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Ricketts 'sceptical' about CCGs relying on in-house support

NHS England’s director of commissioning support strategy has indicated he is “deeply sceptical” that clinical commissioning groups can function at their best without buying in support services.

Bob Ricketts also said NHS England planned to ensure CCGs would not “devastate” the support market by hosting commissioning functions internally, rather than buying them from support units.

He was speaking at the Commissioning Show event in London last week.

Mr Ricketts said CCGs should consider whether their initial commissioning support arrangements were right “over the next three or four months”.

He said both CCGs and support units themselves needed to work with others to support them to transform services.

Mr Ricketts said: “I think I would be deeply sceptical of the ability of any CCG on its own, or any commissioning support unit, without partnering to be able to deliver the really good support on [service] transformation.”

In relation to CCG in-house support, he added: “At the very least there’s a responsibility to work through that process and do it in an informed way [so] that you’re aware of what the options out there are.”

“There needs to be some challenge,” he continued. This could be in the form of auditors assessing whether CCGs’ support services represented good value, he said.

Last week HSJ revealed there is a hundredfold variation in the size of CCGs’ workforces. The main reasons are variation in their populations size, the extent to which they outsource to CSUs, and how much they share support services with other CCGs.

Mr Ricketts said: “It wouldn’t be acceptable for a CCG to say it’s going to do [everything] in house, and then you find lo and behold it’s not doing transformation.”

He also revealed NHS England would hold private discussions with CCGs in the summer about the need for them to be aware of the effect their decisions on commissioning support could have on the wider system.

“If a CCG decides it wants to put it all in house, and the effect of that is to devastate [provision] for its neighbours, I think there’s a system interest in terms of managing risk… CCGs need to behave responsibly.”

A strategy for developing commissioning support, published last week, revealed NHS England would assess the effectiveness of CCGs’ approach to outsourcing support, and how far they have “the right balance” of in-house and external services.

Readers' comments (12)

  • A year ago, it was all free love and let a thousand flowers bloom in CCG-land. Now the indications are the will be some "indications of a preferred direction". I also distinctly recall that CCGs were told to do what was best for them, not the greatest good for the greatest number..... Another indication that this whole cockamamie reorganisation is heading for the cliff edge that was predicted by all of us. Lansley has got one hell of a lot to answer for.

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  • Oh for heavens sake! You spend a fortune inventing a half cocked "market" for commissioning support and then before it has had even a few months to bed down you start to dictate to the supposed "consumers" what they should be buying from it.

    I'm also a little confused as to why NHS England seems so conviced that in-house services, rather than bought-in services, are less likely to be delivering transformation. Where is the evidence for this please?

    I can't help but get the feeling that there's some genuine panic in the corridors of the DoH that their insane plans for "commissioning organisations that don't so much commission services themselves but rather commission other (preferably private) organisations to commission for them" is starting to unravel.

    That was the point of this whole debacle after all wasn't it? Shifting a sizable chunk of the commissioning bureaucracy into CSU's that (once contracts were awarded) would then be snapped up by the big consulting firms, reducing the public sector pay bill and pensions liability?

    Having the GPs get all independent on you and make their own decisions, forcing you to get all authoritarian on them and get NHS England to boss them around is going to be embarrassing for a health secretary that has spent his entire time in office banging on about how GPs were the only people to be trusted with decision making in the NHS.


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  • so is Bob lining up a job with United health or mcKinsey?

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  • This ought to be the classic market decision of whether to 'make or buy'. You look at the products and decide if you'd be better to do it yourself or pay someone else to do it for you. If as a seller you have a product too few people want to buy, you change the product or leave the market. If the buyers are told to but products they don't want then it isn't a market, it's a command and control economy. Oh, now wait.......

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  • If there was a time when anybody should go out to the front line to appreciate a sense of reality, that there is a non-existent market in the NHS, it is now and it is Bob.
    Until the NHS has a real market, allowing those organisations that cant "cut it" to fail and allows commissioners to act as commissioners, without the centre holding a strangle tight grip on commissioning plans these half baked ideas will remain exactly that - either let the market play out or stop pretending there is a market. Alternatively wait for the next strategy flower to bloom which questions the purchaser provider market should not be long!

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  • Bob Ricketts is responsible for a great deal of shoddy thinking with no evidence but this takes the biscuit. CCG are being "told" there is only one way we can not have a "choice" or an evidence based debate. Where is the evidence for the "private buy-in " model being successful ? Where is the VFM model that is based on any sense of reality comparison with what a good company spends to run a business ? None produced for any of these policies.

    Sadly these ill-thought through reforms will increase transaction costs and put clinicians off leading "clinically led commissioning".

    No one has factored in the now compulsory procurement costs for each contract renewal, never mind the potential legal challenges costs.

    This is on top of the impossible £25 per head running costs policy from "no evidence" base policy drawer.

    Then the real winner CCGs do not need access to patient identifiable information to do our job !!!!!

    What is the point in trying when the powers that be are trying to stop you being able to do your job ? Contract management, 111 call reviews, risk assessment registers etc all to be based on bought in "clean" information? People will look back in three years time to wonder what the idiots were up to ?

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  • The real issue is CSU's are not yet working properly and Bob wants no alternative in his "market" so their will be no choice but to buy in from "independent" specialist CSUs which will all go to market and Bob will be Director of one of the big 4 or 5 consultancy firms to run the market. Nice work if you can get it and sodd choice or best interest of the NHS.
    The policy is set ( but with no evidence it will work) and this is about squeezing out the possible opposition or alternatives before it becomes a viable alternative to buying in !!

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  • Spot on Anonymous 6:18.

    This is all about protecting the CSUs, intended for private takeover in 2016....McKinsey's et al are no doubt complaining that their future cash cows are in danger of being closed down before they get a chance to take them over.

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  • Did anyone really think that Nichloson and his cronies would actually pass control to GP's and other clinicians ???
    CSU's are not working properly and certainly do not offer VFM - they still haven't grasped the concept that they are the supplier NOT the customer and until they do they won't be an attractive proposition to CCG's.

    Lansley's reform was disturbing in the speed of implementation but it is difficult to argue the case that the NHS shouldn't be clinically led?

    The problem you have is that there were a lot of arrogant people in the NHS who think that nobody knows better than they do and all that has happened is that the reorganisation has just moved them to a different place or given them a different title - if you are going to have revolution and not evolution then do it properly and clear out all the dead wood not just move it - the continuing scandals that keep hitting the NHS are evidence enough that it is time to do so - yesterday's news from CQC is a classic example -name and shame those at the CQQ who covered up the failings

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  • Anon 5.48, completely agree. This is a compete shambles and add that the assessment of CCG risks is being done by the very people who are creating the biggest risks in the first place. The incompetence of it all is beyond anything I've ever seen in 35 years of public service.

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  • NHSE won’t allow CCGs to access patient identifiable data thereby forcing them to buy in services from CSUs

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  • NHSE won’t allow CCGs to access patient identifiable data thereby forcing them to buy in services from CSUs

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