Commissioning support units are frustrated by an ongoing lack of clarity over how much income they will receive from the NHS Commissioning Board, HSJ has learned.
It is understood the board is reviewing what services it plans to buy from CSUs, leaving their leaders in the dark about, for instance, the extent they will support the board in commissioning primary care or specialised services.
One senior CSU figure said they had been told to assume that they would receive no income at all from the board, because services such as human resources could be provided in-house rather than through CSUs. The source said this was contrary to most people’s previous understanding of how the board would operate.
CSUs were required to write business plans over the summer as part of the board’s assurance process but these have not been made public due to commercial confidentiality. HSJ understands that since then the board has indicated to CSUs that it will give them less business than many of their business plans assumed.
A “scheme of delegation” is scheduled to be published next month by the board. It is hoped that this will set out how much autonomy the board’s local area team directors will have over their budgets, and therefore how far they will be free to commission support services from CSUs.
A CSU managing director described the situation as “messy” and potentially “risky” for CSUs. “There’s a pressure on the board to be clear, but they are much less together than [clinical commissioning groups],” they said. “Local area team directors don’t have the faintest idea what they’re supposed to do.”
Another told HSJ: “They will have to sort this pretty quickly… some CSU leads are very frustrated by this.”
CSUs are also still waiting to be told of funding arrangements for data management and integration centres, which will store patient information and enable different data sets to be joined up and analysed at scale.
There is also no clarity yet on how much money CSUs will receive for providing information technology support to GP practices. A board spokeswoman said this would be down to CCGs, and that primary care operating models for GP IT services would be published “shortly”.
CSU leaders discussed the issue with Bob Ricketts, director of commissioning support strategy and market, and Andrew Kenworthy, director of CSU transition, in a meeting last week, but no new information was given.
Some CCGs are behind plan on their agreements with CSUs. Guidance from the board required CCGs to be clear about their CSU spend by the end of October.
“It’s still moving,” one CSU source said. “We might have assumed they were going to provide their own contracting function as a CCG, but then they were not able to recruit, so they go to the CSU and say can you do it?”
Rotherham CCG, for example, was in discussions with the South Yorkshire and Bassetlaw CSU into November, while Derbyshire’s CCGs were still finalising specifications beyond the October deadline.