MANAGING COMMISSIONING COMMISSIONING SUPPORT
Seeking support
Some CCGs have been seeking alternative support instead of relying entirely on their local commissioning support units. GEORGE CAREY looks at the current state of the CSUs and asks if it’s worth looking elsewhere or sticking with what you know
D
espite not actually being mentioned by name in the original 2010 whitepaper, commissioning support units have been set up by primary care trusts under the oversight of the Commissioning Board, to supply clinical commissioning groups with essential back-office functions, such as communications, finance, human resources, IT, and data analysis. A lot has happened in the intervening years and plans, as they will, have evolved slightly in that time. How has the landscape changed and do CSUs still represent the best quality and value support? With 163 of the proposed 211 CCGs already authorised, and the rest not far behind, these organisations put in place to help commissioners with their vital role in the new-look NHS are extremely important. However, there are already signs that the system will be significantly different to initial plans. There will always be tweaks involved in such huge changes, but it remains to be seen if CSUs will offer the best support to commissioners. The Commissioning Board originally committed to the figure of 23 CSUs, which it felt was the appropriate number to effectively support CCGs nationwide. This now looks unlikely, as numbers have already started to reduce, possibly an indication that some of the smaller units were not independently fit for purpose. Merseyside and Cheshire, Warrington and the Wirral CSUs merged late last year, while Essex and Hertfordshire CSUs are now being run as a single organisation with two business units. There has also been a certain amount of debate surrounding the length of the initial service level agreements. The Commissioning Board’s advice had suggested no longer than 18 months, as the deals didn’t involve any of the normal procurement process, and any deals longer than that could be open to legal challenge. An 18-month deal from April this year would finish in September, with CSU MDs divided over whether this is beneficial or not. Some feel it is a wise move because it would mean they would avoid renegotiating with CCGs in April when they are also working on the commissioner/provider contract.
The wording of SLAs is something else that has caused some confusion, with some agreements appearing rather vague. Shailen Roa, MD of medical consultancy Soar Beyond, feels this is an area that requires a subtle balance: “An element of commissioning is enabling
t“Numbers have started o reduce, possibly an
indication that some were not fit for purpose”
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