On Nov. 22 the British Medical Association (BMA) stated that the governments new proposals would provide the commercial sector with an in-build advantage in the commissioning support process. Numerous recommendations regarding how clinical commissioning groups (CCGs) should operate from 2013, as well as how the “back-office” and technical functions should be provided, are in the draft guidance from the Department of Health – “Developing commissioning support: Towards service excellence”.

Commissioning support would be positioned in a full-scale market with these proposals and would introduce commercially-focused criteria to decide who is suitable to give this support.

For CCGs these criteria would make it extremely challenging for them to hire their own commissioning support staff. Furthermore, these criteria would make it difficult for NHS commissioning support bodies evolving from current PCT clusters to contend with large, established commercial organizations.

Clinical commissioning groups would be left with little choice, but to use these commercial companies in order to provide a vast variety of commissioning support services, such as supplying CCGs with the sensitive and complex population data that inform commissioning decisions, and transactional services like IT services and payroll.

Considerable worries have been raised that this would result in an imbalance of power between large commercial providers of support and clinical commissioners, impairing the government’s proposals for real clinician-led and locally-focused commissioning.

Commenting on the guidance, Dr. Laurence Buckman, Chair of the BMA’s GP committee, explained:

“The government promised a greater role for clinicians in its plan to reform the NHS and created CCGs, placing local GPs and other healthcare professionals in a leading position in the commissioning process. Yet now it seems barriers are being put in place that would undermine the ability of clinicians to take local decisions.

This latest guidance gives the commercial sector an in-built advantage and appears to be yet another worrying step towards an NHS focused on commercial priorities.

CCGs need proper professional support, but they must have the flexibility to decide who is best able to provide these services.

The skills and experience of staff n current PCT clusters will be invaluable as they support the development of CCGs. To provide continuity at a time of huge financial pressure and structural overhaul, current PCT clusters should be supported to become viable commissioning support organizations and should not be forced into an unfair competitive process with large, commercial organizations.

We are seeking an urgent meeting with the government to urge them to reconsider these proposals.”

Written by Grace Rattue