Just 20 commissioning support services could be set up in England if primary care trust clusters get authorisation for their plans.

The number of commissioning support services has fallen from around 35 earlier this year, when they were also known as commissioning support organisations.

In a message to the NHS, Barbara Hakin, national director of commissioning development, said yesterday that clinical commissioning groups would need to make a choice between using an NHS CSS, or other sources of commissioning support, or a mixture of both.

She added: “In practice it is likely that the vast majority of commissioning support will come from the local primary care trust cluster / emerging CSS for April 2013, while the NHS makes the transition and statutory responsibilities are changing.”

Hakin said the current indications are that there will be around 20-25 local CSS and four ‘at scale’ CSS offers.

The ‘at scale’ offers are likely to include one CSS covering four clusters and 12 PCTs in NHS North East and one CSS covering six clusters and 11 PCTs in the Greater East Midlands.

Four PCT clusters, including NHS Cambridgeshire and Peterborough and NHS Bournemouth, Poole and Dorset, are understood to have no plans for a CSS. The intention is that all CSSs should become stand-alone organisations by 2015-16.

Some CCGs have complained that they are being pressured to use NHS commissioning support by their cluster PCT, or warned that they will have to take-on redundancy or other costs if they choose to get commissioning support from other providers.

Hakin said that if CCGs felt they could get a better service from an emerging NHS offer elsewhere, or from other providers of commissioning support, the NHS Commissioning Board would work with strategic health authority clusters on a case by case basis “so that the HR and other operational and financial implications can be handled appropriately.”

Emerging CSSs must submit outline business plans to the board’s business development unit by the end of this week.

CSS leaders will be appointed over the next three months, with full business plans completed by the end of August. Final service level agreements between CCGs and CSSs must be in place by March 2013.

This week, HSJ reported that the NHS CB will be responsible for appointing CSS leaders with appointments due to happen in May and June.

It also reported that if a CSS plan is found to be unviable, the board could bring in a new leadership team or force a takeover by a viable CSS. Hakin said the aim was for CSSs to be delivering “high quality, commercially viable commissioning support services for customers by August 2012.”

She said emerging services would need to demonstrate they were already supporting CCGs. She also said that emerging CCGs would be involved in the business review process through a customer survey, and that a CCG leader will sit on the CSS review panels.