The NHS Commissioning Board will not take on the budget responsibilities of clinical commissioning groups which fail to win full authorisation by April next year, HSJ has been told.
Where a group is judged not competent or is unwilling to take over its full budget responsibility it is instead likely to be told to use a specific commissioning support service, or employ specified managers.
It had been widely expected that such groups’ budgets could be passed to either a local branch of the Commissioning Board or another CCG – but NHS chief executive Sir David Nicholson is understood to have ruled out the former option. Some primary care trust cluster chief executives were told about the clarification late last year. It is also thought that in many cases it may not be possible for a nearby CCG to take over the budget.
The board, which will decide whether CCGs are authorised and determine any “conditions” on their authorisation, has not yet decided the alternatives to transferring responsibility to another CCG or itself.
However, senior NHS sources said the options were likely to include requiring the CCG to work with a particular commissioning support provider. Well placed sources said in other cases the CCG could be told to employ particular senior leaders, either management or clinical. They would help run the CCG, in an arrangement described to HSJ as similar to a management franchise.
Although the DH has insisted the “vast majority” of CCGs will be authorised, it is increasingly expected that many will be authorised with conditions, which they could later have lifted.
NHS Alliance chair Michael Dixon last week told HSJ as many as 50 per cent may not be fully authorised. The DH has said CCGs wishing to be fully authorised next year must have taken on their full budget in shadow form, as a subcommittee of a PCT, from April.
British Medical Association GPs committee vice chair Richard Vautrey told HSJ that in some cases GP commissioners would welcome the indication that the board would not take over directly.
However, he said in areas where CCGs were not ready the current system should be allowed to stay in place temporarily in the form of PCT clusters operating as a branch of the commissioning board.
He said: “We need to be giving CCGs the right amount of time to get up and running. By forcing a time frame we could end up causing problems and resorting to these types of arrangements.”
Dr Vautrey also said GPs would be “very concerned” about CCGs being told to use support providers, or management franchise-style arrangements.
Meanwhile, the DH has told emerging CCGs and PCTs to submit applications for authorisation from July. The Commissioning Board will make decisions from October.