Exclusive: DH publishes detailed plans for commissioning support

Draft guidance on commissioning support seen by HSJ says “business intelligence” such as collecting and organising data, “major clinical procurement”, back office functions such as IT, estates management, human resources and finance, and communications services are best done “at scale”.

The document, Towards Service Excellence, was circulated to primary care trust cluster leaders late last week. It says: “There is evidence to indicate that initially a national approach might enable the most effective delivery of each of these services.”

The DH considers the four functions “critical to the future smooth running of commissioning”. It says that in each case considerable savings would be demonstrated by delivering the functions nationally and they risked becoming unsustainable if not centralised.

Officials are considering a range of options for how these services are structured in future. They are: A single nationally managed service, delivered locally; a nationally-coordinated network, with teams in various locations providing different specialist elements, and the potential for these elements to become separate organisations later; a hub approach, with the potential to create several organisations later; and a national specification and price with a range of approved suppliers.

Elsewhere the guidance appears to recommend strategic health authority-sized bodies to provide some parts of NHS business intelligence.

It says: “Evidence from South Central, West Midlands and East Midlands suggests aspects of business intelligence would be delivered most effectively by operations that cover an average population of around five million. If these sized units were replicated nationally this implies that these aspects of business intelligence could be provided from approximately 10 units.”

The document also renews the DH’s commitment to a full marketisation of commissioning support. “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of commissioning support now, needs to make the transition from statutory function to free standing enterprise,” the draft guidance says.

Clinical commissioning groups will have to enter into formal procurement to purchase commissioning support. The DH says: “Where an alternative provider is selected through procurement TUPE [transfer of undertakings (protection of employment)] is expected to apply.”

The guidance proposes that the “period of NHS development is extended” so that NHS commissioning support units, currently being developed by PCT clusters, will be hosted by the NHS Commissioning Board until “no later than 2016”. They would remain at arm’s length from the Commissioning Board and “operate on commercial lines”.

Meanwhile, between 25 and 35 “end-to-end” commissioning support units have been suggested. These services, currently delivered by staff in PCT clusters, would be shared by CCGs to maximise commissioners’ power in negotiations with providers.