Exclusive Clinical commissioning groups (CCGs) could be free to commission more creatively due to an unlimited service insurance policy handled by healthcare sector regulators Monitor.
A letter shown exclusively to The Commissioning Review reveals Monitor will continue to provide services locally should an individual provider get into serious financial difficulty – so long as the commissioner has ‘requested’ it.
Exclusive Clinical commissioning groups (CCGs) could be free to commission more creatively due to an unlimited service insurance policy handled by healthcare sector regulators Monitor.
A letter shown exclusively to The Commissioning Review reveals Monitor will continue to provide services locally should an individual provider get into serious financial difficulty – so long as the commissioner has ‘requested’ it.
CCGs, commissioning support units, NHS England area teams and specialised commissioners have been asked to designate essential services as commissioner requested services (CRS), to let Monitor know which services the regulator needs to guarantee.
An unlimited number of services can be designated as CRS, but Monitor will be working with commissioners over the coming months to decide which ones are vital.
The letter states: “As an NHS commissioner you have a critical role to play. With the support of NHS England, you have primary responsibility for ensuring the continuity of services for patients in your area.
“That responsibility includes designating a range of services you believe should continue to be provided locally if any individual provider is at risk of failing financially.”
The CRS application process can take up to four months to complete, and will open in January 2014.
‘Safety net’
Frontline GP commissioner Dr Joe McGilligan welcomed the announcement, which he believes will be a vital “safety net”.
Dr McGilligan, chair of East Surrey CCG said: “In times of austerity it’s clear that some people will fall into serious difficulties. It’s not unrealistic.
“CRS is a good thing, a safety net for commissioners so that if a provider falls over the service doesn’t disappear. But if anything, this puts a lots of pressure on Monitor – as commissioners we are going to have to be careful what we judge as essential.”
But Dr Steve Kell, co-chair of the NHS Clinical Commissioners leadership group, and chair of Bassetlaw CCG said the CRS service should go further than just supporting failing providers.
He said: “This is not about propping up failing providers, it is about making sure that, as a local commissioners, our patients can continue to have access to essential services which are critical to them and which no other provider may be close enough to or able to deliver.
“CCGs worked with Monitor to develop their system for designating commissioner requested services and we would urge them to now engage with Monitor to make sure you are aware of your obligations and are designating services appropriately, taking into account local needs, demography and clinical evidence.”
All providers of NHS services, including independent providers, will require a Monitor license from 1 April 2014.
Monitor will enforce sanctions, such as fines, against providers that continue to provide services to the NHS without a licence.
The licence sets out the conditions providers must meet to help Monitor:
– Ensure choice and competition operate in the best interests of patients.
– Set prices for NHS-funded services.
– Use regulatory tools to incentivise and enable the delivery of more integrated care so services are less fragmented and easier to access for patients.
Providers who do not need to register with the Care Quality Commission, GPs, dentists, NHS trusts, providers with a turnover of less than £10 million per year and providers of NHS continuing healthcare and NHS-funded nursing care will not be required to apply for a Monitor license unless they have been designated as a CRS.
Governors and directors of providers hoping to obtain a Monitor license must meet the fit and proper persons test – which includes criminal records checks and financial background searches.
