Finance and QIPP (Quality, Innovation, Productivity & Prevention) Plan 2015/16 John Ingham, Chief Financial Officer

Transcription

1 Agenda Item: 11.2 Subject: Presented by: Finance and QIPP (Quality, Innovation, Productivity & Prevention) Plan 2015/16 John Ingham, Chief Financial Officer Submitted to: NHS West Norfolk CCG Governing Body, 26 March 2015 Purpose of Paper: For agreement Executive Summary: Clinical Commissioning Groups (CCGs) have a fundamental financial duty to ensure that their expenditure does not exceed the amount allocated by NHS England. Part of the process for delivering this duty is for a CCG to produce a balanced financial plan each year. Furthermore, CCGs are expected to meet key financial planning requirements set down by NHS England which in 2015/16 include the delivery of a 1% surplus as in previous years; a commitment to Parity of Esteem for mental health services (ie increased levels of funding for mental health to match the percentage increase in CCG funding); investment in operational resilience schemes; an increase in the marginal rate paid to acute providers for emergency hospital admissions; significant funding transfers to Social Care under the Better Care Fund. This paper outlines the West Norfolk CCG funding allocation of 229.9m for 2015/16 and proposes start year budgets totalling 234.6m and a QIPP plan of 7.1m in order to deliver all of the above planning requirements. It also proposes broad areas for the application of non-recurrent funding and highlights key risks to delivery of financial balance in 2015/16 and associated mitigations. KEY RISKS: Clinical: None Finance and Performance: This paper presents a balanced budget for 2015/16 but highlights financial risks in Section 8. Impact Assessment (environmental and equalities): None Reputation: Failure to deliver a balanced financial position will adversely affect the reputation of the CCG and could affect its on-going viability. Legal: None Patient focus (if appropriate): None Reference to relevant Governing Body Assurance Framework: 1.5, 3.1, 3.2, 5.1, 6.2 Recommendation: The Governing Body is asked to: Note the CCG funding allocation for 2015/16 totalling 229.9m; Approve the start year budgets totalling 234.6m proposed in Section 4, noting the QIPP (savings) requirement of 7.1m in order to deliver the required 1% surplus; Approve the QIPP plan outlined in Section 5 to deliver the QIPP requirement; Agree the proposed usage of 1% non-recurrent funding as outlined in Section 7; Note the financial risks and current mitigations described in Section 8. 1

2 1. Introduction 1.1 Clinical Commissioning Groups (CCGs) have a fundamental financial duty to ensure that their expenditure does not exceed the amount of funding allocated by NHS England. Part of the process for delivering this duty is for a CCG to produce a balanced financial plan each year. 1.2 The background for West Norfolk CCG s (WNCCG) 2015/16 financial plan is a forecast surplus in 2014/15 of 2.2m (ie 1% of funding, in line with NHS England expectations). The draft 2015/16 financial plan was presented to the Governing Body in January 2015; this included discussion around NHS England s approach to setting CCG allocations for 2015/16, which is not repeated in this paper. 1.3 This paper outlines the CCG s financial planning assumptions for 2015/16, presents for approval the resulting budget and QIPP (Quality, Innovation, Productivity, Prevention) plan, describes the proposed use of non-recurrent funding in 2015/16, and highlights the main financial risks facing the CCG and the currently identified mitigations. 1.4 The information contained in this report is consistent with that included in Financial Planning Templates submitted to NHS England in recent months as part of the operational and strategic planning process for all CCGs, and will be used as the basis for the final planning submission required in early April. 2. CCG Funding 2015/ In December 2013 NHS England published CCG allocations for both 2014/15 and 2015/16. However in December 2014 additional NHS funding of 2bn was announced for 2015/16, some of which enabled CCG allocations to be increased. WNCCG s final 2015/16 allocation growth for programme spend (ie commissioning activities) was confirmed at 7.2m ie 3.4% uplift. 2.2 A further allocation adjustment is made to CCG baselines in 2015/16 in respect of funding historically held by NHS England for transfer to Social Care; from April 2015 this forms part of the funding that CCGs are required to put into the Better Care Fund (BCF). The relevant figure for WNCCG is 3.6m. 2.3 In 2015/16, CCG running cost allowances per head of population are set at 10% below 2014/15 levels, in line with previous NHS England commitments. WNCCG s total running cost allowance therefore falls from 4.1m to 3.7m. This reduction in funding will be offset by a reduction in the cost of services commissioned from North East London Commissioning Support Unit (NELCSU), which avoids the need for any reduction in staffing within the CCG. 2.4 The NHS funding regime allows for a surplus or deficit from one financial year to be carried forward to the next year as a one-off adjustment. As WNCCG is currently forecasting a surplus of 2.2m (1% of funding) in 2014/15 this surplus is to be carried forward to 2015/16 to support the CCG s commissioning activities. 2.5 The WNCCG total funding allocation for 2015/16 resulting from the above adjustments is 229.9m, comprising programme funding of 226.2m and running costs allowance of 3.7m, as shown in the following table: 2

