Further details have emerged of the process through which organisations to help GPs and clinicians commissioning NHS services will be established.
Commissioning support services (CSSs) that pass the NHS Commissioning Board’s assurance process will be awarded a “licence to operate” setting out the rules under which they will conduct business.
The licences will apply while CSSs are “hosted” by the board, before they are “externalised” to become independent organisations. This is expected to take place no later than 2016.
Guidance for the final “checkpoint three” stage of the CSS assurance process was released this week.
It says the licence to operate will be provisional from this October and “more formal” from April 2013. It will “describe the rules, processes and policies that will underpin the operational arrangements of CSSs during the hosted period”.
It will be in addition to a binding development plan set to be agreed between the board and each CSS that passes checkpoint three.
The guidance states: “As part of these arrangements there are likely to be some additional checks up to and during hosting that provides the commissioning board with the necessary reassurance that CSSs continue to provide efficient, responsive and viable services.”
Checkpoint three will begin on 31 August, when CSSs send full business plans to the commissioning board. It will visit CSSs and survey their customer clinical commissioning groups in September, and make a final decision on whether to host a proposed CSS in October.
The guidance says that if a CSS breaches its licence terms the board could decide to “terminate operations”.
An additional financial planning guide says CSSs will be expected to run at a surplus of 5 to 10% of turnover as a contingency for “in year pressures”. However, they should aim to break even each year - suggesting that surpluses cannot be carried over. CSSs are also instructed to plan for 4% savings per year between 2012-13 and 2015-16.
Initially CSSs will not have their own bank accounts, and “will benefit from operating via the commissioning board’s”. This will minimise the need to increase working capital in the commissioning system, and “enable the board to ensure that cash flows around the new system in an appropriate way”.
The guide also reveals that at checkpoint three CSSs will have to set out their projected income and expenditure for four years, inclusive of the current one, across 30 service lines and by each customer, including CCGs, the board and specialised commissioning authorities.