Primary care trusts that demonstrate they are 'world-class commissioners' could be rewarded with foundation trust-style freedoms.

The Department of Health has dispatched a questionnaire asking for ideas on what 'world-class commissioning' - the phrase coined by director general of commissioning and system management Mark Britnell - might look like.

In a letter sent with the questionnaire, DoH commissioning director Gary Belfield says a central aim of the world-class commissioning programme is introducing 'earned autonomy' for PCTs as a reward for being effective commissioners.

Freedoms could include less frequent performance management, greater financial autonomy and the ability to enter joint ventures without DoH permission.

Mr Belfield said the questionnaire followed on from the government's fitness for purpose exercise, which analysed PCT's commissioning capabilities last year.

The letter, sent to stakeholders including NHS Confederation networks and a number of Framework for Procuring External Support for Commissioners suppliers, said the programme had three main aims:

  • 'To articulate the vision of world- class commissioning over the next five years, clearly setting out what it is and what PCTs need to do to achieve it;

  • 'to put in place an earned autonomy system for effective commissioning, to hold people to account and to reward development;

  • 'to put in place a support and development programme that PCTs can access to improve their commissioning capability.'

NHS Confederation PCT network director David Stout said the consultation aimed to get a consensus. 'We need to know what it would look like and what the competencies and attributes would be,' he said.

The DoH is thought to be keen to draw up 10 to 15 competencies that PCTs would need to adopt to become world-class commissioners.

Mr Stout said the government wanted to compare the best UK and international commissioning. He said when the DoH decided what commissioning should look like it would set a system to judge whether PCTs were achieving it.

'Part of this process is to define that and develop a compliance regime which would allow PCTs to have an earned autonomy and greater independence on a parallel with foundation trusts,' he said.

PCTs are expected to be subject to risk-based regulation, similar to that imposed by Monitor, but overseen by strategic health authorities.

The DoH will also hold a 'world-class commissioning' conference at Warwick University at the end of September. This will involve around 75 'leading thinkers and practitioners from the NHS and its partner organisations'.

NHS Partners Network acting general manager Graham Kendall told HSJ commissioners would need to demonstrate broad capabilities. 'They need to show breadth of vision, have no preconceptions, be financially competent and able to measure value for money, be free from political interference, and have good negotiating skills,' he said.

Great Yarmouth teaching PCT chief executive Mike Stonard said it made sense to 'leave PCTs alone' if they were performing well.

'Our local SHA operates this model already in that if a PCT is going through financial recovery or there are concerns then the SHA will intervene and PCTs will be subject to a monthly performance review. However, if they are doing well they will be performance managed on a quarterly basis.'

Another PCT chief executive based in the North said that he hoped earned autonomy for PCTs would mean 'financial and capital expenditure freedoms and the ability to enter joint ventures with local authorities without having to get permission from the secretary of state or SHA every time'.

Sheffield PCT chief executive Jan Sobieraj said PCTs should be allowed to have the same type of freedom as foundation trusts.

'The key thing is for PCTs to demonstrate that they are good enough to be left alone and only be performance managed year by year by SHAs.'

The questionnaire: what the DoH is asking

  • What do you believe should be in that vision [of world-class commissioning]?

  • What do you believe 'world class' looks like?

  • What are some of the competencies that PCTs need to have in order to deliver the vision?

  • Where could we find 'world-class' examples of these competencies?

  • An 'earned autonomy' system for effective commissioning is proposed. This will hold commissioners to account and reward development. Do you have any advice on the system's design?