The NHS Commissioning Board has admitted that “key risks” to its success include the haemorrhaging of senior leaders during the reform transition and a shortage of staff to commission specialist and primary care.
The organisation has set out the 11 most significant risks in a document showing the first detailed proposals for its own design, structure and functions. It is due to be published today.
The document, Design of the NHS Commissioning Board, says one of the main risks to its “resilience” will be trying to run its functions with “50 per cent less resource [than is currently spent on them] by 2014-15”.
The paper highlights concern about whether the board will have the “capacity” for its largest direct commissioning tasks – specialised services, and primary, dental, pharmacy and eye care services.
Under the NHS reforms the board will take over those functions, as well as overseeing the entire NHS commissioning budget and clinical commissioning groups’ performance, from April 2013.
Other key risks include “potential loss of senior leaders, especially [primary care trust] cluster CEOs”, “ensuring key posts are filled to support transition” and “[not] giving staff greater clarity about the system architecture, HR options and process”.
Another key risk identified by the board is that it may face “differences with [the] DH” about the tasks the board has to carry out with its £492m annual running cost budget, and “pressure” to take on more.
Commissioning board managing director Bill McCarthy, speaking exclusively to HSJ, said the biggest risk was staff leaving because of uncertainty.
He said: “[Addressing the problem] will be about giving them the right support, right help and as much clarity as early as we can about how they will find a place in the new system.
“We know their abilities and skill are remarkable, we just need to help them exercise that in the new world.”
In particular, Mr McCarthy urged PCT cluster chief executives to consider becoming the director of their local board office. He said some local offices would take on extra roles, for example specialised commissioning on behalf of a wider patch.
Mr McCarthy said: “Local office leadership is going to be a really important role. It is different to a PCT cluster chief executive because it’s part of a single organisation, with a single way of working. But I think there are very many cluster chief executives who would find it an exciting prospect.”
The document reveals the structure of the board’s local offices (see diagram). They will cover the same area as the 44 PCT clusters outside London. In the capital more functions will be carried out by the regional, citywide “sector”, and there will be a yet-to-be-announced number of “local operations teams” below that. HSJ understands discussions have so far focused on three teams for London.
The other regional sectors will cover the South, North and Midlands and East, matching strategic health authority clusters. The sectors will have a total of just 200 staff – fewer than national and local levels – in what the document describes as an “hourglass model”. The regional NHS will be much smaller than at present. Around 3,500 are currently employed in SHAs.
However, the document says the board, in particular the regional sectors, will have a role in major service change. It says the sector “medical and nursing leads will work closely with [academic health science centres] on major reconfiguration issues”.
The move may address fears of a lack of regional leadership of reconfiguration in the new system. However, it could also worry local GP commissioners who are concerned the board will encroach on their decisions.
Mr McCarthy said the board would be “supporting [CCGs] to get together” to commission services but not “be taking it from them”. He said: “It’s for the CCGs to do collectively. Where they want help and support in that we’ll be there to offer it.”
The document sets out how the board will directly commission specialised services. A single national director in the operations directorate will manage contracts. There will be input from all directorates, for example clinical advice from medical and nursing and contract guidance from the commissioning development directorate.
The board wants some functions, including legal services, to be outsourced. The document also indicates it will publish a “five to 10 year strategy to improve outcomes”.