DH commissioning support vision revealed

The plans, which would see some functions run by around 30 standalone units descended from primary care trust clusters, has been attacked for attempting to satisfy too many competing priorities, and described as conflicted and “messy”.

The draft guidance from the DH was circulated to PCT cluster leaders last week. It confirms commissioning support organisations are intended to become independent bodies by 2016. Officials “expect” that by then a commissioning “market” will be established, enabling clinical commissioning groups to buy in support services.

The commissioning support organisations currently being established by PCT clusters will evolve into 25-35 “end to end” units, providing a range of services to be shared between CCGs. The guidance says collective power provided by these units will aid CCGs in negotiating contracts with major providers. The guidance says that for many services, commissioners and support service staff should work together on a medium or long term basis.

• View the Towards Commissioning Excellence draft attached right

From 2013 – when PCTs and strategic health authorities cease to exist – to “no later than 2016”, commissioning support will be “hosted” by the NHS Commissioning Board. It will ensure these services are efficient and viable, ahead of their full scale marketisation. “The NHS sector, which provides the majority of commissioning support now, needs to make the transition from statutory function to free-standing enterprise,” the draft guidance says.

The DH is to set up a business development unit, to “maximise commercial development”, by April 2013. This is intended to minimise the length of time the commissioning board hosts commissioning support.

Some services, such as those associated with running a CCG, will be provided separately. The DH has identified four commissioning support functions which should be provided “at scale” – possibly on a national level.

The guidance recommends the procurement of clinical equipment, back office functions such as HR and finance, communications and, business intelligence such as data analysis are carried out using CCG staff working in a “national system”.

“Initially a national approach might enable the most effective delivery of each of these services,” the document says. This could involve a central organisation with local outposts, a centralised network of smaller bodies, or a range of providers operating to central standards.

The guidance suggests that the best scale for some business intelligence services might be at a level similar to the size of SHAs, which have now been clustered. It suggests 10 bodies, each serving a population of around five million.

Nuffield Trust senior fellow Natasha Curry said the guidance “seems to be trying to satisfy two different needs, both of which are likely to be in conflict for as long as the efficiency challenge continues to bite”.

She said while it was logical for CCGs to save money by pooling support functions, “how that squares with the aim of developing a plural market is not made entirely clear… providers would be forgiven for asking what exactly is the real policy”.

“There are also questions about whether the commissioning board is well placed to add commissioning support to its already extensive and indeed lengthening list of functions,” she said.

PCT Network director David Stout said the solution was “messy, but about as good as you’re going to get”.

“This could become very centralised and controlling – or it could be very liberating and very free. It depends on the style of the commissioning board,” he added.

CCGs will be able to run in-house commissioning support organisations, sell services to other CCGs and/or work together to provide support collectively. However, the document emphasises CCGs’ clinical knowledge and their relationships with patients. “It is vitally important that they are enabled to focus on these strengths,” it says.

CCGs will be free to decide for themselves if they want to procure commissioning support from alternative providers from 2013. TUPE (employment protection) rules for ex-PCT staff transferred to new providers are expected to apply.

The DH guidance says commissioning support organisations will be under pressure to cut costs, and that the services are “likely to be delivered by a reduced number of organisations and by a reduced cohort of NHS staff” during the next 15 months. The document says it is imperative that commissioning support is “an attractive proposition for talented and experienced people currently working in the NHS”.

Managers in Partnership chief executive Jon Restell said although it was difficult to know how many NHS staff would be affected, “my guess would be at least 10,000 and probably many more”.

He welcomed plans to host commissioning support services centrally. “It’s a way of holding on to existing people and skills by offering them some certainty over the next five years,” he said.

Support organisations will set out a service “prospectus” by December. An outline business plan will be published by March 2012 with a full business plan following by the end of August.