CCGs ‘likely to use CSSs in practice’

The NHS Confederation’s deputy chief executive has predicted that while clinical commissioning groups will be able to go “anywhere” to buy commissioning support services in theory, in practice “they won’t.”

Speaking to eHealth Insider after a Westminster Health Forum earlier this week, David Stout said: “In practice, to a large degree, there won’t be any alternative providers of commissioning support by 2013”, when CCGs will start work.

And although he acknowledged that this was likely to “change over time”, he said many CCGs would decide to use their local CSS.

“That’s partly because they quite like the people they have worked with in the past and are wary of corporate players coming in and offering good deals when they don’t feel confident about what they actually want,” said Stout.

“Over time, how much that will change will depend on how good the local service is.”

The issue of whether CCGs will be expected to get IT, information analysis, and other support from the CSSs that are now being set up around the country has become a touchstone for how much “autonomy” they will have in the new NHS.

HSJ reported this week that the NHS Commissioning Board will not only authorise CCGs and CCSs – which are being taken through a series of ‘checkpoints’ to make sure they are fit for purpose – but that it will co-ordinate the process of recruiting to them.

The process of appointing managing directors should be complete this month, after which recruitment will take place in a series of waves, lasting into the autumn, the magazine reported.

Some CCG leaders have persistently complained that they are being expected to use their local CSS, in part because of concerns about redundancy payments, when they would rather look to the private sector for support.

Conversely, the BMA has expressed concern that private providers will step in when the CSSs become freestanding organisations in 2015-16.

The union’s Annual Representative Meeting will debate a motion condemning the ‘outsourcing’ of commissioning support at the end of the month.

Stout told EHI that CCGs need to learn how to become “intelligent customers” when buying support services.

However, he said that a number of CCG leaders were “astonished” by the poor quality of data used for commissioning and were applying pressure to see that improved.

He argued this demand for “something better” could drive improvements in data quality, but the £25 per head management fee set for CCGs could be a barrier to this.

While some CCGs are already looking to niche providers for certain IT services, such as risk stratification and case finding, others will prefer to have one contract with their CSS, which may in turn contract with niche providers.

KPMG associate partner Gary Belfield told the regular forum to inform MPs about health matters that CCGs would appear to be fully functioning mature organisations from next April, but in fact they would be like adolescents with a lot to learn.

“For people expecting big bang next year with massive commissioning changes, it isn’t going to happen.”

Belfield said CCGs would need time to adjust to their new role and work out what support they needed, which would mean CSSs also working through a period of “massive transition.”