3 Description Programme Running CCG spend costs Total m m m 2014/15 recurrent allocation b/f Recurrent growth (3.4%) Better Care Fund additional allocation Running Cost Allowance Recurrent funding 2015/ Non-recurrent allocations: Return of 2014/15 surplus Total funding 2015/ /16 National Planning Requirements 3.1 In December 2014, alongside CCG allocations, NHS England published the Planning Framework for 2015/16. This included the following key financial business rules for CCGs (which were also discussed in the January report to the Governing Body): Delivery of a 1% surplus; Establishment of a contingency fund of at least 0.5% of allocation; Setting aside 1% of funding for non-recurrent spend. 3.2 Also reflected in the December planning guidance were a number of additional investments required from CCGs, the key elements being: a) Applying real terms growth to Mental Health services in order to deliver Parity of Esteem. This expects CCGs to increase spending in 2015/16 by at least as much as each CCG s allocation increase. For WNCCG, as the 2015/16 allocation increase is 3.4%, this results in additional investment of 0.7m; b) Maintaining local investment in operational resilience schemes, as funding historically distributed by the NHS on a non-recurrent basis is embedded in CCG recurrent baselines from April The specified figure for WNCCG is 1.2m; c) The marginal rate for acute non-elective activity is to be increased from 30% to 50% (activity above the baseline level, set at 2008/09 outturn activity, is paid at a marginal rate to encourage providers and commissioners to work together to appropriately manage the demand). The financial impact of this change for WNCCG is around 0.8m. 3.3 In November 2014, Monitor published its draft tariffs for 2015/16 for consultation with providers. The key assumptions within these tariffs were as follows: Provider inflation of 1.9%, with an additional acute provider inflation pressure of 1.1% in respect of Clinical Negligence Scheme for Trusts (CNST) premiums Provider efficiency requirement of 3.8% Therefore a net tariff deflators of 1.9% (= 1.9% - 3.8% efficiency) for non-acute providers and 0.8% for acute providers. 3.4 The above assumptions have been modelled in CCG financial plans; however in January 2015 it was revealed that due to the number of adverse responses to the Monitor consultation exercise 3

