Commissioning support units are engaged in a “ritual dance” to find appropriate partners after NHS England signalled another round of consolidation in the sector.

Close crop of Andrew Lansley's eyes to illustrate Lansley's 2010 vision

Close crop of David Nicholson's eyes to illustrate NHS England's 2013 plan

New details have emerged of how preparations are beginning to assess each CSU on its long term viability. Meanwhile, NHS England’s procurement framework for support services has said the overall number of units offering a full range of services will fall.

The framework is intended to provide the easiest means for clinical commissioning groups to access the sector. However, the document sets out the latest thinking on how the support services market will be tightly managed from the centre, in contrast to former health secretary Andrew Lansley’s vision of CCGs being able to freely choose from a market of support service providers.

HSJ has learned CSUs are in discussions with one another − closely monitored by NHS England’s business development unit − to form networks, which will enable them to get accreditation to the framework.

A two tier CSU sector is expected to result, led by those who gain accreditation from NHS England as “lead providers”. CSUs providing only a narrow range of specialist services could only survive as subcontractors to the lead providers.

An NHS England document leaked to HSJ confirms that each CSU service line will be assured for quality. Privately, CSU leaders expect these tests will be extremely rigorous, forcing the units to form the networks to remain viable.

Part of the purpose of the discussions between CSUs is to decide which are able to become lead providers, which organisations they will partner to supply a full range of high quality services, and whether mergers are necessary.

One CSU leader, who did not want to be named, plans for their organisation to focus on specialist services around transforming pathways of care, without becoming a lead provider. It is now in discussions to join a consortium with other CSUs.

Another senior source described CSUs as being engaged in a “ritual dance where you talk to umpteen people about who you end up going home with”.

HSJ has also learned that NHS England is to continue to evaluate CSUs on their ethos, values and vision. These assessments will form part of the process of making CSUs independent of NHS England, but they have caught some CSU bosses by surprise, because formal assurance “checkpoints”, which focused on the quality of CSU leadership, finished in April.

An NHS England guide to the framework, circulated this month, sets out five service lines that accredited lead providers must offer. They are: “business support and transactional services”; “healthcare procurement and provider management”; “service specific redesign”; communications; and business intelligence, data management and information governance.

The NHS England document says there will be space on the framework for 10-15 lead providers − including private firms and charities and other public bodies such as councils.

As there are currently 17 CSUs, this means some will either cease to function, or will only supply some services by acting as a subcontractor to another CSU. CCGs will be able to procure support services via the framework by early 2015.

The NHS England document says the support services market is potentially worth double what CCGs are currently spending. This week it was expected to circulate guidance to encourage them to outsource more services to CSUs − a move which will be resisted by CCGs.

Once operational the framework will enable CCGs to procure support services within three months - much faster than through a full independent procurement, which can typically take nine to 12 months. NHS England says the framework will also leave CCGs less vulnerable to legal challenge.

Steve Kell, co-chair of NHS Clinical Commissioners, said support service procurement should be “driven by CCGs”. He said: “If it’s centrally driven and centrally prescribed, the less useful it is to CCGs. Having clarity about procurement rules is helpful but it should be up to CCGs how they use those rules.”

  • Update, 18 October Since we published this article yesterday, we have been sent the following statement by Bob Ricketts, NHS England’s director for commissioning support services strategy and market development:

“The article states that the ‘market will be tightly managed from the centre’. Nothing could be further from the truth.  Use of the framework is voluntary and it will be for CCGs to decide what they source from it. There will of course be alternative options available for those who choose not to source from the framework.

“Secondly, the article states we plan to ‘circulate guidance to encourage them [CCGs] to outsource more services to CSUs’.  This is wrong. It is neutral as to who they secure them from. 

“Lastly – the article implies there is a disagreement between NHS England and NHS Clinical Commissioners around the principles that should shape procurement of commissioning support services. This misrepresents our position. CCG choice remains an absolute commitment from NHS England.”