Filed Under (Clinical Commissioning Groups, Commissioning Support Services) by Paul on 17-07-2012
Regular readers will be aware of the ongoing tussle between the writ of the Secretary of State and that of David Nicholson, CEO of the National Commissioning Board. Over the last year readers will have recognised that this takes a number of forms, and one that takes place regularly continues to be the amount of freedom that clinical commissioning groups have and will have to select the support they need in their commissioning role – and from which organisations they can obtain it.
The Secretary of State thinks back to the golden days of the White Paper in July 2010 when the new GP led commissioning organisations that he wanted to set up as autonomous organisations would be able to choose the sort of assistance that they wanted from whatever organisations they wished.
The Chief Executive of the NCB recalls the time earlier this year when the Secretary of State was at his most vulnerable – with a Bill to get through Parliament. At that time amendment after amendment, tying CCGs down, was hurled at the Bill’s opponents to persuade them that everything would be run from the centre.
Now, in the summer of 2012, the two protagonists circle each other over the different attempts to implement the Act with different messages emerging at different times.
To supplement this story a recent survey of CCGs asked them what they wanted. Interestingly it also asked the Commissioning Support Services, being set up as a part of the NCB, to say how they saw the future.
Commissioning Support Services (CSSs) are currently moving through a business planning and assurance process. The process has a series of three separate ‘checkpoints’ during 2012. Checkpoint 2 was undertaken in April/May 2012 and emerging NHS CSSs were assessed to ensure they were on a viable and secure path to develop a full business plan and be authorised by August 2012 at checkpoint 3.
As part of the second checkpoint the coalition of the National Association of Primary Care and the NHS Alliance carried out a survey of all emerging CCGs and CSSs to provide an independent view of how the services and relationships are developing.
At the moment – when asked where they were getting their support – around a quarter of emerging CCGs expected to source commissioning support exclusively or almost exclusively from NHS CSSs. Just over half can be classified as high or almost exclusive users of NHS CSS support – expecting to source at least 50% of the support through this channel. Around a quarter (27%) expected to source between 30% and 49% of commissioning support from NHS CSSs, with 17% saying they expected to source less than 30% in this way.
Confidence in the existing relationship between CCGs and CSS is good. Around 80% of emerging CCG respondents have personally met the leader of their main NHS CSS and 79% were very confident or quite confident that there was a mutually beneficial and constructive dialogue between the emerging CCG and CSS.
With regard to exercising choice during 2012/13, the majority of emerging CCGs intend to carry on with the same NHS CSS, one in ten said they wanted to exercise choice and around a quarter didn’t know.
Whilst this appears to be a static and contented picture of CCGs, the majority of emerging CCGs (around 60%) want more information about the choice of commissioning support available to them as well as advice about how to access and procure support. The majority of emerging CCGs expect NHS CSSs to source and work with organisations outside the NHS to support emerging CCGs, most notably local government, the independent sector, and the third sector. This is an interesting customer expectation that is being laid on CCSs. CCGs expect CSSs to create their own relationships with a range of different commissioning support providers and to help CCGs by brokering those relationships. This is a different role from the one that most CCGs see themselves undertaking.
After the transition period there is a much higher degree of uncertainty about sources of commissioning support – 33% want a change and 29% don’t know how commissioning support will look after April 2013. This means that about 50% of CCG customers may be looking to change their support organisation at the moment that they start commissioning for real.
There are a number of important details to be worked out that will determine how quickly CCGs will be able to carry out their wish to look further afield. One of these will be the length of the break clauses in the contracts that the nascent CCGs will be signing with the CSSs. If, for example, the CCG signs up to a contract with a year’s break clause then the only way they will be able to have a new CSS support organisation from April 1 2014 will be to give notice that they want to change the contract from its first day – April 2013. Given that this is the first date that they will be experiencing that new support, it will be difficult to issue a break notice on or near that day.
It’s likely that CCGs will want to experience the support they have signed up to for a little while. But if they have a year’s break clause then the 50% of CCGs who may want to move support to another organisation may not be able to do so until 2015.
On average, emerging CCGs have set aside £11.52 per head for NHS CSS commissioning support services but this figure varies significantly across the country, from £3 through to £25 per head. Whilst 45% of CCGs think the emerging offer is affordable, a further 43% don’t know, with 12% suggesting that it is not.
Most emerging CCGs are confident the arrangements they are putting in place for commissioning support will allow them to achieve authorisation, with 91% of emerging CCG respondents being very or quite confident (31% and 60% respectively) that their commissioning support arrangements will allow them to progress through authorisation successfully.
There is, however, lower confidence that CSS leadership would deliver commissioning support in a new and innovative way with 51% having confidence and 42% not confident.
Concluding this picture, it appears that most CCGs are content with their current and emerging relationship with CSSs, but a substantial proportion may well want to move from April next year. This is a short period of time to construct a proper market of different support organisations and for this to work emerging CCGs need to be given more information about choices open to them from 2013 and how they might realise those choices.