Exclusive: NHS Commissioning Board may stipulate staff CCGs employ

The NHS Commissioning Board (NCB) will have powers to stipulate types of staff clinical commissioning groups (CCGs) employ, according to draft authorisation guidance to be discussed next week.

Dame Barbara Hakin: 'We can't expect CCGs to be brilliant from day one.'
Dame Barbara Hakin: 'We can't expect CCGs to be brilliant from day one.'

It details the four application waves CCGs can take part in lasting several months, beginning July 2012, before becoming fully authorised.

It also reveals the six criteria the 220 or so bodies expected to cover the whole of England will have to meet before taking over full responsibilities from PCTs.

Authorisation criteria
1. A strong clinical and multi-professional focus which brings real added value.

2. Meaningful engagement with patients, carers and their communities.

3.
Clear and credible plans, which continue to deliver the Quality, Innovation, Productivity and Prevention (QIPP) challenge within financial resources, in line with national requirements (including excellent outcomes) and local joint health and wellbeing strategies.

4.
Proper constitutional and governance arrangements, with the capacity and capability to deliver all their duties and responsibilities including financial control, as well as effectively commissioning all the services for which they are responsible.

5.
Collaborative arrangements for commissioning with other CCGs, local authorities and the NCB as well as the appropriate commissioning support.

6.
Great leaders who individually and collectively can make a real difference.

CCGs began operating in shadow form this month and are expected to complete authorisation by April 2013, meaning they are fully responsible for their roles.

However CCGs might be authorised with conditions and these are explained in the guidance to be discussed at a meeting of the NCB in Leeds on 13 April.

The guidance says: ‘If a CCG has some significant areas where it does not meet the criteria the NCB may assess the CCG needs temporary additional support to develop and deliver. The NCB sector will determine the most effective source of support which might include putting specific management support in the CCG, the option of placing a representative on the CCG governing body for oversight, and assurance or temporarily ‘junior partner’ status in collaborative commissioning arrangements may be agreed where necessary. The NCB could make full alternative arrangements for the commissioning of some services’

Practice involvement will be key with the guidance saying: ‘Strong relationships across member practices will be the driving force behind successful CCGs and the improved services and outcomes that CCGs deliver. At the heart of maturing CCGs, members will proactively support the delivery of CCG objectives.’

NCB comment

Speaking exclusively to GP, NCB national director of commissioning development Dame Barbara Hakin said: ‘CCGs are brand new organisations. We can’t be in a position where we expect them to be brilliant from day one, although they are on the right track to become really good.’

She added that those CCGs that become authorised would have freedoms like the earned autonomy that foundation trusts enjoy.

Conditions could be time-limited and may mean initially that some services within a CCG with conditions are commissioned by a neighbouring CCG.

Dame Barbara said: ‘I firmly believe that you can’t run organisations from outside. If you have three CCGs in a city and have a couple of main providers, quite often this might already have begun.

‘If you have a really advanced CCG and one much less able, you might see for the moment that the more mature one leads with that provider.’

On staff stipulation, she added: ‘If the NCB is concerned say about a CCG’s financial abilities, the NCB might say actually we would expect you to have advice from this person two or three days a week working with you for the first six months.’

This might include stipulating that a commissioning support unit is deployed rather than CCGs looking to do such work themselves.

The NCB has drawn up examples of tasks CCGs could undertake to help them become authorised and this includes explaining half a dozen examples where its intervention has improved services for patients.

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