JOINT PRIMARY CARE COMMISSIONING COMMITTEES

Transcription

1 JOINT PRIMARY CARE COMMISSIONING COMMITTEES TITLE: Primary Care Finance report Month 5 DATE OF MEETING: 29 th September 2016 PAPER REF: JPC/16/101 AUTHOR: Marcus Pratt, Associate Chief Finance Officer, Sarah Szubert Primary Care Hub PRESENTER: Marcus Pratt, Associate Chief Finance Officer ISSUE: The enclosed finance reports provide the 2016/17 month 5 primary care position for both Mid-Notts CCGs. For Mansfield & Ashfield CCG (M&A) this gives a 410k year to date underspend and Newark & Sherwood CCG (N&S) a 33k overspend. The majority of the M&A underspend is due to lower than expected costs in relation to estates costs, although discussions are still on-going with NHS Property Services. Both CCGs have a caretaker practice in place in 2016/17 and budgets currently reflect this cost. The 1% non-recurrent reserve which covered the costs of the caretakers in 2015/16 is no longer available for use presenting additional pressure to the primary care budget. Notably in N&S CCG, this has left a negative reserve which the CCG will need to cover in order to remain within budget. Both CCGs have delivered the majority of their QIPP target for the year but delivery needs to be maximised to ensure that financial targets are met both within the delegated position and the overall CCG. M&A CCG is forecasting a primary care underspend of 1,194k and N&S CCG and underspend of 181K. The improved run rate in N&S CCG is due to the expected delivery of 500k in dispensing Drs. It is understood that these costs are the responsibility of NHS England. RECOMMENDATION: To note To agree the recommendation (see details below) HOW DOES THIS CONTRIBUTE TO THE STRATEGIC OBJECTIVES OF THE CCG: To provide a full understanding of the primary care financial position to enable the committee to make informed decisions and achieve financial balance. RISK ASSURANCE:

2 Risks are monitored and managed through the mid-notts CCGs Activity & Finance Committees CONFLICTS OF INTEREST: This is a recommended action to be agreed by the Chair at the beginning of the item. No conflict identified Conflict noted, conflicted party can participate in discussion but not decision (see below) Conflict noted, conflicted party can remain but not participate (see below) Conflicted party is excluded from discussion (see below) CONFIDENTIALITY: Is the information in this paper confidential? No Yes 2

3 Delegated Co-commissioning Finance Report June 2016 Mansfield & Ashfield CCG (04E) NHS England North Midlands At the end of month 5 the primary care position for Mansfield & Ashfield CCG shows an underspend of 409,546. The main reason for underspend relates to planned budgets in relation to estates costs now released following discussions with NHS Property Services. Note that the CCG has not yet received final confirmation of this position from NHSPS, leaving a level of risk in this position. A summary of the month 5 financial position by expenditure category can be found below. Category Actual Variance Dispensing/Prescribing Drs 9,599 9,589 13,969 4,380 Enhanced Services 1,672, , ,827 38,275 General Practice - APMS 885, , ,442 23,491 General Practice GMS 7,267,545 3,028,138 3,034,922 6,784 General Practice - PMS 7,708,622 3,211, ,962 Other GP Services 331, , ,530-1,559 Other Premises costs 579, , ,528 0 Premises Cost Reimbursement 3,087,217 1,286,160 1,297,170 11,010 QOF 2,318, , , Reserves 1,777, , ,017 Grand Total 25,638,460 10,457,897 10,048, ,547 A further analysis of reserves can be found below. Much of this relates to expected costs in year that has not yet been contracted e.g. increases in contractual payments due to population growth. The reserve previously held in relation to the caretaker contract at KCPCC has now been moved into operational budgets as per the agreed contractual costs. QOF achievement and aspiration payments have now been completed in relation to 2015/16. This has led to a financial benefit of 150k to the CCG. The impact of this has been transacted and reflected in reserves. QoF growth for 2016/17 has also been recalculated leading to a budgetary increase of 36k over and above that which was earmarked in reserves. The CCG continues to hold 0.5% contingency and also has a significant level of risk reserves. These reserves mainly relate to potential property costs with a proportion of the underspend reflected in the year to date position.

