Clinical commissioning groups will be liable for the cost of making primary care trust staff redundant if they use non-NHS suppliers of commissioning support, HSJ understands.
Guidance due to be published in coming weeks will reiterate that CCGs will be free to decide who provides their support from April 2013.
However, it will also give them an incentive to buy from commissioning support providers developed from PCT clusters, by saying CCGs would foot large redundancy bills if they chose to use alternative suppliers.
In the new system, roles performed by the majority of current PCT staff are likely to become the responsibility of commissioning support providers.
Several senior sources involved in the discussions said the guidance would also begin to set out options for commissioning support units.
Previously, the government has said commissioning support would be provided by commercial or third sector providers in conjunction with former NHS commissioners, or by local authorities. The current plan is for most commissioning support units – employing current commissioning staff – to initially be “hosted” by the NHS Commissioning Board from April 2013. Some of the units may also be hosted by CCGs.
However, support units hosted by the board will still be expected to become fully independent of it and move to a commercial or social enterprise model by 2016. The Department of Health thinks there is not enough time to establish robust independent providers by April 2013.
The likely number of commissioning support units is not yet known but it is thought they will be fewer in number than PCT clusters – of which there are 51. Some will provide services nationally.
James Kingsland, DH adviser on clinical commissioning and National Association of Primary Care president, said it was right for CCGs to be able to decide their own support, but that in many cases they would want to retain current PCT managers.
Dr Kingsland said: “We’ve got to be absolutely clear, we’ve got to retain managers. There is experience and skills at stake here. But I don’t think we should be saying, ‘You have no option’.”
Although ministers have accepted the NHS Future Forum’s recommendation that CCGs should not cross local authority boundaries, commissioning support services are likely to cover more than one local authority area. This is due to an expectation that they would not be financially viable for areas with a population of fewer than 300,000 people.
HSJ’s sister magazine Local Government Chronicle understands at least one local authority area that is keen on running its own commissioning support services has identified the population issue as a potential barrier to its plans.