The new clinical commissioning groups (CCGs) and commissioning support services (CSSs) will need to understand when clinical involvement is essential and when other members of the commissioning team are better positioned to take over certain parts of the process, says a new report.

The report, which also acknowledges that CCGs and CSSs will wish to maximise the benefits of clinically-led commissioning, has been produced jointly by NHS Clinical Commissioners (NHSCC) and the University of Birmingham's Health Services Management Centre, to help support CCGs develop effective relationships with CSSs.

As CCGs move on to full authorisation, they will need all the support they can get, says NHSCC. The report, based on a simulation event which tested how CCGs might utilise CSSs, is designed to help CCG leaders think through how they can make best use of their own clinical strengths and expertise, while drawing on the resources available from CSSs to commission the best services possible for their local community.

Other key learning points from the simulation and subsequent report are that:
- CCGs need to understand the range of options available to them, both locally and nationally. CSSs need to market their services in ways that are meaningful to CCGs, to enable them to make informed choices about where and what support they will access;
- the role of the wider clinical team in offering expert advice and support to the commissioning process - including nurses, allied health professionals and acute trust clinicians - needs to be embraced; and
- CCGs and CSSs need to be aware of which services are available and necessary. They need to invest time in expanding their networks and in understanding the roles and responsibilities of other players.

The customer/suppler relationship between CCGs and CSSs needs to be explored and tested in practice until an acceptable balance is achieved, and CSSs need to maximise the potential for joint working without impairing accountability, the report adds.

"This is a critical issue for CCGs and CSSs," said Dr Charles Alessi, interim chairman of NHSCC and chairman of the National Association of Primary Care (NAPC).

"It is of fundamental importance that CCGs are fully aware locally of their specific needs before deciding upon any commissioning support arrangement. It is of equal importance that they are alert to all the consequential implications of the decisions they are taking. These should be explored and discussed with available legal support," he emphasised.

"This is also about cultural change, with clinicians, including nurses and other professionals, and with advice from local management expertise, determining their requirements. No longer do clinical commissioners have to submit to central imposition. However, it is of equal importance that all parties maintain constructive relationships,” said Dr Alessi.

The report identifies the following seven key themes and respective learning points: - relationship development; - leadership and authority; - customer/supplier models; - using clinical expertise; - learning from others; - rule of rescue or business acumen; and - governance mandate.

These themes and lessons will be used to inform the NHS Commissioning Board Authority and other partners on their approach to commissioning support development over the coming months, says NHSCC.