Primary Care Commissioning Committee

Transcription

1 Primary Care Commissioning Committee DETAILS Part 1 (Open) x Part 2 (Closed) Agenda Item 4.1 Meeting Primary Care Commissioning Committee Date 12 October 2017 Title of Paper Finance Report August 2017 Executive Lead / Clinical Sarah James, Chief Financial Officer, BaNES CCG Debra Elliot, Director of Commissioning, NHS England (South Central) Lead Author Dean Walton, Finance Manager, NHS England (South Central) John Fogg, Senior Finance Manager for Non-Acute services, BaNES CCG Appendices N/A Request Approval Discussion x Information x Assurance x EXECUTIVE SUMMARY Purpose This report is an update on the financial position for Primary Care services as at 31 st August Following transfer of Primary Care budgets from NHS England to the CCG on 1 st April, these budgets and costs are now all held by the CCG. Recommendation The committee are asked to note the contents of this report regarding the current CCG financial position on Primary Care services. Risk High Medium Low x Impact on Quality No direct impact on quality from the presentation of this report. Impact on Finance No direct financial impact from the presentation of this report, but it is intended to ensure members of the committee have an understanding of the CCG s financial position on Primary Care.

2 1.1 CCG Finance Update Shown below is a summary of the financial position to 31 st August 2017 of the areas of Primary Care spend under PCOG s remit: YTD Budget YTD Actual YTD Variance Annual Budget Forecast Outturn Forecast Variance Additional Primary Care funding allocations 26,247-30,042-56,289 63,000 63,000 0 Early Home Visiting Service 148, , , ,954 0 Locally Commissioned Services 850, ,145-81,198 2,023,675 2,023,675 0 Primary Care Delegated Commissioning 10,109,103 9,840, ,790 24,945,000 24,568, ,995 Transformation fund - 3 / head 37,585 47,119 9,534 90,204 90,204 0 Grand Total 11,171,867 10,775, ,783 27,522,833 27,145, ,995 The relevant sections of the Primary Care budgets are forecast to underspend by 377k (-1.37%). As agreed at the June 2017 PCCC meeting, a summary is provided of other Primary Care expenditure to 31 st August 2017 for information only. This information will be provided each month, but any detailed queries should be raised at the appropriate meeting: YTD Budget YTD Actual YTD Variance Annual Budget Forecast Outturn Forecast Variance BDUC 1,101,270 1,100, ,643,058 2,659,030 15,972 Central Drugs 267, ,073-16, , ,123-16,102 Home Oxygen 80,125 88,635 8, , ,724 20,425 Medicines Management Team 212, ,687-22, , ,742 0 NHS Care UK 235, , , ,454-25,728 Other Primary Care 31,740 32, ,182 79,654 3,472 Prescribing 10,233,492 10,580, ,767 24,560,456 24,396, ,649 Primary Care IT 329, , , , ,633-40,354 Grand Total 12,492,048 12,669, ,240 30,009,131 29,803, ,964

3 2.1 Commentary by Exception Summary: There are few material variances to report. As a result, the CCG s primary care budgets within PCOG s remit have been forecast to budget with the exception of Primary Care delegated commissioning. The underspend on delegated commissioning of 377k is associated with the release of the 1% surplus target and the 0.5% risk reserve headroom within the Primary Care delegated commissioning allocation. It has been agreed with NHS England that these funds can be released and it is also the case that they would not have been available to Primary Care if not being released into the overall CCG financial position Locally Commissioned Services (LCS): A breakdown of the LCS budget and forecast is shown overleaf. Year-to date figures are based on the amounts paid for quarter 1 with an accrual for estimated costs for July & August As only one quarter of costs has been paid, which was in-line with budget, the forecast position for LCS remains as breakeven. Whilst the budget for supporting Primary Care Engagement in CCG clusters appears to have been utilised already, funding will be reallocated from services that are underspending within the LCS budget once quarter 2 data is received, at which point the forecast position will also be reviewed again.

