MANAGING COMMISSIONING COMMISSIONING SUPPORT


the providers to shape the market. The analogy I always use is that of a builder. We’re all commissioners, effectively of building services. When you bring someone in to build something for you, invariably you know what you want but you don’t start specifying the grade of cement and brick, you expect a specialist to do that.” He continues: “Your job as a commissioner is to know exactly what you want and make sure you get it in the best way you can. Otherwise you find that it’s too open-ended and they haven’t specified what they want built. But the other end of the spectrum is that they over-specify and try to spell out everything.” This inflexible approach is something that he’s had first-hand experience of, with requirements being too dictatorial around details, rather than focusing on the overall outcome and value. “That, to me, is a part of the art of commissioning, finding that balance. In the work we do with the private sector, particularly pharmaceutical companies, they’re much better at that. They know what they want but they ask us to tell them, and pitch to them, so they get new ideas as a result.” Each CCG has decided what range of services to acquire from its local CSU, with some choosing to perform certain areas in-house or seeking private sector assistance. There doesn’t yet appear to be any that have decided to out-source the entire job to the likes of Serco, rather some are approaching companies on an individual service basis, for assistance with matters such as human resources or medicines management. The tighter contracts involved and more individual expertise offered by specialist consultancies are elements of the private sector offering that could prove attractive to some commissioning groups. Roa doesn’t see the situation changing radically in the near future: “I think it’s difficult, because they’ve got the incumbent CSUs at the moment; I think it’s a case of watch this space. As the reality beds in, some CCGs will find their feet and exercise their right to look elsewhere; I think that’ll happen in some areas.” He concludes: “In most areas my fear is that they’ll just accept what’s given to them and the broad membership of the CCG won’t feel like it’s their agenda, they’ll just go along with what the ‘management’ are doing and that just describes what we’ve had for the last however many years with PCTs.” Only time will tell if CSUs are fully equipped to offer CCGs the level of service they require, but it may be time for a little reconnaissance, to see what else is out there.


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