A review of commissioning 'specialised services' within the National Health Service has stressed the potential for interrupting some care pathways, and urged the development of new systems to ensure continuity of access to treatment.

Specialised services - i.e services for rare and uncommon conditions and illnesses - such as AIDS, cleft lips and rare genetic conditions - will be outside the normal remit of local clinical commissioning groups (CCGs) when they take hold of the purse strings in April 2013. 

Instead, they will be organised differently and commissioned on a wider scale, the government said.

A new national model for these services is currently being developed by the NHS Commissioning Board (NHSCB).

This new model aims to improve access and boost the quality and efficiency of services, while reducing variation across the country, and will be led by ten of the NHSCB’s Local Area Teams which will work closely with healthcare providers and CCGs. 

“The NHS is there to treat all of the public’s needs, including those with rare and uncommon conditions. It is vital that these services are not only available to the public, but that they are of the highest possible quality," noted health minister Lord Howe.

A new report has now set out recommendations on which health services treating rare and uncommon conditions should be nationally commissioned.

But highlighting potential issues with the new system, review lead Kathy McLean, former Medical Director for NHS East Midlands and member of the Independent NHS Future Forum, noted that there will be many incidences where aspects of services will be specialised while others are controlled by CCGs. 

Working together

Her team was "struck by the need for commissioners to work together where a patient pathway crossed between CCG and NHSCB responsibility," she said, and advised of "potential risks in creating a commissioning 'boundary' - especially where separate budgets will apply". 

McLean did stress that "these risks were identifiable but should not preclude prescription of a service", but also added that the commissioning board “will need to develop systems to ‘join-up’ commissioning for these services.”

The report's recommendations are now being considered by the Department of Health, which said it will publish a final set of regulations later in the year specifying the new arrangements.