A new report from NHS Clinical Commissioners (NHSCC), based on a simulation exercise, aims to help CCGs meet their commissioning support unit needs.

A scenario workshop held in May 2012 explored how CCGs can most effectively draw on CSU resources when commissioning local services.

The report identifies the need of CCGs for greater clarity on the CSU options available to them and how the organisations can best work together.

It describes how six emerging CCGs, four CSUs and an acute hospital trust worked together to develop an operational plan, redesign COPD services, and implement the redesign.

Key learning points identified in the report included:

• CCGs need to understand the support options available to them locally and nationally, while CSUs need to market their services more effectively.

• Both CCGs and CSUs need to understand when clinical leadership is necessary in commissioning and when other CCG members can lead the process.

• The role of the wider clinical team, including nurses and hospital specialists, in guiding the commissioning process needs to be developed.

• The customer/supplier relationship between CCGs and CSUs needs to be explored and tested.

Julie Wood (pictured), Interim Commissioning Development Director at NHSCC, said: “It is absolutely crucial that clinical commissioners receive the support they need to create a robust strategy for their work with commissioning support services.

“Not only do CCGs need a lot more clarity on the options available to them in terms of using CSSs, but they also need to be able to access a range of practical support which is relevant to their requirements.”

Dame Barbara Hakin, National Director of Commissioning Development, commented: “There is still a great deal of work to do to ensure that clinical commissioners have all the support they need, and we have used the insights from this report to inform the next phase of the NHS Commissioning Board Authority’s programme of practical, targeted CCG and CSU development support.”

Addressing performance levels of GPs who do not provide value for money will improve the standards of primary care in poorer areas, a senior DH advisor has said.

Sir John Oldham, National Clinical Lead for the QIPP agenda, called for clinical commissioning groups to tackle performance levels to counter under-resourced primary care services.

He said improving standards of primary care doesn’t necessarily involve investing huge sums of money but “looking at what return we get on existing investment”.

The GP advisor was speaking after he chaired an international review of primary care standards. The summit found that the majority of countries required investment to drive improvements.

Sir John acknowledged that funding was unlikely in England at a time when the NHS is challenged with making £20bn of efficiency savings. But he did say that the NHS Commissioning Board and CCGs should challenge underperforming doctors.

“We need to make sure provision in less well-off areas is as good as in well-off areas,” he said. “Most of us recognise the minority [of poor GPs] need tackling, not least to make sure patients receive a good level of care, but also to make sure they are contributing to CCGs’ commissioning aims.”

Up to 6,000 jobs may be lost over the coming months as part of the final transitional stages of the new NHS structure, a leading union boss has predicted.

It’s believed that 400 jobs at the Birmingham, Solihull and Black Country PCT and a further 400 positions at Greater Manchester PCT will be the first axed.

Jon Restell, Chief Executive of Managers in Practice, said he was “expecting something big to happen” in the next three months due to the NHS still needing to “downsize”.

The wave of job cuts are as a result of CCGs, CSS and the NHSCB only now calculating how many employees they will be able to afford when they are fully authorised from next April.

The hundreds of jobs predicted to go in the Midlands and the North West have also been replicated in other parts of England. However, regions such as London reduced posts “harder and earlier” in the restructuring process, Restell said.

A reduction of 400 posts at the Birmingham, Solihull and Black Country PCT would result in a 30% reduction in staff. However, it’s expected that those who will lose their jobs will take on new roles in the local CSSs, council public health teams, Public Health England and other bodies formed after the reforms.

NICE has failed to recommend Alimera’s Iluvien (fluocinolone acetonide intravitreal implant) for the treatment of chronic diabetic macular oedema (DMO) in draft guidance.

Its independent Appraisal Committee raised concerns over the economic model submitted by Alimera and the evidence it supplied during the appraisal.

Professor Carole Longson, Health Technology Evaluation Centre Director at NICE, said the Committee “agreed” that the evidence supplied “could not support a positive recommendation”.

Around 336,000 in the UK with diabetes have DMO. Prevalence increases to nearly a third (29%) of people with diabetes who have used insulin for more than 20 years.

DMO occurs as a result of changes in retinal blood vessels. Iluvien is a corticosteroid which has anti-inflammatory and anti-vascular endothelial growth factor (anti-VEGF) properties. By inhabiting VEGT, the implant can decrease the oedema and improve vision.

But NICE concluded economic models “underestimated” the incremental cost-effectiveness ratio for the treatment and that data supplied did not “accurately reflect” current clinical practice.

The draft recommendation is now open to consultation.

ESyDoc CCG in Surrey has claimed delays in commissioning support service (CSS) appointments are holding back its authorisation.

The CCG, whose committee has existed since 2007, blamed the time taken for the NHS Commissioning Board to appoint CSS leaders for its “slow down”.

The NHSCB responded that its appointment of CSS managing directors was well under way and “on track” for completion.

ESyDoc currently commissions both primary and secondary care services for 170,000 people. It consists of 18 GP practices in south-east Surrey.

As a prospective CCG, ESyDoc is positioned in wave 3 of the authorisation process (commencing 1 September 2012).

According to Dr Joe McGilligan, Chair of ESyDoc CCG, establishing a viable CSS contract is “the most difficult” aspect of authorisation. “We have only just received an offer from our local NHS CB hosted CSS, and even that is well over what we can afford at £15 a head,” he said.

“In accordance with the nationally set deadlines, we should have signed off on our commissioning support by now.”

However, an NHSCB spokesperson said that managing directors had been appointed for 10 of the 23 CSSs and the others were “on track” with interviews currently taking place.