M /13 Finance Report

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1 M /13 Finance eport Name eport owner: Tonia Parsons Doc completed by: T adia Progress since last update This report updates members on M11 results and forecast for 2012/13. BTUH forecast has been updated to reflect agreed financial position for 2012/ /13 full year forecast is an overspend of 10,292k. Potential/current concerns Next steps for the Workstream group members: Implement and manage activity outside of secondary care by various initiatives such as SPO, Community Geriatrician, use of community beds etc eview those practices with higher than plan of secondary care activity Control consultant to consultant referrals and cap on FU outpatient appointments at BTUH ecommendations/actions for the BCCG Board: Note M11 position and full year forecast 1

2 2012/13 February 2013 (Month 11) Financial Position Overview to M11 This paper sets out the current and forecast financial position of the Basildon and Brentwood Clinical Commissioning Group (BBCCG) for Month 11 of 2012/13 financial year. BBCCG is showing a deficit of 8,495k at Month 11 (YTD M10 8,095k) and by Locality is as follows: Locality - 000's Total Acute MH&LD CH MM Other MC Arterial 320 1,296 (80) 215 (129) (984) 1 Brentwood 2,762 3,374 (46) 39 (747) Partnership and BIC 1,698 3,338 (26) (43) (118) (1,453) (0) SEMC 3,710 3,733 (38) (65) (963) 1,043 0 Management 5 5 Total 8,495 11,741 (189) 146 (1,957) (1,255) 8 Please note that in brackets means under budget whereas without brackets is over budget in report above and throughout this report. CH - Community Health (SEPT, NELFT, continuing healthcare, other community) MM - Medicines Management and prescribing Other - Children s commissioning and eserves MC - Management Costs Full year forecast is 10,292k deficit and by locality is shown below. The forecast has not moved significantly from that reported in M10 of 10,259k. Locality - 000's Total Acute MH&LD CH MM Other MC Arterial 719 1,690 (87) 235 (140) (979) 1 Brentwood 3,230 3,845 (50) 42 (815) Partnership and BIC 2,091 3,776 (28) (47) (129) (1,481) (0) SEMC 4,245 4,225 (41) (71) (1,051) 1,183 0 Management 7 7 Total 10,292 13,535 (206) 160 (2,134) (1,071) 10 Detailed Locality Finance eports are shown in Appendix 2. 2

3 Of the YTD acute overspend of 11,741k by locality: Provider 000's Total Arterial Brentwood Partnership and BIC SEMC BTUH 9,233 2,303 1,596 2,318 3,015 Southend Other acute hospitals (1,306) (2,181) Other acute services NCAs 202 (0) 270 (1) (68) Other PCTs (0) (0) (0) (0) 0 Ambulance Other providers 1, Other Total 11,741 1,296 3,374 3,338 3,733 The BBCCG forecast for the year shown on the next page reflects agreement with BTUH on an agreed financial envelope for 2012/13. This agreed position was of mutual benefit to both parties as YTD performance suggested a higher final figure and from BTUH perspective they were facing financial penalties due to not meeting A&E and other performance targets. Forecast Outturn has not changed from that reported at Month 9. SW Essex Cluster (BBCCG and TCCG are in this cluster) is reporting that it will meet its agreed surplus for 2012/13. Consequently the expectation is that BBCCG will not have any deficit carry forward into 2013/14. Movements in Budgets are shown in Appendix 1. 3

