Specialised Services

Renal Dialysis

Specialised Services Commissioning

Specialised services are those services provided in relatively few specialist centres to catchment populations of more than 1 million people. These services are not provided by every hospital, and tend to be found in larger hospitals based in big towns and cities

Specialised services are identified in more detail in the Specialised Services National Definitions Set published by the Department of Health (DH). It is estimated that specialised services account for about 10% of total PCT expenditure on hospital services.

In England specialised services are either commissioned by Specialised Commissioning Groups (SCGs) or nationally by the National Commissioning Group (NCG). This depends on the rarity of the condition or treatment.

From October 2011 the ten Specialised Commissioning Groups (SCGs - see below for previous arrangements) were ‘clustered’ into four organisations along the same footprints as the Strategic Health Authorities. This is a stage in the transition into a single nationwide function for specialised services.


The underlying aim of the arrangements for commissioning specialised services is to ensure fair access to clinically effective, high quality, specialised services right across the country.

Specialised services are services where patient numbers are small and a critical mass of patients is needed in treatment centres to:

  • achieve the best outcomes and maintain clinical competence
  • sustain the training of specialist staff
  • ensure cost-effectiveness in provision
  • make the best use of scarce resources (including staff expertise, high tech’ equipment, and donor organs)

Specialised services are high-cost, low-volume interventions and treatments. The risk to an individual Primary Care Trust (PCT) of having to fund expensive, unpredictable activity is reduced by PCTs grouping together to commission such services collectively and share financial risk. PCTs therefore group together to commission and share high cost, low volume specialised services.

Previous National Arrangements

On the recommendation of the Carter report (Review of Commissioning Arrangements for Specialised Services, May 2006) ten Specialised Commissioning Groups (SCGs) were established to commission services on a regional basis in England. Each SCG acted on behalf of a population of about five million people and is aligned with the 10 Strategic Health Authorities (SHAs) and its constituent PCTs.

A National Commissioning Group (formerly known as the ‘National Specialist Commissioning Advisory Group’) commissions services on a national basis for a specific group of extremely rare conditions or very unusual treatments. Most services commissioned by the NCG relate to a condition where the national caseload is less than 400 people.

This page was last updated on 27 September 2012.

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