North west London CCGs to bring services in-house

The decision, made last week by eight north-west London CCGs, comes as their counterparts across the country begin negotiations on new service level agreements with commissioning support units.

The North West London CSU, which had previously provided services for the group of CCGs, now aims to merge with two neighbouring CSUs as it is no longer sustainable as an individual unit. Work for the eight CCGs was worth £31m, almost a third of its total income.

A spokesman for the CSU said that without the CCGs’ contract it was no longer a viable standalone organisation.

“We had already formed a consortium with South London and Kent and Medway CSUs with the aim of merging in the future,” he said. “We’re currently confirming options with our other customers, which include either transferring the existing [service level agreements] into the consortium or seeking an alternative provider.”

All staff involved in delivering support to the CCGs will transfer to their in-house services under the transfer of undertakings employment rules.

The group’s business case said they had “long-standing concerns” about the quality and value for money of commissioning support services provided by the CSU.

“In overall terms the CCGs feel that the services are not responsive enough, not well connected and not providing sufficient quality to meet their commissioning requirements,” the papers added. “This presents a big risk to the CCGs.”

The CCGs had issued several service improvement notices to the CSU over the past few months.

Steve Kell, co-chair of the NHS Clinical Commissioners leadership group and chair of Bassetlaw CCG, said he expected more CSU contracts to come under review as CCG income became increasingly scarce.

“CCGs have the right and the duty to do what’s best for their population,” he said.

“It’s particularly important that CCGs work together when making these decisions. Over the next few months CCGs will be reviewing their contracts. With tighter running costs I think it’s important that we do this in order to get the best for our populations.”

However, one senior CSU source urged caution for other CCGs considering bringing their support services in-house.

“We’ve been here before with [primary care groups] and then [primary care trusts]. The smaller PCTs struggled,” he said. “They never had the scale and the resilience that CSUs are able to call upon.

“I just think if we’re going down the path of CCGs, for all intents and purposes recreating PCTs, [that would be] a massive missed opportunity.”