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NHS rethinks back-office service provision

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NHS England could allow clinical commissioning groups to take ownership of their support service providers, rather than allowing the units to be moved into the private sector, LGC’s sister title Health Service Journal has learned.


The proposal is one of a range of options for the long term future of commissioning support units currently under discussion.

NHS England currently hosts the support units, but is expected to publish details on how they can become standalone entities in November or December.

This process had been referred to as “externalisation” since 2011. However HSJ understands that that term has now been dropped, in favour of “autonomisation”.

Allowing CCG ownership of the units would amount to a radical re-interpretation of the long term vision for the units, which were intended to become “freestanding enterprises” under Department of Health guidance set out two years ago.

This had been understood to mean the units would float off into the private sector.

Bob Ricketts, NHS England’s director for commissioning support strategy and market development, said: “We’re saying we’re creating autonomous CSUs. That means no longer directly owned or controlled by NHS England.

“Externalisation doesn’t really convey that – we’re looking to create CSUs that are autonomous. To say they are independent of NHS England is a better description.”

Mr Ricketts confirmed that CCG ownership was one of a range of options for the long term future of the units now being looked at by NHS England.

Other options include setting units up as social enterprises, or allowing GP co-operatives to take them over. Private sector take-overs have not been ruled out.

The idea of a CCG-owned support unit is being discussed as a possible option for Anglia CSU, whose managing director and finance chief were replaced by NHS England in April.

Anglia CSU is understood to have been the main area of focus for NHS England’s business development unit, which supports and assures CSUs, in recent weeks. A number of long term solutions for Anglia CSU are being discussed by CCGs, NHS England, external consultants and the CSU’s leaders.

If adopted, the approach could involve one CCG acting as “host” to an operationally independent CSU, or for the unit to be co-owned by several CCGs.

Beyond Anglia, HSJ understands that the CCG ownership model is under consideration for CSUs more generally, and that the idea has attracted some interest among CCGs wishing to more actively shape the direction of their support service providers.

One influential CCG leader told HSJ there was little appetite among clinical commissioners to float off CSUs into the private sector or to create a market in support services. CCGs were more interested in ensuring support services demonstrated good value for money, they added.

Meanwhile HSJ also understands that there are concerns at a high level in NHS England over why, if CSUs prove valuable to the NHS, it would want to lose that value to the private sector.

One well placed private sector source observed that if CSUs were to move into the private sector by 2016, much of the debate over what would happen to them, and the nearly 9,000 staff working in them, would take place around the time of the 2015 election.

But, the source added that the CCG-ownership model was “flawed”. “It will be the death of CSUs, if it happens. I do not know of another model where the strategic direction of a business is set by its customers,” he said.

HSJ reported last week that the deadline for CCGs to procure their support services had been put back 18 months to March 2016.

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