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Gold, incentives and meh

CCGs face authorisation conditions

Exclusive: First-wave CCGs have reported mixed outcomes from the NHS Commissioning Board’s authorisation process, with some reporting high-level conditions may be placed on them, Pulse can reveal.

Some CCG leaders said they had been informed they may be authorised subject to conditions, including levels three to six, which indicate they could have some functions removed from their responsibility on authorisation.

Other first-wave CCGs are reporting that the whole process has been ‘reasonable’ and has helped them improve.

The NHS Commissioning Board’s conditions panel met on 2 November and informed the 35 first-wave CCGs of provisional conditions to be placed on them.

They will have the opportunity to appeal any provisional conditions before they are officially authorised early next month.

There are six levels of conditions, which can be applied to CCGs against 119 criteria.

Pulse understands that some first-wave CCGs have had the more serious conditions levels three to six placed on them. They have 10 days to respond to the conditions panel’s findings; the final subcommittee will ratify their authorisation, with or without conditions, on 5 December.

One GP serving as a CCG board member, who asked not to be named, said: ‘It has been a challenging process and there have been teething problems. Some of the people in the assessing teams were as not as experienced as they should have been. There have also been variations in CCGs being given red and green flags.’

However, the officer said the process had been a good one on the whole and said the NHS Commissioning Board should be applauded.

Another GP commissioning leader, also speaking on condition of anonymity, said her CCG was ‘really pleased’ to have received just a handful of red flags and one level-three condition.

Dr Steve Kell, chairman of Bassetlaw CCG, said: ‘It has been a reasonable process. Some people have said it is bureaucratic, but it has to be – CCGs are spending lots of public money. But our CCG has certainly been helped by the process.’

In a letter to the NHS Commissioning Board, interim NHS Clinical Commissioners chair Dr Charles Alessi warned that although authorisation was an important process, CCG leaders were concerned the board would attempt to ‘micromanage’ them.

He said: ‘While we recognise that not all CCGs will be at the same level of development, we fully support the principle that it is for the CCG to propose the action to be taken to rectify the concern identified.

‘Given this, it is for the CCG to decide whether to make use of the support package proposed by the [NHS] Commissioning Board or to identify for themselves where to obtain the support needed to address the required development.’

A spokesperson for the NHS Commissioning Board insisted that all assessors carrying out ‘desktop reviews’ had been ‘fully trained’. She added that more details about the authorisation process would be released in December.

CCG condition levels

1 No action necessary
2 NHS board will make
advice/expertise available if needed 
3 NHS board sign-off needed for specific decisions made by the CCG
4 NHS board will place a specific team or individual on to the CCG board
5 CCG’s accountable officer will not be ratified and an alternative will be appointed          
6 Specific functions will be removed         
7 All CCG functions will be removed

Source: NHS Commissioning Board

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