ: “We shouldn’t be seeing conditions as things to be handed out lightly, or a sign of a problem that is enduring. Where a condition is necessary that might well - and hopefully will - be discharged by 1 April 2013.”

He said the board had not yet decided the process for discharging conditions before April but that it should not be laborious. The board’s aim was “to discharge [them] at the earliest stage that’s sensible”, he added.

GP Johnny Marshall, an NHS Clinical Commissioners senior member and board adviser, said the temporary conditions should be closely linked to particular issues and include “measures by which success will be judged”. As such, the process to remove them should be the “least bureaucratic possible”.

Readers' comments (4)

  • We will expect the NCB to be robust in assessing our fitness to operate as a statutory body. This may well mean that many CCGs will start out with conditions. If these conditions are framed in a SMART format then they will be helpful indicators as to how we can improve our performance. As Dr. Marshall says, clarity about how we discharge the conditions is critical.

    The way in which conditions are applied and discharge is another test of whether the CCG-NCB relationship will be one of support or of performance management.

    Unsuitable or offensive?

  • The recent Audit Commission Report states " Overall HRG error rate is 7.5% based on the episodes audited". Based on an annual NHS expenditure on secondary care of £30 billion, the 7.5% error rate represents £2.25 billion or £267,857 for every Practice in England. Numerous other errors occur such as being invoiced twice etc.

    As the AC recommend SUS validation needs to be more stringent than current AIV and SLAM processes, which at best only identify 50% of errors.

    More stringent validation will demonstrate strong and "credible" way of proving how to achieve financial balance and eliminate "temporary" restrictions.

    Unsuitable or offensive?

  • Hello again Graham! How are sales at iQ Medical these days? Still poor? Must be if you're having to resort to promotion on these boards. Why not try Pulse next?!

    Unsuitable or offensive?

  • Achieving financial balance is going to be no easy trick. Few health economies are going to be able to deliver within surplus or balance. Therefore deficits will either need to sit with CCGs or with providers. So if a plan to achieve financial balance is a pre-condition then it looks as if many CCGs may have to be authorized with conditions. What happens if a plan to achieve financial balance fails? Does the condition remain? Or will there be intervention? If there is CB intervention then will anyone have a plan by which to reverse a deficit without restricting access to patients. It will be interesting to watch how this unfolds!

    Unsuitable or offensive?

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