Clinical commissioning groups are opting to host support functions in-house rather than outsource to “unproven” commissioning support services.
The trend threatens to undermine the government’s plan to create a marketplace for “standalone” support services.
The move has come to light amid criticism of the failure of CSSs to engage with CCG leads. It also comes as the NHS Commissioning Board announced this week that plans for three CSSs have been scrapped and a further nine identified as needing “rigorous management” at the critical “checkpoint two” stage of the CSS assurance process.
The national communications service CSS; West Mercia CSS in the West Midlands; and Peninsula CSS, which covers Devon and Cornwall, were judged not fit to proceed.
HSJ understands that the formation of North, East and West Devon CCG, covering a population of 900,000, has given commissioners the scale they need to host their own commissioning support service. This removed a large part of the potential market for the Peninsula CSS.
CCG interim chair David Jenner told HSJ: “We want to retain the organisational memory of skilled health service managers. In my view there is less risk in keeping a service under your own management than outsourcing to an as yet unformed and unproven organisation.”
It appears other CCGs are also planning to spend limited sums with CSSs.
Peninsula CSS had expected an annual turnover of just £4.5m out of a potential £40m spent on support functions by the area’s three CCGs.
Five out of the seven CSSs for which HSJ has obtained budget plans expect to receive less than half of the running cost allowance of local CCGs.
The NHS operating framework 2012-13 set running cost expenditure at £25 per head of population. Expected budgets per head of population amount to £10 in CSS South, covering Hampshire and the Isle of Wight, £12 in Arden CSS in the West Midlands, £8 in South London CSS and £9.50 in Greater East Midlands CSS.
Nottingham City CCG chair Hugh Porter told HSJ it would spend £5-£10 per head of population with the Greater East Midlands CSS. The CSS expects to get a budget at the top end of this range.
“To make clinical commissioning work [we] need to have a cohesive team of managers and clinicians as integrated as possible. We thought we could do that best within the organisation, with a clinician in every contracting team,” he said.
He added that in-house support teams were more flexible, as using outside organisations “potentially turns everything into a transaction”.
Greater East Midlands CSS interim managing director David Sharp said the service had been told by CCGs “we had spent a lot of time creating ourselves and not so much being relevant and visible to our customers”. This feedback was “very chastening”, he said.
Mr Sharp believed the role of the CSS would grow “as they demonstrate they can improve patient care”.
National director of commissioning development Dame Barbara Hakin said key factors in deciding whether CSSs passed the checkpoint included “how committed CCGs were to the particular business model [of each CSS], and how much the leadership of the organisation had managed to make significant inroads into customer relationships”.
For “frontline staff” in the abandoned CSSs, “their day-to-day roles are likely to continue unchanged – but the senior management arrangement and the organisational model will change”, she said.