Councils have been encouraged by the Department of Health to push to be the organisations that support GPs and clinicians to commission health services in a reformed NHS.
A policy paper circulated to council chief executives said the department would work with the sector to draw up a list of commissioning support functions where local government could “distinctively add value”.
But despite the paper giving broad support to maintaining existing joint commissioning arrangements between councils and the NHS, some in the sector said the changes to PCT boundaries that had already taken place ahead of the emergence of clinical commissioning groups (CCGs) could make this unlikely.
The paper, by the DH’s director general for social care, local government and care partnerships David Behan and director of commissioning development Dame Barbara Hakin, said that “if local government is to be brokered in as a significant provider of commissioning support in the future, more clarity and specificity is needed to define the distinctive local government role”.
To that end, “the pathways where it would be most appropriate for local government to work very closely with CCGs and [the NHS Commissioning Board] as partners in commissioning” will be produced by the department and the sector”.
Where integrated commissioning already exists, such as at Blackburn with Darwen Teaching Care Trust Plus, “a ‘do no harm’ principle should be applied”, the paper said.
“It is important that in the understandable haste to develop strong commissioning support arrangements that existing integrated commissioning arrangements are not unpicked unilaterally.”
However, the paper also made clear that the benefits of local government working with CCGs would not be realised if done at the individual local authority level.
“All potential suppliers must acknowledge the reduced resource envelope under which NHS commissioners are operating and the need for appropriate economies of scale,” it said. “This may well mean that some future joint arrangements for commissioning support will have to work across several local authority boundaries, particularly in some metropolitan areas or where smaller unitaries are situation [sic] in larger counties.”
The NHS has set up support organisations based on clusters of PCTs, which are due to become stand-alone bodies after 2013. Many are on a sub-regional scale, and so councils would have to collaborate if they wanted to provide commissioning services, though some areas may prove too large for this to be practical.
Andrew Cozens, the Local Government Association’s strategic adviser for health and social care, said: “The big concern of local government was disruption to pre-existing joint commissioning agreements and resource pooling when PCTs go and CCGs take over.
“The NHS has put in place externally sourced support already through clusters, and there is a market already.”
He said the paper “helpfully promotes steady state and encourages councils to go further” but was sceptical about the chances of councils of providing wide-ranging commissioning support beyond “so-called Cinderella services including learning disabilities, mental health, homelessness”.