When Dame Barbara Hakin, the Managing Director within the Department of Health and now the NHS Commissioning Board, who is responsible for setting up the new commissioning environment for CCGs, first came into post, she described her three key tasks as:
- Developing CCGs to be fit for purpose and ready to take on responsibilities from 1 April 2013,
- Developing the authorisation and assurance processes to ensure that CCGs are safe to proceed in 2013, and
- Developing commissioning support services so that they could support CCGs in their endeavours.
She felt that, whilst the first two were daunting in themselves, the third one represented the biggest challenge. Over a year later, whilst there remains much to be done in relation to all three tasks, not least because Royal Assent for the Bill has only just been secured, it feels as though there is still some significant way to go before the commissioning support services (CSSs) are fully ready to support CCGs in a very different way, as customers.
In their new role, it is critical that CSSs provide support that will deliver the vision and aspirations of CCGs in transforming care and healthcare outcomes for local populations. But let's be realistic, this is a big ask, especially considering that many have previously operated within a set of top down ‘system managed' architectures that are not used to ‘liberation'.
How much choice do I have in securing commissioning support?
There are a few things you need to think about in becoming a discerning customer of commissioning support so that you don't feel you are left with ‘Hobson's choice'.
The truth is that you do have choice, and it shouldn't matter how large or small your population base is. Smaller CCGs will probably have a greater need for commissioning support that is ‘bought in'. However, irrespective of size, you need to be a discerning and informed customer. Otherwise, you run the risk of not getting what you need, while retaining the responsibility and accountability not only for what you get but also for the decisions you make based on the support you receive.
Specifically in relation to NHS commissioning support services during 2012, you can secure commissioning support from another NHS CSS or other providers. But the reality is that – with procurement rules and associated timelines, not to mention the fact that most CCGs are very understandably ‘neck deep' in configuration and governance discussions and preparations for authorisation – choice in a big way has become a challenge. However, none of this means that during 2012 you should act as a passive customer, accepting your NHS CSS' offering (or in fact assume that this offering is what you need moving from 1 April 2013) and making Hobson's choice your reality.
CCGs need to assert their authority as customers of commissioning support. To do this, you need to be clear about what you want and what you need to buy. Accountability for the outcomes of the commissioning support rests fairly and squarely with the CCG in the future. Therefore, it is absolutely critical that you are able to define your requirements and have a clear line of sight with those who are delivering this for you.
How do I get the best out of my NHS CSS?
First of all, you need to build up a relationship with those leading your local NHS CSS. They maybe the same people you have worked with in PCT land, but not necessarily.
In building up this relationship, you will need to articulate your vision and ambition as a CCG and outline how the CSS can support you to achieve these. You need to be specific about the services you want the CSS to provide for you and the outcomes and outputs you expect to see, including delivery style, culture, approach and resource requirements.
Remember that this support must be accommodated within your £25 per head running costs allowance, which also has to pay for the ‘in house' elements of commissioning. Having these conversations early on will help you get ready towards authorisation. It will also mean that you will have as much support as you can in the run up to 2013.
This will put your CCG in a very good position to effect further choice from 2013 onwards, if you wish, and consider providers from elsewhere in the NHS, or the third,voluntary or private sectors.
Julie Wood is the National Director of Clinical Commissioning for the NHS Alliance
