Simon Stevens is set to invite clinical commissioning groups and local authorities to experiment with a further “step change” in joint commissioning arrangements.

The move follows the NHS England chief executive’s offer to CCGs in May to become “co-commissioners” of primary care alongside his organisation’s area teams, which currently manage it.

NHS England has received expressions of interest from 183 CCGs - more than four in five of the 211 total - which it will approve or refuse by October.

However, a paper due to be presented to the organisation’s board meeting by Mr Stevens on yesterday said this was “just a first instalment in a series of further local options we will be making available over the coming months”.

These will include a “radical new ‘step-change’ option”, which he planned to set out in the near future, the paper says.

Well placed sources said NHS England was expected in coming months to promote options for developing commissioning including:

  • Pooling large proportions, or the entirety, of CCG and local authorities’ health and social care budgets.
  • New models of joint governance such as single committees overseeing local authority social care and public health budgets together with NHS England’s primary and specialised care and CCGs’ general acute and community services.
  • Changes to the divide between commissioners and providers, with providers taking on more financial risk and responsibility for the health of specified
  • populations.
  • New models for providing and commissioning out of hospital services including general practice. NHS England is expected to highlight, among other approaches, the potential for using “alliance contracting”, under which group of providers are commissioned jointly and share accountability and financial risk.

One senior commissioning source said NHS England was looking to identify a number of areas in which commissioners would “push the boundaries of population integrated budgets”.

Meanwhile, CCGs which are not among the 183 that had submitted bids to co-commission primary care have been told they have not “missed the boat”, indicating NHS England is keen for others to extend their role in the future.

NHS England director of commissioning policy and primary care Ben Dyson told the Commissioning Show event in London last week: “I would see this very much as a journey with increasing numbers of CCGs and [NHS England] area teams joining those co-commissioning arrangements once they’re ready.”

He said it was “quite hard to see how one can go about creating that more cohesive out of hospital care” without a closer connection between the two.

Mr Dyson said CCGs’ proposals varied widely, some simply wanting to work more informally with area teams, but that a “significant number” wanted to take on formally delegated responsibilities and budgets.

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