The Framework for procuring External Support for Commissioners has finally arrived. Launched by the Department of Health at the start of last month after several delays, the government hopes that the framework will usher in a change in the shape and strength of commissioning in the NHS.

The DoH’s commercial directorate has picked 14 private sector companies to appear on the framework list, which it hopes will be used by primary care trusts to help them in their commissioning role.

Seven organisations have already started down the road of using FESC, with some at the early stage, drafting a business plan for use of the private sector before consulting the board and other stakeholders.

Others, namely London’s Hillingdon PCT, are further advanced. The organisation has already picked BUPA Commissioning as preferred bidder to help it manage and analyse more effectively the contracts it holds with its acute sector providers.

The results from HSJ’s survey of 93 chief executives, commissioning directors, finance directors and others from a total of 74 PCTs about their views on FESC make for interesting reading. Four in five thought there were ways other than FESC to help the commissioning process at PCT level, and nearly half thought that the framework would prove only ‘a little’ successful within their organisations.

And although the PCTs were fairly confident - 61 per cent of respondents - that their uptake of the use of the FESC would not be performance managed by their strategic health authority, almost all respondents said that their SHA would be performance managing them on the quality and effectiveness of their commissioning.

This HSJ Commissioning supplement is an attempt to gauge the view of commissioners and performance managers on FESC. It analyses the government’s reasons for introducing such a framework and asks how it might work.

DoH director general of commissioning and system management Mark Britnell explains how FESC forms part of the wider push for World Class Commissioning.

We also look at how the seven organisations selected to pilot FESC intend to go forward and what they are likely to use the framework for.

It remains to be seen how FESC will be used and how the private sector-PCT relationship will evolve. A best case scenario is that PCTs recognise what commissioning help they need and use the FESC and those private sector companies on it to provide real, intelligent commissioning expertise which remains within those organisations long after the private companies have departed.

It is clear that many PCTs are failing at present to manage the job on their own and, as Hillingdon PCT’s chief executive Professor Yi Mien Koh says, the private sector could well provide the ‘quick injection’ of expertise needed to make the commissioning process work in a landscape of payment by results, tariff, and an increasing number of semi-autonomous foundation trusts.