Specialised Commisioning

The NHS operates on the basis of services being commissioned by one party (the commissioner) from another (the provider), depending on factors such as facilities, expertise and anticipated patient numbers. The majority of services are commissioned at a local level, with the bulk of money being spent on conditions affecting large numbers of people, such as cardiovascular disease or musculoskeletal conditions. A significant amount, however, needs to be allocated to rare diseases and other more complex conditions. The planning and procurement of these services is known as specialised commissioning.

Under the Health and Social Care Act 2012, the commissioning of specialised services is the direct responsibility of NHS England. This is in contrast to the majority of mainstream healthcare, which is commissioned locally by Clinical Commissioning Groups. In commissioning specialised services, NHS England is supported by over 40 Clinical Reference Groups (CRGs) combining clinical expertise with patient and public representation. The CRGs help develop national specialised service policies. These specify the services patients can expect to receive and where they will be provided. They also set out what high cost treatments NHS England will or won’t routinely fund.

10 of NHS England’s 27 Area Teams have the task of implementing these national policies at a local level, managing contracts with their providers on behalf of patients drawn from anywhere in England. It is intended that services should be broadly uniform across England. As NHS England is the sole statutory commissioner of specialised services, variation in access to treatments could be liable to legal challenge.

If you have information about provision of specialised services that you would like to bring to our attention or if you would like to know more about the SHCA, please contact us at: team@shca.info