4 2012/13 Forecast 4

5 Brentwood & Basildon CCG February 2013 Original Current Date Budget Date Spend (Under)/ Over Forecast Year End (FIMS) Prior Month Forecast Acute Providers BTUH 81,209 95,286 87,700 96,933 9,233 p 10,200 q 10,454 Southend 11,430 12,782 11,693 12, p 713 p 602 Other acute hospitals 36,443 36,932 34,428 33,122 (1,306) q (913) q (755) Other acute services 611 3,114 2,855 3, p 943 p 912 NCAs 1,638 1,588 1,459 1, q 318 tu 318 Other PCTs (0) (0) - - Ambulance 6,996 7,863 7,208 7, p 629 tu 629 Other providers 3,218 3,864 3,542 4,939 1,397 p 1,524 p 1,333 Other p 121 q 127 eserves , , , ,626 11,741 p 13,535 q 13,621 Non-NHS SLAs Non-NHS SLAs 2,271 2,551 2,338 2, p 596 p 594 2,271 2,551 2,338 2, p 596 p 594 Mental Health & LD Service Level Agreements NHS MH 24,844 27,425 25,139 25, p 63 p 62 NHS LD Non-NHS MH (18) q (20) q (13) Non-NHS LD q 1 q 2 DAT eserves (230) q (251) tu (251) 25,888 28,415 26,047 25,858 (189) q (207) q (200) Children's & Young People Services Children's & Young People Services 3,826 3,581 3,794 3,495 (299) q (149) q (132) 3,826 3,581 3,794 3,495 (299) q (149) q (132) Community Care Ex-PCT Providers 29,220 32,382 29,683 29, p 89 p 70 Other NHS Providers p 239 q 247 Continuing Healthcare 6,022 7,059 6,471 6, p 116 p (70) Other providers 3,022 3,242 2,972 2,673 (299) q (326) q (238) Other / eserves 159 (0) p 41 q 45 39,129 43,375 39,760 39, p 159 p 54 Primary Care GP Practices : GMS q 31 q 39 GP Practices : PMS (7) q (7) tu (7) GP Practices : PCTMS GP Practices : APMS tu 1 tu 1 Dental Pharmacists Opticians Out of Hours 1,185 1,151 1,055 1, p 170 p 162 Other Primary Care q 22 q 31 eserves ,247 1,416 1,298 1, p 217 q 226 Prescribing / Medicines Management GP Prescribing 35,656 39,490 35,886 34,198 (1,687) p (1,841) p (2,000) Other prescribing / med mgmnt 2,205 2,143 1,964 1,695 (269) q (293) q (274) 37,860 41,632 37,850 35,894 (1,956) p (2,134) p (2,274) PCT Management Costs Board p 7 p 1 Quality & Patient Experience Medical Commercial Finance & Performance q 0 q 2 Commissioning (0) - - Primary Care & Partnerships Transition & ning 770 1,183 1,088 1,089 1 q 2 tu 2 Public Health Workforce Estates Other / eserves ,104 2,009 2,017 8 p 9 p 5 Other / eserves Other Central eserves 0 3,082 1,701 - (1,701) q (1,734) q (1,634) Contingency - Anticipated LAs ,082 1,701 - (1,701) q (1,734) q (1,634) TOTAL COMMISSIONE 252, , , ,178 8,495 p 10,292 p 10,259 5

6 QIPP The BBCCG finance plan is based on a QIPP ambition of 7,232k with a required target delivery of 6,329k. BBCCG has formulated plans to this value. The actual QIPP delivery is based on the CCG configuration, as recognised by the NCB. However QIPP ambition and target needs to be refreshed in the light of the revised allocation and change in membership. Scheme delivery tracker is in Appendix 3. ned Care YTD target 719k Actual overspent 1,062k - ed The planned care schemes are highlighted red on the tracker as it is behind target by below 70%for delivery. All 5 ned Care savings initiatives London epatriation, MC, Consultant Led Haematology Service, Community Dermatology Service and MSK Tier 2 service is below 70% delivery target. For all these schemes refresh and other initiatives are planned or implemented which should have an impact in the coming months. Unplanned Care YTD target 2,246k Actual overspent 1,127k - ed Unplanned care at BTUH in ed whilst unplanned care at BHT plan is Green. MDT and Community Geriatrician launched late September and targeted practice visits are expected to improve on QIPP delivery at BTUH. Prescribing YTD target 630k Actual achieved 1,421k - Green There are 9 work streams. Schemes ahead are Oral Nutritional Supplements, Scripswitch, Wound care products, Care Homes, espiratory and Ezelimber. Schemes behind plan are unlicensed special order products, Stoma applications and Blood Glucose testing strips. Ambulance and Mental Health schemes are on target. 6

7 Key isks The main risk with regards to achieving breakeven for BBCCG is over performance at BTUH and non-achievement of QIPP. As described above initiatives to care outside of hospital are being publicised with the practices and targets agreed with the relevant provider. egular practice visits to ensure usage of community pathways and agree other actions to manage activity out of hospital. These actions should mitigate this risk. ecommendations Board Members are asked to approve this financial report of BBCCG for Month /13. Terry adia Interim Chief Financial Officer 21 st March

8 Appendix /13 Budget Allocation Analysis of budget allocation to date is as follows: Month Actioned BBCCG Allocation 000 M5 Budget as previously reported 5 287,186 Specialist Commissioning budgets removed from Acute contracts 5 (2,717) MC budget allocation Enhanced Services budget heumatology 6 36 NELFT 6 (715) NELFT Various from Public Health Budgets unning Costs 7 2,211 Carers Strategy COPD M7 Budget 7 287,415 Various 8/9 16 M9 Budget 9 287,431 BTUH Specialist Commissioning

