All clinical commissioning groups will sign a “development agreement” with the NHS Commissioning Board and many will also be given a “rectification plan”, before they take over budgets next year.
The NHS Commissioning Board’s draft Guide for Applicants, due to be presented to the NHSCB board for approval on Friday, confirms the details of authorisation requirements - revealed by LGC’s sister title Health Service Journal in March.
It also confirms the timetable under which CCGs will be told whether they have been authorised between October and January.
HSJ understands one of the authorisation requirements most concerning CCGs is a survey of more than 50 figures in their local health economy. It is understood these will include specified individuals such as local authority directors, and acute trust chief executives. Two CCG leads told HSJ there was little time to build relationships with such a wide range of people.
The guide says all CCGs will be asked to sign a “development agreement” when they are authorised. It indicates the agreement could be used to set priorities for particular CCGs, such as addressing a “financial challenge or major reconfiguration plan for acute services”.
If CCGs are not fully authorised they will either be given specific “conditions” and “directions” by the board. In what is expected to be a small minority of cases they could have all their duties and budget passed to another nearby CCG, or to the commissioning board.
The Guide for Applicants says CCGs which are given conditions and directions will “agree with the NHSCB a time-limited rectification plan for removal” of them.
The board’s director of commissioning development Dame Barbara Hakin told HSJ details of conditions would be decided on a “case by case basis”.
Likely options include CCGs being told to employ particular senior staff to help run it or support its development. Dame Barbara said other conditions could be as minor as telling the CCG to improve its planning in a particular area.
The authorisation regime appears less rigorous than Monitor’s approval process for foundation trusts, which many trusts have failed or taken years to pass.
Dame Barbara said: “It is really important to remember these are the first NHS organisations to be authorised before they exist. Monitor authorises organisations which, if they fail, still carry on doing their day to day work. It is impossible to compare.”
NHS Alliance chair Michael Dixon told HSJ he thought the board had got the “balance about right” between assuring quality and being too demanding. However, he warned the board against “tying up” CCGs with requirements after they are authorised.
Meanwhile, another paper updating the board on the NHSCB’s development highlights the “inherently high risk” of its job of recruiting “nearly 4,000 people… over a short period”. It says the problems are exacerbated by the board’s exact functions and design remaining unclear.
The remaining very senior NHSCB roles will be appointed before July, and others to be filled by the end of the year.
It has been confirmed that Suzette Woodward, previously National Patient Safety Agency director of patient safety strategy, will be the board’s director of patient safety.