4 the draft tariff could not be implemented. In late February, Monitor and NHS England announced an Enhanced Tariff Option (ETO) that was available to all providers for 2015/16, which awarded an additional 0.3% inflation and further increased the marginal rate for non-elective activity from 50% to 70%. There is additional funding identified nationally to support the impact for commissioners of this late change, with the allocation by CCG to be announced on 25 th March At the time of writing, it is assumed that 100% of the costs of the ETO are covered by additional funding (hence this features in the risks table in Section 8 of this paper); however a verbal update will be given to the Governing Body if further information is available /16 Budgets 4.1 The national planning requirements and assumptions noted in Section 3, alongside other local planning assumptions, are applied to CCG historical spend in order to derive budgets for 2015/ The starting point for calculating the CCG budgets for 2015/16 is the forecast outturn spend for 2014/15 (as at month 10). A range of adjustments is then applied to account for anticipated changes in 2015/16 as summarised in the following table, with further detail explained in sections Description m 2014/15 forecast outturn expenditure Removal of non-recurrent spend / benefits in 2014/15 (see 4.3) (5.8) 2015/16 inflationary adjustments (see 4.4) (1.4) 2015/16 anticipated activity growth (see 4.5) /16 cost pressures (see 4.6) /16 new investments (see 4.7) /16 CCG budget (before QIPP savings) There were various elements of non-recurrent (one-off) expenditure in 2014/15 that are removed from the CCG plan in 2015/16, the main areas being as follows: Non-recurrent winter pressures costs 2.2m and Mental Health resilience funding 0.2m (both matched by specific funding in 2014/15); One-off costs relating to clearing waiting list backlogs 0.5m (matched by specific funding in 2014/15); Developments funded by CCG transformational or non-recurrent funding, for example the Psychiatric Liaison Service at the Queen Elizabeth Hospital (QEH) 0.4m, the Virtual Ward 0.5m (net of contribution from winter pressures funding), mobilisation costs for new contracts for Pathology services 0.4m and Patient Transport Services 0.2m, and infrastructure costs relating to West Norfolk Alliance work 0.4m. (Some of these costs are recurrently factored into the 2015/16 budgets as cost pressures); CCG contribution to the national risk pool for Continuing Healthcare (CHC) legacy restitution claims 0.3m; Costs of GP IT services 0.5m (these costs were offset by funding from NHS England in 2014/15 as is expected to be the case in 2015/16, but the current 2015/16 budget includes neither the funding nor the costs until these are confirmed by NHS England); Full year savings from the new Commissioning Support Unit (CSU) arrangement from October m, which enables the CCG to live within its reduced running cost allowance. Further adjustments are made to add back non-recurrent QIPP savings relating to 2014/15 provider performance penalties 0.8m, and to recognise the anticipated allocation adjustment 4

5 from South Norfolk CCG to reflect the full year effect of patients transferring from the Watton practice to Swaffham practices in summer 2014 ( 0.5m). 4.4 Inflationary adjustments are applied to provider budgets in line with the national guidance summarised in 3.3 and 3.4. No inflation is applied to GP prescribing budgets as unit prices are currently flat, and have historically decreased year on year. 4.5 Budgets are then increased by anticipated activity growth, key assumptions being as follows: Baseline demographic growth has been factored into most budgets at the rate of 1.3%, which is above the level of raw population growth (around 0.8%) as it takes account of the ageing population; Non-demographic growth has been applied to a number of budgets: o 0.4% for acute contracts, to reflect specific pressures such as increased numbers of endoscopies following the introduction of new screening programmes; o 8.7% for CHC to bring the total activity growth assumption to 10%, which reflects historical trends; o 3.7% for GP prescribing to bring the total activity growth assumption to 5%, again reflecting historical trends. 4.6 In addition to activity growth certain budgets are exposed to cost pressures in 2015/16, the main areas being: The impact of the change in marginal rate from 30% to 50% (before the ETO) 0.8m, as outlined in 3.2; Other acute contract pricing and activity changes, for example the contract with the Queen Elizabeth Hospital (QEH) includes adjustments for extra Cardio-Respiratory activity 0.5m and a reduction in the credit received for excessive readmissions 0.4m; Anticipated growth in the costs of acute high cost drugs 0.3m (due to new NICE guidance); Funding recurrently the costs of the Virtual Ward 0.5m (net of a continued contribution from system resilience funds); Rebasing of the costs of emergency Ambulance services across CCGs in the East of England. The additional full year cost for WNCCG will be 1.0m, but CCGs have agreed a 3 year transition period that results in a pressure of 0.2m in 2015/16; Establishment of a Contingency reserve of 0.5% of allocation ( 1.2m) in accordance with the planning requirements identified in 3.1 above. 4.7 There are also significant investments required of the CCG in 2015/16, the key areas being as follows: Transfers to Social Care in relation to the Better Care Fund (BCF) 6.3m, and establishment of a BCF Performance Fund 1.1m. This investment is part-funded by the 3.6m specific allocation increase outlined in 2.2, leaving the balance of 3.7m as a new commitment for the CCG; Commitment to Parity of Esteem for mental health services 0.7m (see 3.2); Establishment of a 1% reserve for non-recurrent expenditure 2.3m (see Section 7 for further details of planned utilisation); Investments in operational systems resilience 1.2m (see 3.2); this funding is overseen by the West Norfolk Systems Resilience Group (SRG). 4.8 The end result of applying the various adjustments above is a total budget requirement of 234.6m, compared with an allocation of 229.9m, leaving a gap of 4.7m. This gap then grows to 7.1m in order for the CCG to deliver a 1% surplus (= 2.3m) as required by the national planning guidance. This situation sets the CCG s QIPP (Quality, Innovation, Productivity, Prevention) target for 2015/16. 5