9 Brentwood Community Hospital 10 (154) SHA Development money M10/11 Budget 287,586 Locality Financial Performance Month /13 Arterial Appendix 2 9

10 Arterial January Original Current Date Budget Date Spend (Under)/ Over Forecast Year End Acute Providers BTUH 27,294 29,145 26,905 29,208 2,303 2,544 Southend 3,343 3,494 3,196 3, Other acute hospitals 4,813 7,711 7,317 5,136 (2,181) (2,126) Other acute services 161 1,217 1,116 1, NCAs (0) (0) Other PCTs (0) (0) (0) Ambulance 1,928 2,919 2,675 2, Other providers 647 1, , Other eserves ,618 45,918 42,524 43,821 1,296 1,690 Non-NHS SLAs Non-NHS SLAs , , Mental Health & LD Service Level Agreements NHS MH 6,671 10,059 9,221 9, Non-NHS MH (17) (19) Non-NHS LD eserves (84) (92) 6,947 10,421 9,552 9,473 (80) (87) Children's & Young People Services Children's & Young People Services 1,009 1,247 1,331 1,274 (57) (29) 1,009 1,247 1,331 1,274 (57) (29) Community Care Ex-PCT Providers 7,844 11,806 10,822 10, Other NHS Providers Continuing Healthcare 1,588 2,638 2,418 2,413 (5) (5) Other providers 797 1,152 1, (80) (87) Other / eserves ,456 15,782 14,467 14, Primary Care GP Practices : GMS (11) (12) GP Practices : PMS (3) (3) GP Practices : APMS Out of Hours Other Primary Care Prescribing / Medicines Management GP Prescribing 10,106 10,374 9,465 9,272 (193) (211) Other prescribing / med mgmnt ,687 10,955 9,998 9,869 (129) (140) PCT Management Costs Transition & ning Other / eserves Other / eserves Other Central eserves (2,084) 1,298 1,301 - (1,301) (1,358) (2,084) 1,298 1,301 - (1,301) (1,358) TOTAL 66,763 87,147 80,571 80, Brentwood 10

11 Brentwood January Original Current Date Budget Date Spend (Under)/ Over Forecast Year End (FIMS) Acute Providers BTUH 10,192 11,007 10,207 11,803 1,596 1,763 Southend 1,391 1,324 1,211 1, Other acute hospitals 25,314 24,440 22,486 23, Other acute services 179 1, , NCAs Other PCTs (0) (0) (0) Ambulance 2,051 2,086 1,912 2, Other providers 1,921 1,898 1,740 2, Other eserves ,528 42,301 38,973 42,347 3,374 3,845 Non-NHS SLAs Non-NHS SLAs Mental Health & LD Service Level Agreements NHS MH 7,279 7,296 6,688 6, Non-NHS MH (0) (1) Non-NHS LD eserves (61) (67) 7,584 7,560 6,930 6,884 (46) (50) Children's & Young People Services Children's & Young People Services 1, , (91) (45) 1, , (91) (45) Community Care Ex-PCT Providers 8,555 8,656 7,935 7,908 (26) (29) Other NHS Providers Continuing Healthcare 1,763 1,782 1,634 1, Other providers (90) (99) Other / eserves 47 (0) ,457 11,532 10,571 10, Primary Care GP Practices : GMS GP Practices : PMS GP Practices : APMS Out of Hours (1) (1) Other Primary Care Prescribing / Medicines Management GP Prescribing 10,928 11,167 10,126 9,529 (597) (652) Other prescribing / med mgmnt (150) (163) 11,574 11,824 10,728 9,981 (747) (815) PCT Management Costs Finance & Performance Transition & ning Other / eserves Other Central eserves (300) (2) (31) (300) (2) (31) TOTAL 74,220 75,568 69,465 72,227 2,762 3,230 11

