All clinical commissioning groups will sign a “development agreement” with the NHS Commissioning Board, and many also be given a “rectification plan”, before they take over budgets next year.
The NHS Commissioning Board’s Guide for Applicants, published in draft form on Wednesday, confirms the details of authorisation requirements which were revealed by HSJ last month.
It also confirms the timetable which will see CCGs told whether they have been authorised between October and January. And the document gives some details of the “conditions” and “directions” the commissioning board will put on CCGs which it thinks are not completely ready to take over from primary care trusts.
The guide says all CCGs will be asked to sign a “development agreement”. It indicates the agreement could be used to set priorities for particular CCGs.
It says: “At the time of authorisation… CCGs will be invited to agree a development agreement with the NHSCB. The agreement will reflect the local challenge and context in which the CCG operates (e.g. financial challenge or major reconfiguration plan for acute services).”
The agreement “may take into account advice from clinical senates, where established, on how CCGs can develop their collaborative commissioning capability to deliver major change, or on how they can improve the extent and range of multi- professional input into commissioning decisions, or on local challenges and context”.
Meanwhile, CCGs which are authorised with conditions will “agree with the NHSCB a time-limited rectification plan for removal of those conditions”.
Commissioning board director of commissioning development Dame Barbara Hakin told HSJ the details of conditions, or arrangements where the CCG is not authorised at all, would be decided on a “case by case basis”.
The document indicates options include the NHS Commissioning Board assigning particular senior staff to develop, support or run the CCG. Another option would be for them to be told commissioning for particular services will be carried out on their behalf by a neighbouring CCG or by the commissioning board.
Dame Barbara said conditions could be as small as improving planning in a particular area. The rectification plan will set out the date by which the CCG should have improved, and have conditions lifted.
Although detailed, the authorisation regime appears less rigorous than Monitor’s approval process for foundation trusts, which many trusts have failed or taken years to pass.
Dame Barbara said it was “developmental” but would ensure CCGs were safe to commission. But she said: “What we are aiming to do is identify whether an organisation is going to develop properly.
“It is really important to remember these are the first NHS organisations to be authorised before they exist. The Monitor process authorises organisations which, if they fail, they still carry on doing their day to day work. It is impossible to compare.”
The guidance document does not detail the assurance and performance management regime which CCGs will have to meet when they take over from PCTs, but it says that framework will “flow directly on from the authorisation process”.