CCGs unhappy with commissioning support

Clinical commissioners are unhappy with the NHS’ commissioning support programme and say they are being given little choice of provider, a survey reveals.

Earlier this year, the National Association of Primary Care and the NHS Alliance issued a short survey on commissioning support for clinical commissioning groups.

In many areas of the country, commissioning support organisations are being set up that could provide a range of services, including IT, data provision and analysis.

However, these have proved controversial. The BMA has expressed concern that the Department of Health’s apparent determination to see CSOs become self-supporting by 2015-16 could see them taken over by the private sector, handing it undue influence over commissioning.

Yet some emerging CCGs have complained that their local primary care trusts are strongly encouraging them to use CSOs set up by PCT-clusters and employing NHS staff, in part because of concerns about the cost of making staff redundant at this stage.

More than four fifths of the 95 respondents to the NAPC / NHS Alliance survey expressed dissatisfaction with the commissioning support programme, with 84% saying they had not been given sufficient information about the choices of support available.

A further 70% expressed dissatisfaction with the commissioning support being offered.

Some 20% indicated they had decided to use their local PCT-cluster offering because they were too busy to explore alternative arrangements.

But more than a quarter of respondents said they had opted to go with the PCT-cluster’s offering because relationships with PCT support staff were good.

Dr Charles Alessi, a senior figure in the Clinical Commissioning Coalition, said the results did not inspire “any confidence in the manner in which the clinical commissioning reform agenda is being rolled-out.”

Nor did it give confidence that CCGs were being allowed to exercise the judgement that would be needed to meet the challenges of the NHS modernisation agenda, he said.

“The Health and Social Care Bill was intended to liberate clinicians to work with their patients. But the reality, as the implementation agenda unfurls, is that what we are seeing here is central control, which is incompatible with the intentions of the Bill,” added Alessi.

“Clinicians must be given the scope to determine with whom they work and at what price. The propositions being put forward in some strategic health authority clusters will severely restrict CCGs’ ability to transform and modernise care.”

He said that in some parts of the country, mature relationships were developing between PCT clusters and CCGs, but these were in the minority. The NAPC and NHS Alliance will be voicing their concerns to the Department of Health.

NHS Alliance chair Dr Michael Dixon said clinical commissioners should be treated as “intelligent customers and not, as happens in some areas, as servants of their commissioning support.

“Furthermore, they should be able to get the right quality of commissioning support and have proper choice of who will provide that. Only in that way will clinical commissioners and their patients get the support that they need.

“It is also crucial that we get this right from the very beginning if we are to allay fears expressed by other organisations that commissioning support will come to dominate and influence decisions that will need, in future, to be made by the clinical commissioners themselves."