4 Locally Commissioned Services (LCS) spend to 31 st August 2017: Budget 2017/18 Variance Forecast Forecast Budget YTD Actual YTD YTD Outturn Variance PMS Review ECG Service 137,889 57,454 57, ,889 0 Ambulatory Blood Pressure Monitoring(ABPM) and Home Blo 110,267 45,945 40,545-5, ,267 0 Care/Residential Homes (Non Nursing) 99,000 41,250 40, ,000 0 Doppler Service 28,304 11,793 5,501-6,292 28,304 0 Spirometry 63,432 26,430 26,430-63,432 0 Basket LES 2 of low volume procedures 60,000 25,000 25,000-60,000 0 Health Inequalities / Promotion / Population 84,269 35,112 35,112-84,269 0 EMI Nursing Home 8,899 3,708 3,708-8, , , ,250-11, ,060 0 CCG Transformation Fund: In-house Practice Pharmacist 37,500 15,625 17,304 1,679 37,500 0 Evaluating a new Multi-Practice Unit Model 15,000 6,250 6, ,000 0 Pilot for Respiratory Chronic Disease Management 37,704 15,710 23,565 7,855 37, ,204 37,585 47,119 9, ,204 0 Winter Pressures 300, , , ,000 0 Balance Old Year 16/17 89, , LCS Schemes: Low risk Basal Cell Carcinoma (BCC) service 8,272 3,447 4, ,272 0 Care/Residential Homes (Nursing) 188,987 78,745 69,320-9, ,987 0 Drug Monitoring Community Enhanced Service 116,195 48,415 44,347-4, ,195 0 Primary Care: Enhanced Diabetes Service 19,858 8,274 5,225-3,049 19,858 0 International Normalised Ratio (INR) Monitoring 387, , ,947-19, ,699 0 Hormone Injections 7,185 2,994 4,439 1,445 7,185 0 Leg Ulcer Management Service 91,381 38,075 36,824-1,251 91,381 0 Secondary Care Initiated Pre & Post-Operative Procedures 142,695 59,456 59, ,695 0 Supporting Primary Care engagement in CCG Clusters (payments to GP practices) 70,491 29,371 77,233 47,862 69, ,032, , ,749 12,431 1,032, Opthom - Glaucoma & Cataracts 9,000 3, ,855 9,000 0 Clinical Leads Total 2,113, , ,264-71, ,113,879 0 EXTRA ALLOCATIONS GP PROGRAMMES GP Forward View Reception & Clerical Training 35,000 14, ,583 35,000 0 GP Resilience Funding 28,000 11, ,709 28,000 0 BEMS+ PCPF Staff Bank refund ,500-16,500 Contribution to Estate Management ,500-13, Total 63,000 26,250-30,042-56,292 63,000 0 Grand Total 2,176, , , ,958 2,176,879 0 Page 4 of 8

5 2.1.3 Additional funding allocations: Under the Primary Care 5 year forward view; there are numerous different funds available to the CCG to bid for. The CCG has been made aware of the following allocations of funding to date: Six Facet surveys (estates) - 13,500 of deferred income brought forward from 2016/17. Reception & Clerical training - 35,000 GP resilience programme - 28,000 ETTF Practice websites and e-consultation software - 91,788 (GP IT budget) The CCG has also received a reimbursement of 16,500 from BEMS+ in respect of unutilised funds from the Staff Bank project originally funded from Primary Care Preparing for the Future (PCPF) Primary Care Delegated Commissioning: As previously reported, the process of transferring the payment of GP practices PMS contracts from NHS England to the CCG has gone smoothly. Teething issues regarding the coding of training and appraisal payments are still to be resolved, but practices continue to be paid on time by NHS England rather than the CCG for these services with recharges being identified and invoiced between the two commissioners. The current focus is on reviewing the costs against budget lines within the CCG ledger to ensure items are being correctly coded, as well as identifying any further recharge invoices that need to be raised. NHS England and the CCG representatives have met during September to discuss the transfer of tasks under the delegated commissioning arrangements. Further developments will be reported to PCOG as and when agreed. The forecast underspend of 377k is due to the 1% NHS England surplus target of 251k that is given to CCGs on all budgets but not required to be delivered on the Primary Care budget. It can therefore be used to contribute to the overall CCG position as it would not have been available to spend on Primary Care in any case. There is then a further 126k (0.5%) of risk reserve headroom funding. The business rules mandate CCGs to leave this funding uncommitted so again this would not have been available to Primary Care. NHS England have agreed that this funding can be released against the CCG s overall financial risk. A breakdown of the Primary Care delegated commissioning year-to-date and forecast spend is shown overleaf with a breakdown by budget line.

