Specialised services are those provided in relatively few hospitals, accessed by comparatively small numbers of patients but with catchment populations of more than one million. These services tend to be located in specialist hospital trusts that can recruit staff with the appropriate expertise and enable them to develop their skills.
Specialised services account for approximately 10% of the total NHS budget, spending circa £11.8 billion per annum. The commissioning of specialised services is a prescribed core responsibility of NHS England.
Four Factors will determine whether NHS England commissions a service as a prescribed specialised service. These are:
- The number of individuals who require the service;
- The cost of providing the service or facility;
- The number of people able to provide the service or facility and
- The financial implications for Clinical Commissioning Groups (CCGs) if they were required to arrange for provision of the service or facility themselves.
The ambition of NHS England is to bring equity and excellence to the provision of specialised care and treatment. This is achieved through a commissioning process which:
- Is patient-centred and outcome based. The patient must be placed at the centre of planning and delivery. Commissioners, working with providers, must deliver improved outcomes for them across each of the five domains of the 2013/14 NHS Outcomes Framework;
- Is fair, consistent throughout the country, ensuring that patients have equal access to services regardless of their location and
- Improves productivity and efficiency.
A national consistent and coherent approach to specialised commissioning is built on universal support. To date, there has been wide variation in how each region discharges its commissioning responsibilities. This has resulted in inconsistencies in the management of the commissioning cycle e.g. budget setting, contract negotiation, performance management and the development and application of service specifications, commissioning policies and quality standards. It has also resulted in duplication of some activities and functions.
A consistent approach to central planning that is delivered locally will help to tackle these variations and take positive steps towards raising standards of care for all patients receiving treatment for rare and specialised conditions with equity across the country.
Specialised services Clinical Reference Groups (CRGs)
NHS England has launched a series of web pages dedicated to each of the 74 specialised services Clinical Reference Groups (CRGs).
CRGs cover the full range of specialised services and are responsible for providing NHS England with clinical advice regarding these directly commissioned services. The CRGs are made up of clinicians, commissioners, Public Health experts and patients and carers, and are responsible for the delivery of key ‘products’ such as service specifications and commissioning policies, which enable NHS England to commission services from specialist providers through the contracting arrangements overseen by its Area Teams.
An additional CRG for Medicines Management, involving pharmacists and pharmacologists, is in development.
The web pages will provide a wealth of information relating to the individual CRG membership and work programmes, as well as being home to key CRG documents and minutes of meetings. The pages will be updated on a regular basis.