Clinical commissioning groups will have to meet 118 authorisation requirements to be approved to take over from primary care trusts in April next year.
HSJ has obtained details of the authorisation process which show CCGs will be assessed in four “waves” with their fate announced between October and January (see attachments).
They will have to submit evidence against each of the criteria including 16 specified different types of documentation.
One NHS source who is helping CCGs prepare said it resembled the notoriously laborious world class commissioning process carried out for PCTs in 2009 and 2010. However, other senior sources said the requirements had been well received by clinical commissioners who had been consulted.
An NHS Commissioning Board presentation describing the authorisation process says it will involve submitting evidence including a series of “case studies”, and a “desktop review” and “site visit” by the board.
It will also involve a “360 degree review” by others in the CCG’s health economy. Around 40 people will be surveyed about each CCG. Representatives from local providers, other CCGs, local authorities, patient groups and member practices will be asked about “experiences of working with emerging CCGs so far and opinions of CCGs’ potential to deliver quality, clinically-led commissioning”.
The board slides also reveal there will be four waves of applications. HSJ understands strategic health authorities have been asked to report on CCGs’ readiness, and help decide which wave they will apply in.
A separate document, compiled by the NHS Institute for Innovation and Improvement to present to CCGs, includes details of the requirements. They are likely to be largely unchanged in a commissioning board authorisation guide to be published in coming weeks.
HSJ understands if CCGs meet all the requirements they will be fully authorised. If some are not met the CCG may be allowed to take on budgets but with “conditions”, or authorised only in “shadow” form.
Neither of the documents say how commissioning would operate in these circumstances. Commissioning board chief executive Sir David Nicholson has made clear the board will not take on CCGs’ duties itself, although it may maintain a right to veto their decisions.
Potential options include passing such groups’ budget to a neighbouring CCG, requiring them to take on specified senior staff, or franchising their management.
Meanwhile, despite the long list of requirements, some notable issues are left out. For example, although CCGs are expected to have involved professionals other than GPs, there is no mention of clinical senates. Following the “pause” to its reforms and the NHS Future Forum review last year, the government said senates “will have a formal role in the authorisation of CCGs”.
A spokesman for the commissioning board said a formal guide to authorisation was due to be published in coming weeks. He said: “As with all NHS Commissioning Board Authority documents, key elements of the guide to authorisation have been widely shared and discussed with CCGs and SHA/PCT clusters in advance of publication.
“In this case we’ve been around the country at regional events that were attended by the majority of CCGs to ensure we have listened to their views on, and helped them to prepare for, the authorisation process.”