Designation is the definition of a service and/or those who provide it. Nationally commissioned services, which are rare or highly specialised services - and those eligible to provide them - are specifically designated by the Secretary of State for health. The NHS pays for these services collectively and they are commissioned through the National Specialised Commissioning Team (NSC Team) which ensures that they are provided to the highest standards of quality and meet patient need. NSC Team will only pay designated providers for such services.
Services and providers are initially designated when the service is first deemed appropriate for commissioned on a national basis. Designation is renewed when the Secretary of State accepts a recommendation from the Advisory Group for National Specialised Services (AGNSS) to continue to designate the service and specific service providers.
The Renewal of Designation (RoD) programme aims to answer the following questions:
The Renewal of Designation is currently being piloted and is expected to begin in full from 2011.
Renewal of designation is aimed at improving the quality and productivity of nationally commissioned services. It provides assessment and comparison of service providers against a range of criteria including quality (safety, patient experience and clinical outcomes), risk, access to services and value for money.
The renewal of designation process enables the National Specialised Commissioning Team to show that it continues to commission services that are appropriate for national commissioning from providers who are able to deliver the best possible service for patients.
In response to the Review of Commissioning Arrangements for Specialised Services by Lord Carter (May 2006), the National Specialised Commissioning Team agreed to implement a cyclical programme of reviewing and, where appropriate, recommending continued designation of existing nationally commissioned services and service providers.
The process provides a mechanism for assessing the continued need for a service to be nationally commissioned, taking into account the decision-making framework used to assess potential new services, and whether current arrangements with existing providers still meet identified need and quality requirements. The process can lead to a programme of improvement, reconfiguration or transfer of the service to other commissioners.
2. How is the National Specialised Commissioning Team planning to implement Renewal of Designation?
The National Specialised Commissioning Team approved a project to:
A pilot is now underway for two nationally commissioned services. The pilot starts in May 2010 and should be completed and reviewed by the autmun of 2010. Guidance on the pilot process can be found here
Following consultation and consideration of the pilot review the full programme will begin in 2011.
3. What is the implication for services commissioned by the National Specialised Commissioning Team?
The number of services suitable for national commissioning is relatively small. For 2010/11 the National Specialised Commissioning Team is commissioning over 60 services from over 50 providers.
Careful consideration is given before a service is accepted for national commissioning including an assessment of the impact of future developments in need, medical technology and clinical practice.
A new decision making framework will help support recommendations to Ministers on which services are suitable for national commissioning.
If an assessment against the framework indicates that an existing service should be commissioned elsewhere, the recommendation to the Minister will allow continued designation while alternative arrangements are explored.
4. What are the implications for providers?
Most services will continue to be nationally designated. Because of the specialised nature of the service and the small number of patients, the number of providers is likely to remain fairly small. However, through the renewal of designation process the National Specialised Commissioning Team will assess providers to determine how they are meeting the contractually agreed quality and performance criteria and, where appropriate, improvement plans may be identified.
Exceptionally, where there are ongoing concerns about performance or changes in patients' needs indicate that more or fewer service providers are required, the renewal of designation process may result in a recommendation to the Secretary of State that a reconfiguration of the service providers is implemented. In this case providers will continue to be designated until any new arrangements are agreed.
The National Specialised Commissioning Team will observe the Principles and Rules for Co-operation and Competition throughout the renewal of designation Process.
If it is agreed that a service should no longer be nationally commissioned then as partners, providers/alternative commissioners will be fully involved in any process through which commissioning responsibility is transferred.
As with all NHS services, the views and input of partners, particularly patients and carers, are very important for nationally commissioned services. It is expected that this would be reflected within reports provided by trusts and the National Specialised Commissioning Team (NSC Team) in the renewal of designation process.
NST Team welcomes direct involvement from all partners in the renewal of designation process. The commissioning team will make direct contact with as many key partners as possible, telling them about the process and inviting them to get involved. NST Team will welcome comments from anyone who has an interest in a particular service.
NST Team intends to publish the Renewal of Designation Reports for each service on this website.
Nationally commissioned services are highly specialised and provided by a small number of providers. Providers must demonstrate their capacity to meet nationally agreed criteria, detailed service specifications and demanding contractual and performance measures. For this reason the market of potential providers of a service is likely to be small.
Potential providers of an existing service are asked to contact the National Specialised Commissiong Team (NSC Team) service commissioner so that the particular circumstances, standards and requirements of the service can be discussed.
NSC Team may identify a need to make changes to the current configuration providers for a service either through normal commissioning activities or through renewal of designation. Potential providers are advised to contact the service commissioner as soon as possible.
7. How is the pilot being carried out? What happens after the pilot?
The National Specialised Commissioning Team (NSC Team) aims to complete and review the pilot by the end of the year. NHS Specialised Services expects to begin the full renewal of designation process in 2011.
The two services being reviewed through the pilot are
The detailed pilot process is described in the guidance which is available from the NSC Team - please email enquiries@nsct.nhs.uk
8. Where can I get more information?
If you have a general enquiry or require more information relating to renewal of designation process or the implementation of the pilot, please contact us. Full guidance and outline guidance on the renewal of designation can be found in the Document Library.
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