CCGs start the authorisation process next month, but some still do not know how their commissioning support services will work.
The NHS Commissioning Board (NCB) has said the first of four authorisation waves of CCGs must file applications by 1 July.
But only last month, Cornwall and Devon’s CCG had its plans to create its own commissioning support service (CSS) scrapped by the DH because it was considered too small to be viable.
Cornwall’s CCG is now in discussions with neighbouring groups about new arrangements, but aims to keep 80% of commissioning staff in-house.
NHS North, East and West Devon CCG chairman Dr David Jenner says his group could offer commissioning support to Cornwall in wave 1 and South Devon and Torbay in wave 2, even though it will itself be one of the last to be authorised.
Dr Jenner says that in Devon, most clinical support services will be in-house.
‘We applied for wave 3 but are in wave 4 because there is a log-jam for wave 3,’ he says. ‘We will have to outsource some clinical support services at scale, with other CCGs. We would rather do this ourselves than in a CSS, which runs the possibility of going to the external sector. If we do it in-house, we have direct influence and control.’
But the GPC is warning CCGs not to enter into long-term contracts without consulting their LMCs first because CCGs can bring outsourced commissioning services back in-house.
‘The government’s intention is for there to be a separate market for CSSs,’ GPC negotiator Dr Chaand Nagpaul says. ‘The GPC believes that commissioning support is best owned by CCGs and where CCGs are too small, they should work with other CCGs so there will be no need to outsource.’
But some CCGs will be too small to provide commissioning services in-house as much as they would like to do so.
Dr Gurdip Hear, one of the four directors of Slough CCG, Berkshire, in the third wave of authorisation, says his group has not decided the shape its commissioning support services will take.
‘Most of our support has been from the PCT and I can’t see any major changes happening until the new year,’ he says.
Swale CCG chairwoman and Kent LMC representative Dr Fiona Armstrong says her group will have to outsource some commissioning services, such as ‘corporate governance and quality and safety’.
‘We are in wave 4 and are going to have to buy in some services,’ she says.
‘We have a 104,000 population and we were looking to merge because we felt the funding was going to be tight and there is a challenge over clinical leadership, but the option wasn’t available to us.
‘From my personal point of view, I have always been keen to support the NHS and that is always my first port of call.’