6 5. Bridging the Gap - QIPP Savings 5.1 As noted in 4.8 the CCG proposed budgets for 2015/16 based on a range of reasonable planning assumptions lead to a shortfall of 7.1m (3.1% of planned expenditure). A range of initiatives has been identified to bridge this gap, which contribute to a QIPP plan also totalling 7.1m. This gives no headroom (ie excess planned savings) to mitigate the risk associated with delays in implementation of schemes or non-delivery; however, the CCG now has a rolling QIPP planning process rather than an annual QIPP cycle, and so it is expected that further schemes will be initiated throughout 2015/16 that will build the QIPP programme for 2016/17 and also provide further savings in-year. 5.2 The 2015/16 QIPP plan should be seen in the context of 2014/15 delivery where savings of around 4m have been delivered against a QIPP target of 5.6m. However, in 2014 the CCG has established a robust QIPP planning and governance process, supported by a full-time Programme Management Office (PMO) Manager, and is currently reviewing the lessons learned from under-delivery in 2014/15 in order to further improve delivery in the future. 5.3 The areas contained within the 2015/16 QIPP plan have been developed over recent months via the new process, with all schemes being initiated through clinical discussion at Clinical Executive (CLEX) meetings. The schemes are identified as either Transformational or Transactional, and are then grouped into themes of similar schemes so as to maximise synergies and avoid duplication. 5.4 The QIPP plan for 2015/16 is summarised below with details of individual initiatives shown in Appendix B. QIPP Theme 15/16 15/16 Planned Planned Savings Savings m % Frail & Elderly % Intermediate Care 0.4 5% Pathway Redesign and New Integrated Models of Care % Urgent Care Flow 0.4 6% Transformational Schemes Total % CHC Quality and Value % Primary Care and PrescribingQuality and Value % Eliminating Waste Through Effective Contracting % Transactional Schemes Total % TOTAL PLANNED SAVINGS % QIPP REQUIREMENT Appendix B also indicates the current progress with each scheme, with both an overall project RAG (Red / Amber / Green) status and identification of the relevant Gateway in the process, which are defined as follows: Gateway 0 - initial idea Gateway 1 - idea has been approved by CLEX following receipt of a one-page summary Gateway 2 - a high-level Project Initiation Document (PID) has been developed Gateway 3 - the PID has been completed, together with clear timelines and metrics. 6

7 As soon as Gateway 3 is cleared, schemes progress to implementation. By default, any schemes at Gateway 0 don t yet have a project RAG status and have estimated savings of 100k with a savings RAG rating of Red. A number of these schemes are due to be presented to CLEX in April. The current split of value by Gateway is illustrated below: 23% 13% 16% Gateway 0 ( 0.9m) Gateway 1 ( 1.1m) Gateway 2 ( 3.5m) Gateway 3 ( 1.6m) 49% Work is on-going to move other schemes through the process as quickly as possible; this is being supported by a prioritisation process so that maximum effort can be focussed on the schemes with the quickest potential benefits. The CCG has also engaged additional project management support in order to ensure that key major projects are progressed in a timely way (for instance the Eclipse project, Prior Approvals, and some of the CHC work). Finally, an element of the 1% non-recurrent reserve is identified for enabling QIPP projects (see Section 7); this is planned to be used for additional project management as outlined above, for sessional pharmacist time to support the Prescribing Quality Scheme, and for any other one-off enabling costs. 5.6 Monthly updates on delivery against the QIPP programme will be reported to both the Governing Body and the Finance & Performance Committee during 2015/ Financial Summary 2015/ The overall position for WNCCG based on its funding allocation, proposed budget and QIPP savings plan is delivery of a planned surplus of 1% as summarised below: Description m Funding allocation 2015/16 (see 2.5) Proposed budget 2015/16 (see 4.2) Initial surplus / (savings target) 2015/16 (4.7) QIPP plan 2015/16 net of headroom (see 5.4) 7.1 CCG planned surplus 2015/16 (1% of allocation) 2.3 7

