Primary care trust clusters will effectively survive to commission GP services and oversee new clinical commissioning groups from April 2013, it was confirmed this week.
NHS chief executive Sir David Nicholson said structures based on the clusters would remain in place as “local arms of the NHS Commissioning Board” – even where CCGs, formerly known as GP consortia, were ready to take the majority of the budget.
In a letter to the service Sir David said: “After April 2013, these local arms would oversee commissioning groups that have been authorised and would also commission some of those services, such as primary care, which are directly commissioned by the board.”
The letter said the board’s regional and local outposts would “secure opportunities for many staff”. However, it warned that, because they would have “significantly less capacity” than PCT and strategic health authority clusters, many PCT staff would still “want to consider opportunities for moving to clinical commissioning groups or establishing commissioning support providers”.
The move responds to calls from the Future Forum review panel for more certainty and job security, to stop good management staff leaving the NHS.
Sir David’s letter said: “By reflecting the arrangements for PCT and SHA clusters in the way the NHS Commissioning Board will be organised, our intention is to give all existing staff in commissioning organisations a potential pathway into the new system, subject of course to agreed people transition policies.”
It was still unclear exactly how commissioning support organisations would emerge, he said, and few signs existed that PCT staff were being actively encouraged to establish bodies outside of the NHS. At least in the interim, it was likely support groups would be attached to NHS organisations, he said.
Sir David’s letter also confirmed SHAs will group into four clusters from October at the same time as the Commissioning Board is established in shadow form. The SHA clusters will later form the sub-national structure of the commissioning board.
One of the four will be London and HSJ understands another will cover the North – embracing the North West, North East and Yorkshire and the Humber SHA areas. The DH’s command paper to Parliament published on Monday confirmed the commissioning board would be “structured around the five outcome domains set out in the NHS Outcomes Framework, with national professional leads for each outcome area”.
The domains are: preventing people from dying prematurely; enhancing quality of life for people with long term conditions; helping people to recover from episodes of ill health or after injury; ensuring that people have a positive experience of care; and treating and caring for people in a safe environment and protecting them from avoidable harm.
The domains will be reflected across commissioning board directorates in what DH insiders are calling a “matrix” structure.
The command paper adds detail to the government’s changes to its reform plans. It says clinical senates “will not be organisations or new forms of bureaucracy, and they will not need to be provided for by amendments to the bill”.
They will not “alter the essential responsibility – and the statutory accountability” of CCGs or the commissioning board (see below).
A new requirement is designed to “ensure [CCGs’] work coherently with local partners”. The paper says a “significant majority of the registered patients that a [CCG] is responsible for will have to live within [its] boundaries”.
Paying for networks and senates
Sir David Nicholson has revealed that clinical commissioning groups would have to pay, directly or indirectly, for the running and expansion of clinical networks, as well as the new clinical senates.
In his interview with HSJ the NHS chief executive said CCGs would either have to “pay in” to support networks and senates or that the commissioning board would “top slice” funds from the groups’ management allowance.
He said the government would “start” by considering establishing clinical senates within England’s “14 to 17 health systems”, as defined by patient flows.
Sir David said the senates’ role in authorising commissioning groups was about establishing “confidence” in CCGs’ plans and advice. They would not be “part of the performance management system” for CCGs, he added.