6 Primary Care Delegated Commissioning Breakdown: Year-to-date budget Year-to-date actual Year-to-date variance Forecast outturn Forecast variance Description Annual budget Core Contract PMS Contract Value 6,530,325 6,530, ,672,920 15,672,920 0 PMS Baseline Adjustment ,575 29, PMS Funding Differential Review 235, , , ,839 0 PMS List Size Adjustments 0 7,869 7, Total Core Contract 6,765,626 6,803,177 37,551 16,237,759 16,237,759 0 DESs Extended Hours DES 160, , , ,972 0 LD Health Checks DES 37,805 33,080-4,725 90,834 90,834 0 Minor Surgery DES 123, ,848-10, , ,333 0 C&M-PMS DES TPP QRISK 0 5,083 5, Out of Area Registrations Total DESs 321, ,320-8, , ,139 0 Premises Actual rent 0 49,667 49, Notional rent 959, ,954-67,303 2,302,304 2,302,304 0 Business Rates 193, ,044-10, , ,423 0 Water Rates 13,655 13, ,856 32,856 0 Total Premises 1,166,794 1,138,320-28,474 2,800,583 2,800,583 0 Dispensing Dispensing Quality Scheme 24,876 24, ,720 59,720 0 Prescription charges remitted by GPs - 91,989-93,931-1, , ,801 0 Professional fees - dispensing 448, ,959-5,124 1,075,419 1,075,419 0 Professional fees - prescribing 55,258 26,899-28, , ,694 0 Total Dispensing 436, ,803-35,425 1,047,032 1,047,032 0 QOF QOF Achievement , ,617 0 QOF Aspiration 685, ,989 15,632 1,644,964 1,644,964 0 Total QOF 685, ,989 15,632 2,326,581 2,326,581 0 Other payments Training Expenses 0 10,598 10, Other professional fees (e.g. District Valuer) 9,336 9, ,418 22,418 0 Occupational Health 4,850 4, ,644 11,644 0 Indemnity fees 43,433 43, , ,370 0 Contract- Refuse & Clinical Waste 40,560 38,059-2,501 97,347 97,347 0 Other General Supplies & Services 38,485 38, ,368 92,368 0 Appraisal payments 0 22,794 22, Doctors Retainer Scheme 31,203 20,615-10,588 74,907 74,907 0 Locums - Adoption / Maternity / Paternity Leave 49,637 54,473 4, , ,148 0 Locums - Sickness cover 4,491 44,065 39,574 10,789 10,789 0 CQC fees reimbursement 43,433 53,662 10, , ,370 0 Seniority 121, ,064 7, , ,077 0 Training costs payment 0 8,982 8, Medical Fees - Adoption / Fostering reports ,141 1,141 0 Translation Fees 4,772 4, ,457 11,457 0 Sterile Products 0 1,514 1, Total Other Payments 391, ,702 92, , ,036 0 Reserves Reserves 342, , , , ,995 Total Reserves 342, , , , ,995 Grand Total 10,109,093 9,840, ,790 24,945,000 24,568, ,995 Please note: Occupational Health budgets are expected to transfer back to NHS England during month 6 as agreed. 6

7 Primary Care Delegated Commissioning Commentary: The year to date position is a favourable variance of 269k against the year to date budget of 10,109k (2.66% favourable). The main variances at month 5 are:- Core GP contracts are 38k overspent year to date due to the additional support being paid to two practices following the PMS review reductions in contract payments. Directed Enhanced Services are currently underspending by 9k year to date. This is due to lower than expected activity for Minor Surgery procedures. There has been one activity collection and payment this year with the next being end of September. The TPP QRISK DES is overspending as the CCG are awaiting confirmation of the national funding available to support this. This temporary enhanced service has been introduced to support practices identify patients significantly affected by the TPP QRISK2 code mapping error. Premises costs are 28k under budget mostly due to lower rent costs being incurred at St Michaels Surgery. Rent budgets require recoding to match the National coding of payments. Rates budgets are underspending due to councils nationally revising charges as GP practices are now assessed on the basis of rebuild cost rather than rental value. Prescribing and Dispending fees are 35k under budget year to date. This can fluctuate on a seasonal basis, so the underspend may not be sustained in future months, especially through the winter. There are a number of expenditure areas currently without budgets which are being funded from reserves each month. Consideration is currently being given to move reserves to fund these areas. Locum costs are currently 44k over budget year to date. There have been additional claims this year due to the following rules being applied nationally from 1 st April 2017 as follows: Sickness leave reimbursement - Cover may be provided by external locums or existing GPs already working in the practice but who do not work full time. - An increase in the maximum amount payable from 1, to 1, per week. 7

8 - Payments will no longer be discretionary. The qualifying criteria for reimbursement will commence when the absence is two or more weeks (as opposed to previous arrangements which is linked to patient numbers and the period of absence). - Sickness leave payments will not be made on a pro-rata basis and will be the lower of actual or invoiced costs up to the maximum amounts as set out in the Statement of Financial Entitlements (SFE). Parental leave reimbursement - Parental leave payments will not be made on a pro-rata basis and will be the lower of actual or invoiced costs up to the maximum amounts as set out in the SFE. All other requirements will remain unchanged. 8