Plans to “externalise” commissioning support units should be given a lower priority over the next two to three years than establishing a market in support services, HSJ has been told.

Bob Ricketts, the NHS Commissioning Board’s director of commissioning support strategy, told HSJ the immediate focus should be on ensuring the market was capable of supplying clinical commissioning groups with high quality services.

He said the board was considering establishing “light touch regulation” of the quality of commissioning support, which would apply to CSUs, the private sector and CCGs supplying support services to their peers. The board is also likely to set up a “continuity of service” regime to ensure a CSU’s failure would not leave CCGs without services, and give extra support to CCGs to enable them to be informed customers of support services.

These measures should enable a mixed, competitive market supplying support services to CCGs to be established, Mr Ricketts said. “That should be a sustainable position for at least two or three years. We then need to think what would externalisation add to that. There may then be good reasons in terms of how the market develops to say we do need to externalise CSUs at some point.

“But in my view, it would be foolish to concentrate too much now on externalisation until we’ve got in place a sensible, mixed, managed market and we’ve seen how it develops. Too much of the debate has been focused on the end point, and too little on that we need to do to get an efficient, effective CCG-driven market in place first.”

Successful CSUs will be “barely recognisable” from the organisations currently under development, Mr Ricketts said. The best ones will supply both “transactional” products such as human resources and finance, and “transformational” services enabling CCGs to reconfigure, integrate or redesign services.

Although the support services market is likely to be “dominated” by CSUs, these will be networked, and be able to bring in expertise from commercial providers, academic and third sector organisations and other support units.

“Success will be around developing a market where there’s competition, but there’s a strong ethos around how you succeed is in developing effective partnerships to pool together the resources that CCGs will need to do transformation,” Mr Ricketts said.

However only a “cohort” of the 23 CSUs under development were currently showing they were able to deliver the range of services CCGs will need, he said. “We’re looking to support and add to that cohort.”