Health secretary Andrew Lansley has said that clinical commissioning groups will have complete freedom to choose the organisation they want to use for commissioning support.
In a letter to Professor Malcolm Grant, chair of the NHS Commissioning Board special health authority, the health secretary has set out his objectives for the transition to the new NHS in March 2013.
The letter states that CCGs will have the freedom to work with “whomever they want” on commissioning support, that they will hold the money for this purpose with no top slicing, and that they will be in “full control” of the support they receive.
The letter says there is likely to be a need for central hosting of commissioning support “in the first instance” but the NHS Commissioning Board will not have a long-term role in providing or hosting commissioning support services.
He added: “The authority should prepare for the establishment of the board on this basis and ensure that arrangements for 2012-13 support both the rapid achievement of this expectation as well as choice for CCGs.”
There have been suggestions that CCGs are being forced to use local NHS commissioning support services formed from primary care trusts to avoid large-scale NHS redundancy costs.
A survey published by the NHS Alliance and the National Association of Primary Care last month found that 70% of the 95 respondents were dissatisfied with the commissioning support being offered, with 84% saying they had not been given sufficient information about the choices available.
Conversely, the BMA has expressed concern that after 2015-16, commissioning support services will be sold to or taken over by the private sector; effectively ‘privatising’ a key commissioning function.
This week, the Coalition of NHS Clinical Commissioners, a collaboration between the NAPC and the NHS Alliance, welcomed the health secretary’s letter which, it said, put down a number of critical markers for which the coalition has been lobbying.
Dr Michael Dixon, a senior member of the coalition, added: “Importantly, it states that CCGs will have the freedom to work with whomever they want to in securing support for commissioning health services.
“The document further specifies that ‘our aim is to move away from top-down management of the NHS to a system where fully authorised CCGs will have… assumed liberty’.
“There are other important statements in the letter, but these two are fundamental to the transformation that is to take place over the coming months and years.”
Lansley’s letter adds that the NHS Commissioning Board will have a vital leadership role in making a reality of ‘no decisions about me without me’ – and greater personalisation of care.
“This includes opening up the choices available to patients and the development of personal health budgets where appropriate,” it says.
“An information revolution, with greater transparency, is essential to support choice and reduce variation in the quality and outcomes.”
The government issued its ‘Information Revolution’ consultation on a new information strategy for the NHS more than 18 months ago. However, the strategy has never appeared, and cannot appear before May because of the local elections.
The letter says the NHS Commissioning Board Authority will be held to account against four strategic objectives relating to: transferring power to local organisations, establishing the commissioning landscape, developing specific commissioning and financial management capabilities, and developing excellent relationships.
It says these objectives are relevant to the period during which the authority is operating; which is until October 2012. They will also apply to the full NHS Commissioning Board, when it is established in its preparatory phase from October 2012 to March 2013.
A mandate for the board from April 2013 is currently being developed and a first draft is due to be published in the autumn.
Dr Charles Alessi, another senior member of the NHS CC, said the coalition welcomed the “clarity and explicit nature” of Lansley’s letter. He added: “This document firmly sets out the direction of travel during the transitional stage of the reform agenda.
“More importantly, [it puts the] emphasis on developing excellent relationships and the cultural and behavioural shift that is required to take place during this period. This represents an important turning point for primary care in general and for CCGs in particular.”
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