8 6.2 The CCG Governing Body is asked to approve the proposed budgets and QIPP plan outlined above, which deliver the national planning requirements including a 1% surplus. 7. 1% Non-Recurrent Reserve 2015/ As noted in 3.1, there is a requirement for all CCGs to set aside 1% of their allocation for nonrecurrent use. (This compares to a similar non-recurrent requirement of 2.5% in 2014/15). 7.2 The CCG already has a number of non-recurrent commitments for 2015/16 that will require funding from the 1% reserve, largely in relation to procurement exercises initiated in previous years that have resulted in mobilisation costs for new services. This leaves a small amount for further discretionary use by the CCG in order to support work on QIPP and system sustainability via the West Norfolk Alliance. 7.3 The planned use of the 1% non-recurrent funds in 2015/16 is summarised below. Description 7.4 The Governing Body is asked to agree the anticipated spend identified above for 2015/ Outstanding Risks and Mitigation Anticipated Spend m Technology & transition costs relating to Pathology (EPA) contract year 2 of 3 (share of Norfolk-wide total) Continuing Healthcare (CHC) legacy restitution costs: mandated 0.6 contribution to national risk-pool - year 2 of 3 Primary Care Mental Health Service: mobilisation costs relating to new 0.2 contract (share of Norfolk-wide total) Better Care Fund (BCF) enabling schemes eg Care Navigators 0.2 QIPP reserve for enabling delivery of schemes: to include additional 0.3 project management time, sessional pharmacists to support Prescribing Quality Scheme, other ad-hoc costs Infrastructure to support on-going West Norfolk Alliance work 0.2 Total There is a range of financial risks facing the CCG in 2015/16 that are not covered within the proposed start year budgets. The main risks identified to date are summarised below; these include the costs of the Enhanced Tariff Option (ETO) outlined in 3.4, for which no funding has as yet been identified. It is also worth noting that the main risk value relates to under-delivery of QIPP schemes, which reflects the challenging nature of the 2015/16 QIPP target and emphasises the importance of ensuring that the new QIPP process outlined in Section 5 is embedded and effective. 8

9 Risks Full risk Probability of value risk being realised 8.2 A range of mitigations is available to offset some of these risks: 8.3 It should be noted that the remaining net risk value, after mitigations, is 1.0m, which is a result of there being no mitigations identified to offset the risk of the ETO; it is not considered realistic to increase the CCG QIPP target by a further 1m when it is already at a very challenging level. 8.4 These risks and mitigations will be closely monitored in coming months, and reported to the Governing Body and Finance & Performance Committee. Potential risk value m % m Under-delivery of acute QIPP savings % 2.1 Acute contract over-performance % 0.5 Under-delivery of prescribing QIPP savings % 0.3 Continuing Healthcare increased activity over and above plan (assumes 5% risk) % 0.3 Operational pressures (eg delivery of performance in A&E and waiting times) % 0.3 Contract settlements above current financial envelope % 0.1 Lack of central funding to cover costs of Enhanced Tariff Option % 1.0 Total risks Mitigations Full mitigation value Probability of success Potential mitigation value 000 % 000 Contingency reserve (assume 25% needed to cover other risks arising in year) % 0.8 BCF Performance Fund % 0.5 Further QIPP schemes to give 20% headroom % 0.7 Delay / reduce investment plans (eg 5 per head schemes, 1% Non-Recurrent Reserve) % 0.8 Additional funding transfer from South Norfolk CCG in respect of Watton patients transferred to Swaffham % 0.3 practices Other non-recurrent measures % 0.5 Total mitigations Conclusion /16 will be a very difficult year for CCGs as they face increasing service and financial pressures at a time of minimal growth in resources. However, this paper outlines a financial plan for WNCCG for 2015/16 that delivers the required 1% planned surplus with a challenging but realistic QIPP savings plan. There are outstanding risks to delivery of that position that need active management and monitoring to underpin delivery of the CCG s financial duties in 2015/16. 9

