Month 3 Financial Position

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Month 3 Financial Position Primary Care Commissioning Committee meeting 21 July 2016 D Author(s) Diane Mason, Senior Finance Manager Sponsor Julia Newton, Director of Finance Is your report for

1 Month 3 Financial Position Primary Care Commissioning Committee meeting 21 July 2016 D Author(s) Diane Mason, Senior Finance Manager Sponsor Julia Newton, Director of Finance Is your report for Approval / Consideration / Noting For Consideration: This report provides the Committee with information on the financial position for primary care budgets at month three (June 2016), together with a discussion on key risks and challenges to deliver a balanced position at year end. At this stage of the year, there is limited information on actual or projected spend against some budget lines but we have produced a forecast year end position. Are there any Resource Implications (including Financial, Staffing etc)? None. Audit Requirement CCG Objectives Which of the CCG s objectives does this paper support? Strategic Objective - To ensure there is a sustainable, affordable healthcare system in Sheffield. It supports management of the CCG s principal risks 3.1, 4.1, 4.2 and 4.3 in the Assurance Framework. Equality impact assessment Have you carried out an Equality Impact Assessment and is it attached? No. If not, why not? There are no specific issues associated with this report. PPE Activity How does your paper support involving patients, carers and the public? Not Applicable. Recommendations The Primary Care Commissioning Committee is asked to note the financial position at Month 3 and consider the risks and challenges to delivery of a balanced financial position against primary care budgets. 1

Month 3 Financial Position Primary Care Commissioning Committee meeting 21 July 2016 1.

2 Month 3 Financial Position Primary Care Commissioning Committee meeting 21 July Introduction The Primary Care Commissioning Committee considered the financial position, risks and challenges at Month 2 at the meeting on 29 June The purpose of this paper is to update the Committee on the financial position at Month 3 and to give a forecast for the first time on the potential year end position. 2. Forecast Revenue Position 2.0 Overview Last month we referred to anticipated funding of 362k which is already included in budgets and which is the first tranche of PMS transition funding which was transferred to the CCG non-recurrently in 2015/16 and used for the new Locally Commissioned Services. The funding was allocated recurrently to the CCG at Month 3 and is already pre-committed as part of the PMS transition arrangements. We have increased the budget for CCG commissioned services by 300k through a transfer from the CCG s general reserves to reflect the updated position on locally commissioned service to support the CCG s transformation and QIPP priorities for 2016/17. For completeness we are now reporting on other existing budgets where there is spend on services /activities supporting primary care such as GP IT and PLIs. Table 2 shows the budgets and projected spend at Month 3. There have been some amendments to individual budget lines. Much of the 3.2m which was reported in Month 2 under other reserves has now been deployed to budgets. Two business cases for Locally Commissioned Services (LCS) were approved by the Committee on 28 June and have resulted in a budget for GP engagement for Elective Service Transformation of 1.2m and GP engagement for Prescribing Quality 0.3m, these budgets allow for sign-up by 100% of GP practices. A further 1.1m has been allocated to fund the contract as currently agreed with Primary Care Sheffield Ltd for a range of activities, principally the piloting of the CASES arrangements. The balance of the reserves 1.1m is largely expected to be deployed in year to support the development of the Neighbourhoods model as part of the CCG s care outside of hospital strategy. Table 1 shows the budgets and projected spend as at Month 3. Table 2 shows the position on other budgets which support Primary Care. 2

3 Table 1: Summary of Resources and projected spend Primary Care Delegated s '000 Additional CCG Commissioned Services '000 TOTAL ' /16 Recurrent 72,174 4,924 77,098 Growth Funding from NHSE 2, ,573 Investment from CCG allocation subject to schemes commencing 3,477 3,477 Opening 2016/17 74,747 8,401 83,148 Transfer between budgets 2016/17 reported at Month 2 (2,619) 72,128 2,619 11, ,148 Month 3 Movements Transfer from General Reserve Transfer between budgets (105) Revised 2016/17 budget 72,023 11,425 83,448 Increase in funding 6, % Projected Spend at Month 3 Core contract Premises Directed Enhanced Services QOF Other GP Services CCG commissioned services CCG commissioned services reserve eg for Neighbourhoods developments 47,993 10,269 3,166 7,433 2,109 10,311 1,114 47,993 10,269 3,166 7,433 2,109 10,311 1,114 Contingency reserve 1.0% systems wide reserve ,023 11,425 83,448 3

