Comment / Department outlines commissioning services proposals

Commissioners’ back-office functions, including finance, could be moved to stand-alone organisations in less than five years, according to draft Department of Health documents.

A draft of Developing commissioning support: towards service excellence, dated October 2011, said back-office services could be part of wider commissioning support organisations that, while not necessarily in the private sector, would be expected to be ‘customer focused and commercially adept’.

The draft said between 25 and 35 ‘end-to-end’ support units, providing the full range of services, could be established, as well as niche services.

The new units would be made up of primary care trust cluster staff and from 2013 would provide support to clinical commissioning groups and the NHS Commissioning Board. Clusters have been asked to form distinct commissioning support units in preparation for 2013.

CCGs will be able to choose their support from 2013, leaving them free to opt for commercial providers, for example. However, the commissioning board would host some commissioning support units from 2013 in order to ensure CCGs have a support ‘safety net’. The units should become independent organisations no later than 2016 and could be acquired by commercial organisations. Some larger CCGs or groups of CCGs will be able to host their own support units.

Commissioning support services may not cover the same areas as PCT clusters and functions will be delivered on a local, regional and national basis. At a national level there should be a single finance and ledger system, while other functions, including payroll, would benefit from minimum, nationally set standards. The paper adds standard pricing and tariffs should be based both at the cluster level (250,000 to 1 million population) and at a larger scale (1 million to 5 million people).

The paper says sharing of back-office services can lead to savings. It gives an example of savings achieved by more than 100 private sector organisations over five years – shared services and outsourcing typically saved 30%-50% of in both the HR and finance functions, and 25%-40% in both IT and procurement.