Clinical commissioning group leaders have firmly asserted their independence ahead of an attempt by NHS England to encourage them to make more use of commissioning support units.
NHS England is expected to send guidance to CCGs this week setting out how and when they can provide their own support services, rather than using CSUs.
It is anticipated that the guidance will set a high bar for CCG-provided services, and will require them to draw up business cases demonstrating that their own services are not of a lower quality and or value for money than those available from CSUs.
CCGs are also likely to be told that they should bear in mind the needs of their neighbours, and should avoid taking decisions that harm the support service provision available to others. This could happen if one commissioner stops using a CSU, and in doing so undermines its financial viability even if other CCGs wish to carry on using it.
NHS England’s procurement framework blueprint says that although CCGs are currently spending about £550m on support services, the market is potentially worth £1bn.
Bob Ricketts, NHS England’s director of commissioning support strategy and market development, has previously expressed scepticism that inhouse services could demonstrate value for money.
In response, HSJ has learned that NHS Clinical Commissioners’ stance will be based around five principles which together assert the sovereignty of CCGs.
- As independent autonomous organisations, CCGs must be free to choose whatever they feel is the most appropriate route to deliver their commissioning support based on what is best for their population
- As statutory bodies, accountability for any decision has to lie with the CCG governing body
- The decision (about where support services are provided) is best made by the CCG
- While CCGs will wish to take into account the impact of decisions on other CCGs, the responsibility of the CCG does not necessarily include the commercial viability of the commissioning support provider.
- NHS England has a role in assurance that a robust process is being followed but must start from the basis that CCGs will make mature decisions and there will be a wide diversity of decisions made.