Commissioning support units will be given a choice of four options for becoming independent, under proposals under consideration by senior leaders at NHS England.

Director of commissioning support strategy and market development Bob Ricketts has submitted his recommendations for the “autonomisation” of CSUs to NHS England chief executive Sir David Nicholson.

He recommends there are four possible options for each CSU. These are:

  • A social enterprise, such as a community interest company;
  • A staff-owned co-operative;
  • A joint venture with a private sector partner; and
  • A customer ownership model.

CSUs are currently hosted by NHS England but, under current policy, have to become independent by spring 2016. One possibility now ruled out is for a CSU to be hosted by a foundation trust. HSJ understands that option had been under discussion earlier this year.

HSJ revealed discussions about the fourth option in August. If implemented, it would see CSUs remaining in the public sector, as they would be hosted by clinical commissioning groups. This would be interpreted as a significant shift from the Department of Health’s original intention to create “freestanding enterprises”.

HSJ understands that under current thinking, NHS England could retain a share in “autonomised” CSUs. It is not clear whether this would be a controlling stake. An NHS England spokeswoman said: “The ownership of future stakes (if any) needs to be considered further by the [NHS England] board.”

The spokeswoman said NHS England was not proposing CSUs be allowed to blend the four options.

This means CSUs would not be able set themselves up as a community interest company run as a staff co-operative, for instance, or a joint venture partially owned by its CCG customers.

HSJ has been told there is an appetite among CSU leaders for these mixed approaches.

For example, one senior CSU figure said their organisation was enthusiastic about becoming a not for profit company, with an ownership split between CCGs, staff, a private partner and either the DH or NHS England. That model, the source said, would ensure that the organisation retained NHS values, while binding in staff and customers, and enabling the CSU to access capital or expertise from outside the NHS.

Several senior sources said they did not expect the third option – a private sector joint partner – would be used to sell CSUs to private equity funders, contrary to some recent reports. NHS England estimates the commissioning support sector is potentially worth around £1bn.

The proposals are due to be considered by NHS England’s board next month. If they are approved there will be a three month consultation period.

Shadow health secretary Andy Burnham said earlier this month that CSUs would remain in the public sector if he became health secretary.