Clinical commissioning groups have been asked to present a business case to NHS England if they want to bring support service functions in house.

The policy is intended ensure the stability of the wider commissioning system by preventing a situation arising where one commissioner stops using a commissioning support unit, and in doing so undermines its financial viability even if other CCGs wish to carry on using it.

However, as HSJ reported last week, CCGs will emphasise their independence and argue that decisions over where support services should be sourced should be made by them alone.

The policy was confirmed in a letter sent out to CCGs on 18 October by Ros Roughton, national director for commissioning development. She said: “Where CCGs wish to bring a significant proportion of commissioning support services back in house from their CSU, because of the impact this may have on the stability of the CSU and the continuity of supply for neighbouring CCGs and NHS England itself, we will be asking CCGs to work closely with their [NHS England] area team to agree a sound business case that demonstrates the basis of the decision and considers the financial and HR implications on the wider community and system as a whole.”

Later this month NHS England will publish a tool for CCGs to use when making decisions about where they source support services from. Use of the tool will be voluntary. Further details on business cases will also be sent out by the end of October.

Ms Roughton’s letter said: “Where CCGs wish to make changes to their commissioning support arrangements, it is critical that the rationale behind these decisions is transparent and properly documented, that they can demonstrate that the new arrangements represent value for money and improved quality, and that the impact on the local health community and in particular neighbouring CCGs has been taken into account.”

CCGs last week emphasised their sovereignty in making decisions about support services, arguing that as independent statutory bodies, they must be free to make the decisions they feel most appropriate.

A small minority of CCGs have pulled services out of CSUs in recent months, HSJ has learned.

Among them are:

  • Central Eastern CSU lost £4m of business from East and North Hertfordshire CCG in May. The majority of services were brought in house, including communications, patient involvement, finance planning, payroll and human resources, performance and activity reporting and contract monitoring and management.
  • Herts Valleys CCG brought £900,000 worth of services in house from Central Eastern CSU, related to quality assurance, service redesign, and choose and book.
  • West Hampshire CCG in-sourced £289,000 of communication and engagement services from South CSU.
  • Milton Keynes, Corby and Nene CCGs pulled £1m of contracting and finance services out of Greater East Midlands CSU.
  • Great Yarmouth and Waveney CCG brought £220,000 of personal health budget, continuing healthcare from Anglia CSU.

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