Recommendation 127

Commissioners scrutinising providers

The NHS Commissioning Board and local commissioners must be provided with the infrastructure and the support necessary to enable a proper scrutiny of its providers’ services, based on sound commissioning contracts, while ensuring providers remain responsible and accountable for the services they provide.

The NHS Standard Contract, NHS England’s assurance of clinical commissioning groups, and the development of commissioning support services, together provide a new infrastructure to ensure that commissioners have the capacity and capability to scrutinise providers’ services.

The NHS Standard Contract provides a clear framework through which commissioners can hold providers to account for service quality and safety, and NHS England will continue to develop this further for 2014/15.

Commissioning comprises some activities for which the statutory commissioning body must retain ultimate responsibility, but there is also a range of other, key support functions which it may be more effective and efficient to be secured externally. These are known as ‘commissioning support services’. Commissioning support services typically include:

  • Health Needs Assessment
  • business intelligence
  • support for redesign
  • communications and patient and public engagement
  • procurement and market management (agreeing contracts)
  • provider management (monitoring contracts)

Provision of commissioning support services is currently dominated by 19 commissioning support units, created from primary care trusts and hosted by NHS England and the NHS Business Services Authority until 2016.

Work has already been done through NHS England’s clinical commissioning groups assurance programme and through the development of commissioning support services to assure the quality of infrastructure and support within, and available to, commissioning organisations. NHS England will continue to develop this as an objective in its Commissioning Support Services Strategy.


The NHS Standard Contract continues to provide a clear framework through which commissioners can hold providers to account for quality and safety. Revised provisions, particularly relating to commissioner’s rights to suspend the provision of services, were published in December 2013 as part of the NHS Standard Contract for 2014-15.

NHS England has developed a new framework agreement for commissioning support services – the Lead Provider Framework – that from January 2015 will give clinical commissioning groups, NHS England and other customers a choice of supplier for some or all of their commissioning support needs, ranging from transactional back office support services to more bespoke services that support local and large scale transformational change projects. The Framework will be available to any organization, within or outside the NHS that wishes to procure some or all of its health and social care support services from a variety of accredited providers. It is anticipated that between £3bn and £5bn of services will be procured through it over the next four years. Use of the framework is optional for clinical commissioning groups.