Campaigners have expressed concern the planning of services for highly specialised conditions may be become more fragmented, potentially harming patients, under plans for the NHS Commissioning Board structure.
The warning, given to HSJ, came from the Specialised Healthcare Alliance which represents patients and charities for about 70 rare and complex conditions, many of them severe and life-threatening.
Examples include lysosomal diseases, acute porphyrias and very severe obsessive compulsive and body dysmorphic disorders.
Currently the services are commissioned nationally, separately from the 10 regional groups which commission most specialist services.
However, the alliance told HSJ that the board had drawn up plans for all specialist services – including for rare and complex conditions – that would be commissioned regionally by 10 of its local area teams.
Alliance chief executive John Murray said it was in discussion with the board, but was concerned about current proposals.
He said: “It seems to us that the diffusion of expertise in this way is not obviously going to be more efficient and potentially carries with it some risks.
“There are very small patient populations [for the conditions] and very small numbers of providers.
“There is scope for problems in the coherence of management, and in their relationships with providers, which are absolutely vital to patient care.”
Mr Murray said having a single national team for specialised conditions promoted innovation. He said medical and technology developments were often led by teams working in these areas.
A spokeswoman for the commissioning board said: “The NHS Commissioning Board will keep a clear focus on highly specialised services within the wider remit of specialised commissioning and has designed the new clinical commissioning system and its own operating structure to ensure we commission the best possible, high quality services for patients with rare and specialised conditions.
“There will be complete alignment between the clinical planning and the contract delivery functions at a national, regional and local level to ensure this happens.”