4 NHS England North Midlands Discussions are on-going with NHS Property Services and CHP to understand and agree the full impact of estates within the primary care financial position. Note that the 1% Non-Recurrent reserve that was available in 2015/16 and used mainly to support the caretaker contract at KCPCC cannot be accessed in 2016/17 as per the planning rules. This reserve is held by the CCG in its entirety with no prior commitments, in line with planning guidance, to ensure an element of system resilience is held within the plans. The guidance as to how these funds will be managed in year is awaited from NHS England. The CCG has a primary care QIPP target of 116k, which has been transacted through reserves. As at month 5 107k QIPP has been delivered. This relates to a review of dispensing practices leading to a reduction in costs. It is expected that the remaining QIPP balance of 9k will be found from a reduction of seniority payments through retiring GPs and premises reductions from practice mergers or premises relocation. The CCG have not been notified of any premises changes that will impact on QIPP in 2016/17 as yet although there may be some benefit accruing from the ETTF process (to be worked through). M&A Reserves Budget '000 Earmarked Reserves 613,078 Risk Reserves 1,044,714 QIPP -8,890 Contingency 128,770 Total Reserves 1,777,672 The overall primary care delegated position remains positive with a forecast year-end variance of a 1,194k underspend, albeit the favourable variances are underpinned by assumptions in cost with NHS Property Services which are still to be confirmed. The primary care position needs to be considered in line with the overall CCG position and is a contributing factor to the CCG control total.

5 Delegated Co-commissioning Finance Report August 2016 Newark & Sherwood CCG (04H) NHS England North Midlands At the end of month 5 the primary care position for Newark & Sherwood CCG shows an overspend of 32,717. Due to increasing general practice contractual and property costs there is significant pressure on the financial position, which will need to be carefully managed throughout the year. Further risks remain in the position particularly in relation to property where costs are yet to be agreed with NHS Property Services. A summary of the month 5 financial position by expenditure category can be found below. Category Actual Variance Dispensing/Prescribing Drs 498, , ,208-23,398 Enhanced Services 912, , ,048 26,732 General Practice - APMS 589, , ,000 9,441 General Practice - GMS 10,213,375 4,255,567 4,256, General Practice - PMS 334, , ,855 1,504 Other GP Services 200, , ,975-2,423 Other Premises costs 204,002 84,981 88,543 3,562 Premises Cost Reimbursement 2,183, , ,924-45,168 QOF 1,812, , ,157-3,159 Reserves -266,113-65, ,124 Grand Total 16,683,480 6,989,062 7,021,779 32,717 A further analysis of reserves can be found below. Much of this relates to expected costs in year that has not yet been contracted e.g. increases in contractual payments due to population growth. The reserve previously held in relation to the caretaker contract at Balderton has now been moved into operational budgets as per the agreed contractual costs. QOF achievement and aspiration payments have now been completed in relation to 2015/16. This has led to a financial cost of 29k to the CCG over and above that which was estimated in the 2015/16 position. The impact of this has been transacted and reflected in reserves. QoF growth for 2016/17 has also been recalculated leading to a budgetary increase of 89k over and above that which was earmarked in reserves. The CCG continues to hold 0.5% contingency. However, following the budget setting process, a number of additional costs above planned levels have been required to be funded leaving the CCG with a negative risk reserve. In addition the 1% Non-Recurrent reserve that was available in 2015/16 and used mainly to support the caretaker contract at Balderton cannot be accessed in 2016/17 as per the planning rules. This reserve is held by the CCG in its entirety with

6 NHS England North Midlands no prior commitments, in line with planning guidance, to ensure an element of system resilience is held within the plans. The guidance as to how these funds will be managed in year is awaited from NHS England. The CCG has a primary care QIPP target of 109k, which has been transacted through reserves. As at month 5, 84k of QIPP has been delivered. This relates to a one-off benefit from business rates review and an assessment of premises plans in Rainworth. It is expected that the remaining QIPP balance of 25k will be found from a reduction of seniority payments through retiring GPs and premises reductions from practice mergers or premises relocation. Following the relocation of the Clipstone practice to Crown Medical Centre there is a potential benefit in-year from the sale of the property or NHSPS taking on the responsibility for the void space. This is estimated at 30k (6-months effect). In addition the CCG is exploring options for Balderton Health Centre to ensure a permanent solution is put in place at an effective cost. Given the budgetary position both for both the delegated budget and overall, the CCG needs to maximise QIPP in all areas. N&S Reserves Budget '000 Earmarked Reserves 55,921 Risk Reserves -381,134 QIPP -25,160 Contingency 84,260 Total Reserves -266,113 The forecast position in relation to primary care delegated budgets is an underspend of 181k. This is clearly considerably better than the current run rate experienced. The underspend arises from the expected delivery of a 500k financial recovery action in relation to dispensing. The CCG have received notification that this cost is the responsibility of NHS England. Discussions are on-going to progress this. The primary care forecast needs to be considered in line with the overall CCG position and is a contributing factor to the CCG control total.