10 WNCCG Proposed Start Year Budgets 2015/16 APPENDIX A Description 2014/ / / / / / / /16 Forecast Full Year Recurrent Inflation/ Activity Cost Planning Start Year Outturn Adjustmts Baseline (Deflation) Growth Pressures Reqmts Budgets Queen Elizabeth Hospital FT 91,366 (536) 90,830 (725) 1,540 2,719-94,364 Norfolk & Norwich Univ Hosp FT 5,537-5,537 (44) ,654 Eastern Pathology Alliance (EPA) 2,791 (173) 2,618 (21) ,859 Cambridge Univ Hosp FT 3,643-3,643 (29) ,720 Other Acute Contracts 9,661-9,661 (77) ,748 High Cost Drugs 3,533-3, ,886 Ambulance Services 5,721-5,721 (46) ,070 Other Acute Commissioning 1,651 (0) 1,651 (13) ,665 Winter Pressures 2,238 (2,238) Total Acute Commissioning 126,140 (2,947) 123,193 (955) 2,030 3, ,966 Norfolk & Suffolk FT Main SLA 12,755 (424) 12,331 (234) ,819 Norfolk & Suffolk FT IAPT SLA (17) Learning Difficulties 1,504-1,504 (10) ,501 Other Mental Health Services 1,647 (176) 1,471 (28) ,646 Total Mental Health Commissioning 16,800 (600) 16,200 (290) ,854 Continuing Healthcare Packages 12, ,928-1, ,221 Continuing Healthcare Restitution 314 (314) NHS Funded Nursing Care ,024 Total Continuing Healthcare 13, , , ,244 Norfolk Community Health & Care 14,207 (590) 13,617 (224) ,207 Other Community Services 6,338 (210) 6,128 (106) ,084 Palliative Care (5) CSU Clinical Recharges (Meds Mgt & CHC) 1,093 (50) 1, ,057 Better Care Fund - Social Care spend ,292 6,292 Reablement Services 249 (249) WN Alliance Programme 419 (419) Total Community Commissioning 22,575 (1,518) 21,057 (336) ,292 27,907 Local Enhanced Services 1,147-1, ,177 GP Out of Hours Contract 1,880-1, ,915 GP Prescribing 31,069-31,069-1, ,622 Other Prescribing 2,306-2, ,336 Referral Management Schemes 193 (50) GP IT 473 (473) NHS Property Services recharges Total Primary Care & Prescribing 37,168 (523) 36, , ,294 Practice Plans Reserve Contingency Reserve ,150-1,150 System Resilience Reserve 53 (53) ,159 1,159 1% Non-Recurrent Reserve 293 (293) ,204 2,204 BCF Performance Fund ,028 1,028 Other Reserves (11) Anticipated Allocation adjustments - (500) (500) - - (1,270) - (1,770) Total Reserves 376 (35) (52) 4,391 4,680 TOTAL PROGRAMME SPEND 216,906 (5,619) 211,286 (1,539) 5,462 4,394 11, ,945 CCG Management Costs 1,784-1, ,829 Commissioning Support Unit (CSU) 1,661 (195) 1, ,503 Recharges from other bodies TOTAL RUNNING COSTS 3,783 (195) 3, ,678 CCG GRAND TOTALS 220,689 (5,814) 214,874 (1,449) 5,462 4,394 11, ,622 10

