Plans for NHS England to co-commission specialised services with clinical commissioning groups will lead to ‘poorer access’ because the ‘vast majority’ of services will be exposed to ‘competing local pressures’, a group representing patient organisations has claimed.

NHS England last month published “notional allocations” for the 2015-16 specialised commissioning budget – £13.5bn was “mapped to CCGs” and £1.1bn remained solely at national level.

NHS England produced the notional allocations to give an impression of how the specialised commissioning budget, which is held by the national body, could be distributed across the country when co-commissioning starts.

David Oliver

Critics claim co-commissioning will hinder access to services

The Specialised Healthcare Alliance, a coalition of more than 100 patient related organisations, claimed that if co-commissioning happens on such a scale, access to the majority of services will deteriorate because CCGs will be “incentivised to redirect funding away from specialised care”.

Under NHS England’s plans, if there is underspending in an area’s specialised commissioning budget, at least part of it will go to the CCGs to spend at their discretion. The aim of this is to control the burgeoning specialised commissioning budget by providing an incentive for investment in other services “to reduce demand on specialised [commissioning]”.

John Murray, director of the alliance, said: “Recent experience shows that local commissioning will lead to poorer access to care for people with rare and complex health needs.”

He added that while it was important NHS England worked closely with CCGs, the national body “must attend to its responsibilities rather than seeking to ditch them”. 

The alliance’s claims have been disputed by NHS Clinical Commissioners. Co-chair Steve Kell said NHS England would still “retain financial responsibility” for specialised commissioning, with CCGs being invited to be “more involved in discussions about… services in their areas”.

“There is no evidence to show that co-commissioning or collaborative commissioning would result in poorer access to specialised services overall,” he added.

However, NHS Clinical Commissioners did separately criticise NHS England’s plans to fully transfer the responsibility and budgets for two specialised services – renal dialysis and morbid obesity – to CCGs by April. The group claims the plans, which it says have been “imposed upon CCGs”, will put patients at risk because commissioners will be unprepared for the services. It has called for the transfer to be delayed until April 2016 and wants CCGs to maintain their “freedom” to draw up service specifications.

Dr Kell said it was important the “transfer is not simply moving financial risk from one part of the commissioning system to another”.

NHS England was approached for comment.