In order to design health services that meet patient needs while also delivering value for money, it is essential that CCGs understand the procurement process - and the power of collaborative procurement. Under the clinical commissioning framework, it is their responsibility to tender for new and replacement services when necessary in response to patient demand.
This is largely unfamiliar territory for GPs and some CCGs will seek help from commissioning support services to manage procurement exercises (more on this in point 5). However, every CCG must be familiar with the legislative requirements of their procurement activities because they are ultimately accountable, even if an external partner carries out the work on its behalf.
Under the Public Contracts Regulations 2006, CCGs have obligations to fulfil regarding transparency, equal treatment and non-discrimination. They must also comply with section 75 of the Health and Social Care Act, which requires commissioners to adhere to good practice in relation to procurement, not engage in anti-competitive behaviour, and protect and promote the right of patients to make choices about their healthcare.
Getting the most from commissioning support services
While the challenges facing CCGs regularly make the headlines, commissioning support units (CSUs) remain a largely unheralded component of the new-look NHS. They were created to provide specialist consultancy, clinical procurement services and back-office functions such as finance and HR for CCGs.
In 2013, Health Service Journal reported that the extent to which CCGs rely on CSUs would vary greatly between groups. It calculated that the average CCG would spend £9 of its £25 per head management allowance on external support, but many would choose to handle the bulk of commissioning activity in-house.
However, the benefits of using a CSU could come into stronger focus as the wider implications of co-commissioning are revealed. In its January 2015 report, the Nuffield Trust suggested that tasking CSUs to run procurement exercises could help to minimise conflicts of interest and ensure transparency.
There are clear benefits of working with CSUs, but CCGs also need to recognise that this is another highly important collaborative relationship that must be nurtured to ensure the best possible outcome for patients. Writing in the Guardian in April 2014, managing director of Greater Manchester CSU (now part of the North West CSU) Leigh Griffin stressed the need for co-design and co-delivery in healthcare. "Immature organisations revert to dysfunctional master-servant relationships, which we must resist," he said.