There is strong support among local leaders for changes to the nine-month-old commissioning system, including support arrangements and NHS England’s responsibilities.

In the HSJ clinical commissioning group barometer survey, run with Marie Curie Cancer Care, 28 per cent said interactions with their commissioning support unit were unhelpful or very unhelpful.

This is an increase from 6 per cent in answer to the same question in January and 7 per cent in April.

More CCGs remain positive, with 41 per cent describing interactions as good or very good in this survey. However, this has fallen from a figure of 62 per cent in both January and April.

The survey also finds a large and much increased proportion of CCG leaders plan to bring significant further functions in-house to their organisation, away from support units.

A smaller but also growing proportion plan to retender a significant amount of support. Asked about choice of CSU, 67 per cent said it was very or fairly important and only 10 per cent said it was not important.

Growing dissatisfaction and problems with support services present a dilemma for the new system. Many CCGs would struggle to afford to host many more functions internally under a capped admin spend, while CSUs will be destabilised if they lose a lot of custom.

One well connected CCG leader said the support model was “broken” but it was not clear how to fix it.

One northern CCG chief officer said: “CSUs are a much more significant matter to NHS England than CCGs. We seem to have got their importance totally out of proportion…They provide little value to CCGs and no value to patients.”

A northern CCG’s chief clinical officer said: “I have a good CSU on the whole but it is still difficult and gets more so as the challenges and new requirements are loaded on us. Can’t see how this will be affordable in future or that we will get what we’re really need.”

The survey also revealed support for changes to the split of responsibility between CCGs, CSUs and NHS England, and more than half CCGs said they would formally ask for delegated responsibility for primary care.

Asked about overarching priorities for the incoming NHS England chief executive, 70 per cent of respondents agreed with an aim to “reorganise split of commissioning responsibility between NHS England, CCGs and support units”.

An NHS England spokesman said: “CCGs and CSUs are currently grappling with a very difficult NHS contracting round and the strategic challenges of the Call to Action, whilst re-negotiating their service level agreements for commissioning support. We are therefore not surprised that in some places there are tensions in relationships. Feedback from other CCGs, however, clearly shows that they value and wish to retain the support they receive from their CSU, and some CSUs are already playing a key role in supporting major service re-design and transformation.

“We have encouraged CCGs and CSUs to address any concerns about service quality and/or price when they re-negotiate their SLAs, to put relationships on a sounde4r footing. The proposed Lead Provider Framework - which CCGs and CSUs are co-developing with us - will set very high standards for capability and capacity, which we believe will drive-up quality and improve value for money, and is already creating a strong momentum for improvement. We are on-track to go to OJEU for the Framework in March 2014.”

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