12 Partnership and BIC PATNESHIP and BIC January Original Current Date Budget Date Spend (Under)/ Over Forecast Year End (FIMS) Acute Providers BTUH 23,182 30,349 27,793 30,111 2,318 2,561 Southend 2,668 3,745 3,426 3, Other acute hospitals 2,614 1,295 1,285 1, Other acute services NCAs (1) (1) Other PCTs (0) (0) (0) Ambulance 1,583 1,150 1,054 1, Other providers Other eserves ,743 37,386 34,335 37,673 3,338 3,776 Non-NHS SLAs Non-NHS SLAs Mental Health & LD Service Level Agreements NHS MH 5,477 4,099 3,757 3, Non-NHS MH (0) (0) Non-NHS LD eserves (34) (37) 5,703 4,247 3,893 3,867 (26) (28) Children's & Young People Services Children's & Young People Services (62) (31) (62) (31) Community Care Ex-PCT Providers 6,439 4,829 4,426 4,412 (15) (16) Other NHS Providers Continuing Healthcare 1,303 1, (2) (2) Other providers (51) (56) Other / eserves ,584 6,513 5,970 5,928 (43) (47) Primary Care GP Practices : GMS (3) (3) GP Practices : PMS GP Practices : APMS Out of Hours (0) (1) Other Primary Care (3) (4) (7) (8) Prescribing / Medicines Management GP Prescribing 6,552 8,550 7,769 7,730 (39) (43) Other prescribing / med mgmnt (78) (85) 7,029 8,919 8,107 7,989 (118) (129) PCT Management Costs Transition & ning (0) (0) (0) (0) Other / eserves Other Central eserves 1,023 1,589 1,445 - (1,445) (1,509) 1,023 1,589 1,445 - (1,445) (1,509) TOTAL COMMISSIONE 54,838 60,074 55,131 56,829 1,698 2,091 12

13 SEMC SEMC January Original Current Date Budget Date Spend (Under)/ Over Forecast Year End (FIMS) Acute Providers BTUH 20,540 24,784 22,795 25,811 3,015 3,331 Southend 4,029 4,220 3,860 3, Other acute hospitals 3,702 3,487 3,340 3, Other acute services NCAs (68) (107) Other PCTs Ambulance 1,434 1,709 1,566 1, Other providers Other eserves ,655 35,825 33,052 36,785 3,733 4,225 Non-NHS SLAs Non-NHS SLAs Mental Health & LD Service Level Agreements NHS MH 5,417 5,972 5,474 5, Non-NHS MH (0) (0) Non-NHS LD eserves (50) (55) 5,654 6,188 5,672 5,634 (38) (41) Children's & Young People Services Children's & Young People Services (88) (44) (88) (44) Community Care Ex-PCT Providers 6,381 7,091 6,501 6,479 (21) (23) Other NHS Providers Continuing Healthcare 1,368 1,565 1,435 1,432 (3) (3) Other providers (77) (84) Other / eserves ,632 9,547 8,751 8,686 (65) (71) Primary Care GP Practices : GMS (6) (6) GP Practices : PMS (4) (5) GP Practices : APMS Out of Hours (1) (1) Other Primary Care Prescribing / Medicines Management GP Prescribing 8,070 9,398 8,525 7,668 (857) (935) Other prescribing / med mgmnt (106) (116) 8,570 9,935 9,017 8,054 (963) (1,051) PCT Management Costs Transition & ning Other / eserves Other Central eserves 1,361 (1,088) (1,014) - 1,014 1,099 1,361 (1,088) (1,014) - 1,014 1,099 TOTAL 56,715 62,294 57,321 61,030 3,710 4,245 13

14 Basildon and Brentwood Appendix 3 BASILDON AND BENTWOOD CCG /13 CCG QIPP Scheme Workstream Summary YTD January 2013 Financial Performance 12/13 Total 12/13 Total 12/13 Total YTD Performance MTD performance Forecast Financial Financial YTD Forecast 12/03/2013 Workstream QIPP Savings QIPP Savings QIPP Savings ned Actual ned Actual Yearend Forecast AG Milestone Milestone Ambition Target Savings Savings Savings Savings Forecast Delivery (YTD) AG (, 000) (, 000) Delivery AG (,000) (,000) (,000) (, 000) (, 000) (, 000) (, 000) (,000) AG Ambulance (353) (353) (353) G G (324) (324) 0 (29) (29) 0 (353) G G Mental Health (514) (514) (514) G G (471) (471) 0 (43) (43) 0 (514) G G Community n/a N/A N/A N/A Prescribing (599) (539) (832) G G (630) (1,421) (791) (67) (156) (89) (1,862) G G Children and Young People (625) (437) (281) ned Care (995) (783) (1,000) (143) (47) 0 47 (1) (719) 1,062 1,781 (93) ,416 Unplanned Care (4,117) (3,061) (3,320) (2,246) 1,127 3,374 (393) (38) 354 1,510 Total (7,202) (5,688) (6,300) (4,533) (26) 4,507 (672) (169) YTD Yield 1% Forecast to Target -3% KEY Forecast to Workbook ned Savings -3% The financial AG is rated as follows: G 80% A 70% Below 70% 14

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