Clinical commissioning groups could be handed a role in commissioning a significant chunk of the £14bn specialised services budget, HSJ has learned.

The move is being considered by a working group established by NHS England’s specialised commissioning task force. NHS England currently commissions the services.

While discussions are at an early stage, HSJ understands that NHS England could ditch sole responsibility for up to half of the 143 services it commissions either through co-commissioning or the wholesale transfer of responsibilities.

The commissioning of services such as renal dialysis and chemotherapy - collectively worth £1.7bn - could be transferred to CCGs.

Steve Kell, co-chair of NHS Clinical Commissioners leadership group, has been involved in the discussions with NHS England. He told HSJ that CCGs would commission or co-commission specialised services where it made sense for patients, but only if they were given the means to do so.

“We need the resources to shift with the responsibility… What would be wrong was if CCGs are handed the bits that are too hard,” he said.

In 2013-14 - NHS England’s first year of commissioning specialised services - the plans were beset by data issues and ended with a £377m overspend.

John Murray, director of the Specialised Healthcare Alliance, said unless these issues were resolved, transfers would be a “nasty parcel” for CCGs.

He also pointed out that changes to services defined as specialised was a decision for ministers, rather than for NHS England.

The national commissioning of specialised services - significantly extended by the Health and Social Care Act 2012 - was designed to end the “postcode lottery” for patients requiring cutting edge treatments.

NHS England oversaw the development of specifications written by leading clinicians for each of the services. It is unclear whether these conditions would form the basis for co-commissioning.

Mr Murray said: “If services are not going to be commissioned in line with the specifications then we would quite quickly revert to a situation where we have a patchwork quilt of provision in many areas.”

However, Charles Alessi, chair of the National Association of Primary Care, said it made sense for CCGs to take on more responsibilities now they were more mature.

He said: “Secondary care clinicians from tertiary and quaternary centres will push back against this because they prefer to have one system for the country, and I have some sympathy with that, but the reality is the country is
not homogenous.”

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