Most clinical commissioning groups will be unable to bring in major new support services to replace ex-primary care trust staff until early 2014, new Department of Health guidance indicates.
The DH last week published a revised draft of its Developing Commissioning Support: towards service excellence document, a previous version of which was leaked to HSJ last month.
The new draft says CCGs are very unlikely to have major support contracts in place by April 2013, when they are due to take over from PCTs.
It says: “At the point that CCGs are ready, willing and able to access commissioning support, they will need to undertake formal procurement processes in line with the rules that govern the public sector. In view of the governance arrangements that will need to be in place, [the procurement process] is likely to be beyond April 2013.”
In contrast, the corresponding passage in the earlier draft had said: “From 2013, CCGs will be able to get their commissioning support from wherever they wish.”
The new guidance points out that significant public sector procurements take up to a year, meaning it would be difficult for CCGs to move to new support services until early 2014.
HSJ understands DH officials decided to emphasise that CCGs will not be statutory bodies until April 2013. This means they would need to work with PCTs if they want to procure any support services to begin on that date. A senior NHS commissioning source acknowledged that some CCGs would see it as another limit on their freedom, but insisted that was not the intention.
Sources suggested the DH is also keen to retain PCT staff by giving them more job security, thereby avoiding potential redundancy bills if CCGs sought support from outside the NHS.
At last week’s National Association of Primary Care conference, health secretary Andrew Lansley told GPs that many talented people already worked in PCT clusters. He suggested GPs would want to recruit them directly or contract with them as part of external organisations.
A lawyer working on NHS commissioning said the DH could have sent a stronger message telling PCTs to buy on CCGs’ behalf. Since that was not the case, he suggested the guidance probably reflected a desire to “give [PCT] staff an extra year of certainty”.
The revised guidance also acknowledges that support providers may be “apprehensive” about taking part in “procurement or entering into a contract for commissioning support with any prospective CCG” before they become statutory bodies. Often there will be no guarantee that a CCG would be fully authorised to take on commissioning budgets.
The document says the DH will work with the most “advanced” CCGs to “understand” how they could buy support in time for April 2013.
It says “for specific products and services… PCT clusters [could] undertake a procurement process on behalf of prospective CCGs”. However, it acknowledges PCT staff may be reluctant to help CCGs procure alternatives support services.
Derek Felton, executive director at Ernst and Young, a potential support provider, said: “Everyone recognises the constraints around procurement timelines but there is a job to be done and there are opportunities to accelerate delivery [of efficiency savings] alongside [the] transition, through practical public-private sector partnerships.”
A government source told HSJ: “The point [of the guidance] is to send a clear signal that they should be thinking about commissioning support now. Those that are most advanced should use 2012-13 as a year to talk to suppliers and begin to put arrangements in place.”
The revised guidance drops a previous reference to 25-35 “end-to-end” support units, because of concern it was dictating the number of services needed. It also highlights the potential for joint working between commissioning support suppliers – for example joint ventures – and emphasises the role of local authorities.
Local Government Association strategic lead for adult social care and health Andrew Cozens said it was a “welcome reflection of our representations about local government’s contribution and experience”.
The new guidance also says “scale services” such as IT, estates management and human resources and payroll will not be “a single national function” but there will be a “coordinated approach” to setting them up.
Business intelligence services, such as data analysis, are likely to take the form of a “network arrangement, with many staff located at all levels in the system”.