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Restrictions for NHS commissioners

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Dozens of clinical commissioning groups are expected to have “temporary” restrictions placed on them when they are authorised, LGC’s sister title Health Service Journal understands.

Health reporting HSJ and LGC logo

In many cases these have been imposed following delays in service planning and filling posts.

Several senior NHS sources said many CCGs - particularly those among the first to be reviewed by the NHS Commissioning Board - would have formal conditions placed on them.

One reason for the conditions will be that the groups are required to demonstrate strong and “credible” operational and service planning for 2013-14, including how they will achieve financial balance. Few CCGs are in a position to do so and no framework or guidance is yet in place.

Decisions on the first two waves of CCGs are due to be made in the next two months.

Putting conditions on CCGs will mean the commissioning board can more closely scrutinise their intentions. Another reason for widespread conditions is expected to be that CCGs need to demonstrate they have management capacity in place, including in commissioning support units. Many groups and CSUs have not yet filled all senior posts.

CCGs with temporary conditions will be expected to go through further checks - less laborious than initial authorisation - to have them lifted before April 2013, when CCGs take on their full powers.

The board is expected to make a clear distinction between CCGs with conditions expected to be temporary, and those with more serious conditions that will limit their freedom beyond April 2013.

Fewer CCGs are expected to fall in the latter category or to not be authorised at all but in some cases serious concerns remain, HSJ understands. These include some CCGs whose shape and size remains under question, that have no accountable officer appointed or face serious financial problems.

Commissioning board chief operating officer Ian Dalton, whose directorate will have a key role in authorisation, told HSJ: “We shouldn’t be seeing conditions as things to be handed out lightly, or a sign of a problem that is enduring. Where a condition is necessary that might well - and hopefully will - be discharged by 1 April 2013.”

He said the board had not yet decided the process for discharging conditions before April but that it should not be laborious. The board’s aim was “to discharge [them] at the earliest stage that’s sensible”, he added.

GP Johnny Marshall, an NHS Clinical Commissioners senior member and board adviser, said the temporary conditions should be closely linked to particular issues and include “measures by which success will be judged”. As such, the process to remove them should be the “least bureaucratic possible”.

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