NHS England is to carry out a fundamental review of its use of commissioning support units, which could see more of the national commissioning body’s back office functions being outsourced, HSJ has been told.

NHS England interim director for commissioning development Ros Roughton said that the review would identify its functions that could potentially be provided by CSUs or procured competitively.

She said budget pressures were one reason for the national body, which currently employs around 6,000 people, to reconsider which services it hosted in house.

“We are always looking for efficiencies on our running cost,” she said. “So [we are considering whether] we are making the most of at-scale offerings. Where we’ve got business at scale we should be [outsourcing] if we can be more efficient.”

CSUs are already providing some services for NHS England, and for many clinical commissioning groups, on a regional or national scale. These include procurement support and support for NHS England’s specialised services commissioning.

Ms Roughton said that since NHS England was encouraging CCGs to use CSUs rather than employ their own staff, “we should ask the same of ourselves”.

She suggested NHS England’s need to reduce costs by outsourcing may be greater than that of CCGs.

“We took a bigger [reduction] on running costs than clinical commissioning groups,” she said.

The review is expected to be finished by the end of November. It is not yet clear which functions are likely to be outsourced to CSUs. However, Ms Roughton said family health services − which covers the commissioning of GPs and other primary care − was not likely to fall under the scope of the review, as it was currently subject to a “massive transition programme”.

Staff carrying out those functions were largely directly transferred from primary care trusts to NHS England in the spring, rather than being restructured, so the organisation is currently changing how they operate.

Meanwhile, Ms Roughton said she hoped NHS England would never again have to exercise its powers to break up a CSU, as it had done for Surrey and Sussex CSU earlier this year, when it was deemed unviable.

She also told HSJ that forced mergers of CSUs “take a long time to realise the benefits”.

Instead, where CSUs were not serving their customers well, she said: “Our approach would be that we already know a number of the CSUs are looking at what opportunities they have to deliver a better offer by working together − we certainly support that.”