The new-look Health and Social Care Bill: what are the next steps for clinical commissioning groups?

The pause in the Health and Social Care Bill's progression created some uncertainty, particularly for pathfinder consortia, who were left wondering whether they should carry on developing at the pace set out in the NHS White Paper.

While the government have given a greater degree of flexibility about when groups will take on full commissioning responsibilities, the pace of authorisation has not let up. The very clear message from pathfinders is a desire to get on with it.

So what should emerging clinical commissioning groups be doing to rise to the challenge? The authorisation process is still being developed by the Department of Health: we are unlikely to know the full details until the NHS Commissioning Board has at least got its feet under the table.

We do however, already know that authorisation will focus on six areas: clinical added value; clear and credible plans; capacity to deliver; collaboration; leadership development, and engagement with patients – these were all stated at the last sitting of the Health Select Committee. A self-diagnostic tool, already tested out by many pathfinder commissioning consortia, will soon be made available to all clinical commissioners. It will cover the main areas of authorisation and enable consortia to assess their own capabilities across these areas.

There is still significant interest in being authorised as soon as possible, an interest essentially born out of consortia's desire for independence.The logistics of authorisation though will be challenging – and it is not clear how the NHS Commissioning Board will manage to process so many consortia simultaneously.

Successful authorisation will depend in part on how consortia obtain their commissioning support – this is probably the biggest challenge they face. At present there is uncertainty about the running cost allowance. Most consortia are modeling their support services on £20 to £25 per head – a sensible and pragmatic start.

However agreement needs to be reached on what support is provided locally and what needs to be done at scale. Simply put, the basic running costs for each service (their board costs for example) will allow less budget for commissioning support. There is no doubt that small size seems to achieve good clinical buy-in but how do we marry localism with overhead costs? Some areas have already developed localities under the umbrella of a single consortia, others now need to start asking these questions, as the quality of support will make or break commissioning.

Consortia – with support from primary care trust clusters, and using the self-diagnostic tool – will need to produce clear development plans. We've finally reached the starting line! But this isn't a race; we rush at our peril.

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