The Department of Health has extended its commissioning support programme without carrying out an expected value-for-money assessment of the scheme, HSJ has learned.

Health secretary Alan Johnson announced last week that the framework for procuring external support for commissioners, FESC, is now open to all primary care trusts to buy in external support from the list of 14 approved private providers.

"Many PCTs involved in FESC are discovering there are real benefits to bringing in external expertise," he said.

The framework was launched in October as a pilot scheme involving a handful of PCTs. So far only Hillingdon PCT has signed a contract (see below). Both FESC providers and NHS sources told HSJ they had expected the pilot to be subjected to a Treasury value-for-money assessment before being opened up.

The chief executive of one FESC provider told HSJ: "The DH's intention was to only open FESC after a value-for-money analysis by the [DH] commercial directorate and the Treasury to make sure it wasn't just a bonanza for the private sector, because the range of opportunities is huge in terms of what the PCT can [contract]."

PCT Network director David Stout said he had also expected a value assessment before the scheme was extended.

The department is understood to have agreed with the Treasury that it makes more sense to assess the value money of FESC after a full year for its wider operation. The move to extend the framework comes as the DH prepares to launch an assurance test to measure how good PCTs are at commissioning services as part of the move towards "world class commissioning". FESC providers are keen to see the details as they believe it could encourage PCTs to take up more of their services.

Asked if the timing of the two policies meant there was now a risk that PCTs could rush into contracts with FESC providers, a DH source said it believed that would only happen in a "minority of cases". The risk was minimised by the fact that PCTs must still agree any FESC contracts with their strategic health authorities.

The world class commissioning assurance test has been trialled at five PCTs in the North West. NHS North West director of commissioning and performance Joe Rafferty told HSJ the test was "searching and challenging for PCTs".

"It's sufficiently uncomfortable enough to ask the really important questions of both organisations and individuals," he said.

All PCTs are expected to take the test every year from this summer. In addition to peer and self-assessment, it will involve top management being quizzed by an assessment panel on evidence submitted on the PCT's procedures and relationships. The process took six weeks in pilots but could be shorter when rolled out.

Speaking at the PCT Network conference last week, Birmingham East and North PCT chief executive Sophia Christie said she expected the test to be tough.

A DH spokeswoman said: "Use of FESC will not be part of assessment under the assurance system for world class commissioning. The system will provide assurance in health outcomes, organisational competencies and governance. Whether PCTs have these capabilities and are delivering improvements in outcomes will be determined under the assurance system, not the tools (like FESC) used to do so."

Progress so far

October 2007

  • DH names seven early adopters of FESC and promises to share lessons from their experience.

January 2008

  • Hillingdon PCT signs deal with BUPA.

March 2008

  • West Midlands Commissioning Business Support Agency "pausing and taking stock".

  • Cambridgeshire PCT withdrawn from talks for "practical reasons and to focus on other PCT priorities".

  • Ashton, Leigh and Wigan PCT in talks with UnitedHealth, BUPA, Humana, McKinsey and Tribal. Expects to sign contract in May.

  • North East Lancashire PCT in talks with UnitedHealth, BUPA, Humana, McKinsey, Tribal, Navigant. Expects to sign a contract in the spring.

  • NHS East of England in talks with UnitedHealth, BUPA, Humana, Axa. Expects to sign a contract by September.

  • Hampshire PCT will present business case to board late summer.