11 West Norfolk CCG Proposed QIPP Plan 2015/16: Transformational Schemes Project Description Planned Savings APPENDIX B(1) Progress QIPP Theme Project Ref Number Project Title Anticipated Effective Date 2015/16 Saving ( 000) Risk Rating Gateway Overall Project RAG Status Frail and Elderly Intermediate Care WN/PMO/001 Frail and Elderly - King's Lynn Frailty Hub Pilot Q4 100 RED 0 n/a WN/PMO/012 Frail and Elderly - Targeted Carer Support and Education Services Q2 100 RED 0 n/a WN/PMO/030 Frail and Elderly - General Practice 5 per Head Proposals Q1 387 AMBER 3 RED WN/PMO/031 Frail and Elderly - BCF Dementia Care Strategy Q2 182 AMBER 2 AMBER WN/PMO/034 Frail and Elderly - BCF Development of Integrated Care Model Q1 221 AMBER 3 GREEN Sub-total 990 WN/PMO/002 Long Term Conditions Integrated Community Care Model Q2 100 RED 0 n/a WN/PMO/006 Intermediate Care - Step-Up/Down Pathway Integration Review Q2 100 RED 0 n/a WN/PMO/033 Intermediate Care - Intermediate Bed Utilisation Q1 164 GREEN 3 GREEN Sub-total 364 Pathway Redesign and New Integrated Models of Care Urgent Care Flow WN/PMO/008 Near Patient Testing and Diagnostics in Primary Care Q3 100 RED 0 n/a WN/PMO/015 Optimise Usage of Eclipse Live Q1 400 GREEN 2 GREEN WN/PMO/024 Pain Management Pathway Redesign Q4 100 AMBER 2 RED WN/PMO/037 Dedicated Tissue Viability Nurse Q1 163 GREEN 3 GREEN Sub-total 763 WN/PMO/018 Urgent Care Flow - Resilience Benefits Beyond April 2015 Q1 200 RED 1 AMBER WN/PMO/035 BCF Integration to Reduce Admissions and Aid Discharge Q1 211 GREEN 3 AMBER Sub-total 411 TRANSFORMATIONAL SCHEMES TOTAL 2,528 11

12 West Norfolk CCG Proposed QIPP Plan 2015/16: Transactional Schemes APPENDIX B(2) Project Description Planned Savings Progress QIPP Theme Project Ref Number Project Title Anticipated Effective Date 2015/16 Saving ( 000) Risk Rating Gateway Overall Project RAG Status CHC Quality and Value Primary Care and Prescribing Quality and Value Eliminating Waste Through Effective Contracting WN/PMO/005 CHC Procurement Savings Q4 150 AMBER 1 RED WN/PMO/029 Continuing Healthcare Optimisation Q1 998 AMBER 2 RED WN/PMO/020 CHC Individual Patient Placements Q2 100 AMBER 1 RED Sub-total 1,248 WN/PMO/010 Avastin for Wet Age-Related Macular Degeneration Q2 100 RED 0 n/a WN/PMO/014 Infliximab Biosimilar Adoption Q2 70 AMBER 1 AMBER WN/PMO/016 Primary Care Commissioned Low Molecular Weight Heparin Q1 100 RED 1 AMBER WN/PMO/021 Reducing Variation in Referral Behaviour Q3 350 AMBER 1 RED WN/PMO/023 Pathology Test Volume Reduction Q2 225 AMBER 2 GREEN WN/PMO/026 Prescribing Quality Scheme 2015/16 Q1 903 GREEN 2 GREEN Sub-total 1,748 WN/PMO/009 Medical Day Ward and Ward Attender Review Q2 100 RED 0 n/a WN/PMO/011 Proactive Excess Bed Days Review Process Q2 100 RED 0 n/a WN/PMO/013 Cambridge Community Services NCAs Q2 100 RED 0 n/a WN/PMO/017 ICES Efficiency Scheme Q1 200 AMBER 2 AMBER WN/PMO/019 QEH Acute Overseas Visitors Q2 50 RED 1 AMBER WN/PMO/022 Home Oxygen Review Q1 100 AMBER 1 RED WN/PMO/025 Prior Approval Process Q2 500 GREEN 2 GREEN WN/PMO/027 Planned Care Contracting Q1 469 GREEN 3 GREEN Sub-total 1,619 TRANSACTIONAL SCHEMES TOTAL 4,615 GRAND TOTAL 7,143 12