Clinical networks could be given a more prominent role to address fears that greater NHS competition will lead to service fragmentation and greater variations in standards of care.

The DH is reviewing the role of the networks, the multi-professional and usually regional groups overseeing the care of particular conditions. Their future funding and existence has been in question but it now appears they could be put on a firmer footing.

NHS medical director Sir Bruce Keogh has been asked to look at the issue by NHS chief executive Sir David Nicholson. He told HSJ: “We need to work out how to make them more useful to bringing better quality care, and bringing commissioners and providers closer together. They are not only safe but they are going to be improved.”

There have been concerns that proposals for greater competition could damage service integration and cooperation and that a larger number of more autonomous commissioners and providers could exacerbate variation in standards, especially as targets are dropped.

One national clinical director for a disease covered by the networks told HSJ: “[Sir] David sees [the networks] as one way of bridging the issue of integration and competition. Collaboration and competition has been one of the difficult issues.”

NHS Networks chair Peter Melton, a North East Lincolnshire GP, said networks could develop into collaborations between commissioning consortia, become providers of external expertise to consortia or act as a link between consortia and the NHS Commissioning Board.

They would be particularly important for less-used specialist services where competition would be unhelpful, he said.

At present some of the funding for networks, which are generally hosted by NHS organisations, comes from strategic health authorities and primary care trusts.

Sources said the DH review was a strong indication they would be funded beyond April 2012, although there has been no confirmation of where this money would come from, or what form the networks would take.

HSJ understands the future of national clinical service frameworks and directors also remains under review. The government published a national outcomes strategy for cancer last year and programmes supporting other existing strategies have been extended until April 2012.

But sources – including some national clinical directors – said it was unclear what would happen beyond next April and that there may still be a reorganisation of national clinical roles, with some directors leaving.

Under consideration is allowing future strategies to cover an entire programme budgeting category, for example respiratory disease rather than chronic obstructive pulmonary disease, and reorganising clinical advisers under the five “domains” identified in the NHS outcomes framework.