The Department of Health has recommended four key commissioning functions are removed from clinical commissioning groups and are transferred to the NHS Commissioning Board’s regional bodies.
In a new guidance, being circulated to all PCT clusters leads, the DH guidance says that collecting and organising data, ‘major clinical procurement’, back office functions such as IT, estates management, human resources and finance, and communications services are best done ‘at scale’.
It has led the GPC to warn that the Government is risking repeating mistakes made in the National Programme for IT and that local practices and clinical commissioning groups (CCGs) should be left alone to make their own local decisions
The DH also says that commissioning support should be fully opened up to the market.
The Towards Service Excellence document says: ‘There is evidence to indicate that initially a national approach might enable the most effective delivery of each of these services.’
The report says the four functions are ‘critical to the future smooth running of commissioning’, adding that in each case considerable savings would be demonstrated by delivering the functions nationally and they risked becoming unsustainable if not centralised.
Among options for how these services are structured are: A single nationally managed service, delivered locally; a nationally-coordinated network, with teams in various locations providing different specialist elements, and the potential for these elements to become separate organisations later; a hub approach, with the potential to create several organisations later; and a national specification and price with a range of approved suppliers.
The guidance also appears to recommend replacement bodies – replicating the current number of SHAs – to provide some parts of NHS business intelligence.
The report says: ‘Evidence from South Central, West Midlands and East Midlands suggests aspects of business intelligence would be delivered most effectively by operations that cover an average population of around five million.’
‘If these sized units were replicated nationally this implies that these aspects of business intelligence could be provided from approximately 10 units.’
Commissioning support should also be opened up to competition, according to the document that says: ‘The NHS sector, which provides the majority of commissioning support now, needs to make the transition from statutory function to free standing enterprise.’
Clinical commissioning groups will have to enter into formal procurement to purchase commissioning support. The DH says: ‘Where an alternative provider is selected through procurement TUPE [transfer of undertakings (protection of employment)] is expected to apply.’
GPC vice chair and Leeds CCG chair Dr Richard Vautrey told Pulse: ‘The Department of Health should have learnt from the experience of the National Programme for IT that doing things “at scale” does not necessarily deliver good value for money nor deliver locally sensitive services.’
‘Practices now and CCGs in the future depend on knowing individuals locally and will not want remote support.’
‘There are also potentially serious risks to the NHS if commissioning support is centralised and then sold off to the cheapest bidder.’
On Tuesday the House of Commons Health Committee will begin collecting evidence on pre-appointment hearings for the chair of the National Commissioning Board that will wield many of the suggested powers.