Guidance

NHS commissioners: designate commissioner requested services (CRS)

Designate which healthcare services should continue to be provided locally if an individual provider fails financially.

Overview

As an NHS commissioner, you are responsible for planning and purchasing healthcare services for your local population. This responsibility includes deciding which services need the protection of the continuity of services provisions of the NHS provider licence. These are called ‘commissioner requested services’ (CRS).

Monitor’s role is to regulate licensed providers to reduce their risk of failing financially, and to reduce the impact on patients if a provider does fail.

This guide for NHS clinical commissioning groups, NHS England and commissioning support units sets out how to designate CRS and how to submit your designations to Monitor.

About commissioner requested services

Services can be designated as commissioner requested services because:

  • there is no alternative provider close enough
  • removing them would increase health inequalities
  • removing them would make other related services unviable

CRS are subject to the continuity of services conditions in Monitor’s provider licence, meaning they have to share certain financial information with Monitor, accept restrictions on their ability to dispose of CRS assets and co-operate with Monitor if they get into financial difficulty.

It’s important to note that:

  • NHS foundation trust services are automatically designated as CRS until April 2016
  • services provided by NHS trusts are exempt from CRS designation

The Risk assessment framework for NHS foundation trusts and Risk assessment framework for independent sector providers of NHS services set out how these providers are monitored.

Designation process

You should follow this 5-step process for identifying commissioner requested services.

  1. Identify the desired long-term outcome, given the needs of your local population and the current local configuration of health services.
  2. Notify providers and other affected groups that you are beginning work to identify commissioner requested services and are seeking their input.
  3. Work through the 4 stages of the Designation framework (PDF, 801KB, 60 pages) and either designate services as commissioner requested services or remove their commissioner requested services designation. Note that if you designate services from an unlicensed provider as CRS, you must request that the provider be licensed by Monitor.
  4. Notify providers of your decisions. You need to send a written request requiring the provider to provide a service as a CRS before the continuity of services protections in the licence will be applied. Providers may refuse the designation of a service as a CRS. When a provider refuses to accept a CRS designation and you still think the service should be designated, you may ask Monitor to carry out a review to determine whether the provider’s refusal was unreasonable.
  5. Refresh and update your designations. Over time, as providers enter and exit a local health economy or service, and technological changes mean services can be delivered in different ways, you will need to review your commissioner requested services designations to make sure they are still appropriate. Providers may also ask you to review a CRS designation. During a review, current designations remain in place until the review is complete.

Submit designations

You should tell Monitor which services you have designated as commissioner requested services to enable us to operate the continuity of services provisions of the provider licence.

You should:

Update designations

If your information changes at any point, you should:

Monitor will use this information to support other commissioners by helping them to understand how the guidance is being applied in practice.

Expiry of designated services: 1 April 2016

We’ve published an update for commissioners (PDF, 282KB, 4 pages) encouraging them to consider whether they need to redesignate services as CRS. As stated above, on 1 April 2016 NHS services at the majority of NHS foundation trusts will lose the automatic CRS status.

Please tell us by 8 January at nhsi.crs@nhs.net if you have already, during the ‘grandfathering’ period, redesignate services provided by NHS foundation trusts as CRS or intend to before 1 April 2016.

More resources

This process is set out in more detail in Guidance for commissioners on designating commissioner requested services (CRS) (PDF, 991KB, 31 pages) .

You should use the guidance with:

Webinar: guidance for commissioners on ensuring the continuity of healthcare services