4 Table 2: Summary of resources and Primary From TOTAL projected spend for Other Primary Care Care CCG s Delegated Main s Allocation '000 '000 ' /17 GP IT Protected Learning Initiatives ,074 1,074 Projected spend at Month 3 GP IT Protected Learning Initiatives ,074 1, Month 3 financial position Appendices A and B show the year to date and forecast financial position for all primary care budgets. Primary Care delegated budget (Appendix A) the main variances relate to; - Core contract where an underspend of 112k is reported, this relates to list size adjustments. The budget for core contract was uplifted by 0.7% for 2016/17 to reflect expected demographic increase. The variance is due to the actual list size is currently calculated as at April 2016 and the increase is less than expected, the volatility of the student population and the dispersal of patients as a result of a GP practice closure. - Premises where an underspend of 170k is reported, this reflects the charges for LIFT premises for GP practices being lower than budget, further work is required to fully understand this position. - Other GP services where an underspend of 70k is reported relating to employment of locum clinicians. Theses variances are currently being investigated with finance colleagues at NHS England to understand their impact on the forecast. We remain fairly confident that overall the expenditure will be contained within budget. Primary Care budget from main allocation (Appendix B) a small overspend of 28k (1% of planned budget) is being reported, this is mainly on the interpreting budget which is subject to increasing demand. The forecast financial position on all budgets is currently to plan as it is early in the financial year and we have limited or no data on many of the individual budget lines. 4

5 2.2 Key Financial Issues, Risks and Challenges Further scenario planning is ongoing to determine whether the uncommitted reserve is sufficient to cover expected pressures. The budgets where expenditure can change inyear are; - Premises impact of ongoing rent and rate reviews - Impact of Primary Care transformation fund applications - Enhanced services dependent on activity undertaken - Other GP services locum services required randomly throughout the year. - List size adjustments noting that 0.7% budget increase has been built in. - QOF dependent on the level of achievement by practices - Locally commissioned services particularly interpreting services annual demand increase and finalisation of any special cases funding for Clover Group practices. - PCS Ltd contract - actual CASES activity % Non-Recurrent Reserve Planning guidance from NHS England requires that all CCGs hold back at least 1% of the programme revenue resource limit to be used on a non-recurrent basis and subject to approval of NHS England. We await further guidance from NHS E as to if/when we can make a case to utilise the funding in 2016/17 or whether we will have to release to the CCG s bottom line to increase our overall surplus and hence carry forward the funding to future years. 3. Recommendation The Primary Care Commissioning Committee is asked to note the financial position at Month 3 and consider the risks and challenges to delivery of a balanced financial position against primary care budgets. Julia Newton Director of Finance July

6 Appendix A Primary Care Delegated Month 3 Position April to June Full year plan Spend Forecast Spend Forecast Core Contract GMS practices 19,297 4,824 4,816 (8) Core Contract PMS practices 26,915 6,729 6,611 (118) Core Contract APMS practices 1, Directed Enhanced Services 3, Premises 10,269 2,567 2,397 (170) QOF 7,433 1,858 1,858 0 Other GP services mainly locums 1, (70) Prescribing & Dispensing Doctors (0) Reserves 1% non recurrent reserve General contingency (76) Total 72,023 17,819 17,390 (429) 19, , , , , , , ,

7 Appendix B Locally Commissioned Expenditure on Primary Care Services Month 3 Position April to June Full year plan Spend Forecast Spend Forecast Paediatric Referral Refinement Glaucoma service CATS scheme PEARS scheme Opthalmology Services Sub Total Hour blood pressure monitoring Anticoagulation Care Homes Care Planning Care Of Homeless Carpal Tunnel Eating Disorders D Dimers Dermatology/Cryotherapy/Cutting Dmards Central Locality ENT Pilot Endometrial Biopsy Hepatitus B Mirena Colorectal Screening Pessaries Zoladex Minor Surgery GP Training Interpreting services PMS transition:"over and Above" & Special Cases 3, GP Engagement Elective Service Transformation 1, GP Engagement Prescribing Quality Contract with Primary Care Sheffield Ltd 1, GP Services Sub Total 9,610 1,773 1, Pharmacy Subtotal Neighbourhood developments reserve 1, ,425 1,948 1, , , , , , ,425 0 Other Primary Care s PLIs GP IT Full year plan Spend (11) 69 Forecast Spend Forecast Other Primary Care s TOTAL

Financial Report at Month 6

Financial Report at Month 6 Primary Care Commissioning Committee meeting 17 November 216 D Author(s) Linda McDermott, Senior Finance Manager Sponsor Julia Newton, Director of Finance Is your report for