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What CCGs should look for in a CSS


12 July 2012

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As April 2013 draws ever nearer CCGs are thinking very carefully about how the various necessary support functions they will need are to be provided. Their choices are clearly affected by their size and the resultant management budget that they have available to them. The stark realities of the economies of scale are now causing a lot of soul searching.

As April 2013 draws ever nearer CCGs are thinking very carefully about how the various necessary support functions they will need are to be provided. Their choices are clearly affected by their size and the resultant management budget that they have available to them. The stark realities of the economies of scale are now causing a lot of soul searching.

The original ethos that GPs were the best people to decide on commissioning issues and to change things in order to improve the quality of services was difficult to argue with. However, it is now becoming apparent that the funding available will not allow smaller CCGs to have anything like as many GPs involved as was previously anticipated. One comparatively small CCG had six GPs involved but has had to cut that to two due to limited funding.

Just as in primary care it is vital that you get the right person doing the right job, the same applies to CCGs. The finance director, for example, needs to ensure that their time and energy is focused correctly and they don’t find themselves carrying out tasks that could be done more efficiently by others. In a recent conversation with a CCG finance director I was told that he intended to do all the contract negotiation with Trusts himself. Was that actually going to be the best use of his time, I wondered?

The NHS Commissioning Board (NHS CB) has recognised the need for CCGs to have access to commissioning support and has encouraged the establishment of Commissioning Support Services (CSSs) as one way of providing that. The new CSSs are having to undergo an authorisation process in the same way as CCGs, the latest stage being Checkpoint 2 where three fell by the wayside leaving twenty three going forward to the next.

It is clear that the NHS CB is fairly open-minded about how CSSs will evolve. Sir David Nicholson commented recently: "On the future form of CSSs, the Board Authority would be guided by CSSs and that a range of models including social enterprises and joint ventures would be explored". It is quite likely that at least to start with most of the CSSs will look very much like legacy PCT teams, however, how long that continues may depend on what happens to the authorisation process after the beginning of April. Unless a robust authorisation continues to be available, then potential new entrants might find it very difficult to get into the market. If they do then we could indeed start to see joint ventures with the private sector springing up.

Which services should a CCG use a CSS for? That will undoubtedly depend on the individuals involved in any given CSS, and standards and abilities will undoubtedly vary. To quote one CCG chief executive: "the CSSs are all recruiting in a fairly shallow talent pool".

Putting in place long term contracts with a CSS because they have one or two excellent people might not be a great idea in a world where competition is increasing and real talent may well be attracted by better offers elsewhere. You don’t really want to find yourself at an event where Elvis has left the building and all that is left is the support band!

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