JOINT PRIMARY CARE COMMISSIONING COMMITTEES

Transcription

1 JOINT PRIMARY CARE COMMISSIONING COMMITTEES TITLE: Primary Care Finance report Month 7 DATE OF MEETING: 24 November 2016 PAPER REF: JPC/16/117 AUTHOR: Marcus Pratt, Associate Chief Finance Officer, Sarah Szubert Primary Care Hub PRESENTER: Sarah Bray, Chief Finance Officer ISSUE: The enclosed finance reports provide the 2016/17 month 7 primary care position for both Mid-Notts CCGs. For Mansfield & Ashfield CCG (M&A) this gives a 545k year to date underspend and Newark & Sherwood CCG (N&S) a 167k underspend. For N&S CCG this is an improvement from previous months due a financial recovery plan action now implemented. 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. 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 postion and the overall CCG. M&A CCG is forecasting a primary care underspend of 1,050k and N&S CCG and underspend of 250K. 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. 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: Risks are monitored and managed through the mid-notts CCGs Activity & Finance Committees

2 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 October 2016 Mansfield & Ashfield CCG (04E) NHS England North Midlands At the end of month 7 the primary care position for Mansfield & Ashfield CCG shows an underspend of 545,654. The main reason for underspend relates to planned budgets in relation to estates costs now released following discussions with NHS Property Services. A summary of the month 7 financial position by expenditure category can be found below. Category Annual Budget YTD Budget YTD Actual YTD Variance Dispensing/Prescribing Drs 18,164 18,154 18, Enhanced Services 1,548, , ,507 69,544 General Practice - APMS 939, , ,542-1,630 General Practice GMS 7,296,306 4,252,263 4,235,881-16,382 General Practice - PMS 7,705,401 4,494, ,167 Other GP Services 313, , ,129 10,189 Other Premises costs 579, , ,134 0 Premises Cost Reimbursement 3,192,101 1,874,341 1,865,730-8,611 QOF 2,282,587 1,279,609 1,298, Reserves 1,762, , ,751 Grand Total 25,638,460 14,465,098 13,919, ,654 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. 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. NHS Property Services are moving to billing arrangements based on the market rental value of the property. Information has been received from NHSPS to support this, however the CCG has made a number of queries in relation to the data supplied. The costs reflected above therefore do not reflect these changes. 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.

4 NHS England North Midlands The CCG has a primary care QIPP target of 116k, which has been transacted through reserves. As at month 7 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. M&A Reserves Annual Budget Earmarked Reserves 1,222,011 Risk Reserves 420,832 QIPP -8,890 Contingency 128,770 Total Reserves 1,762,722 The overall primary care delegated position remains positive with a forecast year-end variance of a 1,050k 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 October 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 underspend of 167,499. This is an improvement from the previous reported position which showed a small overspend. The change is due to an increased level of funding for primary care services in Newark and Sherwood following discussions with NHS England. This is an action within the Financial Recovery Plan and the benefit received forms part of the current overall CCG forecast. A summary of the month 7 financial position by expenditure category can be found below. Category Annual Budget YTD Budget YTD Actual YTD Variance Dispensing/Prescribing Drs 499, , ,445-35,770 Enhanced Services 840, , ,487 12,394 General Practice - APMS 620, , ,830 7,325 General Practice GMS 10,293,836 5,996,533 5,982,880-13,653 General Practice - PMS 334, , ,427 Other GP Services 177, , ,167 12,111 Other Premises costs 204, , ,971 0 Premises Cost Reimbursement 2,165,084 1,237,953 1,232,376-5,577 QOF 1,816,742 1,073,232 1,073, Reserves 227, , ,866 Grand Total 17,178,480 10,012,515 9,845, ,499 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. The CCG continues to hold 0.5% contingency. 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 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. There are risks in relation to costs from NHS Property Services who are moving to billing arrangements based on the market rental value of the property. Information has been received from NHSPS to support this, however the CCG has made a number of queries in relation to the data supplied. The costs reflected above therefore do not reflect these changes, however the impact for N&S CCG is likely to be small as there are few NHSPS properties in the area. Alongside

6 NHS England North Midlands this change NHSPS has developed a vacant space policy, which passes the risk of surplus property to NHSPS. The CCG have declared Clipstone Health Centre vacant and expect to receive some benefit from this. Discussions are ongoing with NHSPS in relation to this. 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. In addition the CCG is exploring options for Balderton Health Centre to ensure a permanent solution is put in place at an effective cost. This is unlikely to achieve a benefit in 2016/17. Given the financial position of the CCG we need to maximise QIPP in all areas. N&S Reserves Annual Budget Earmarked Reserves 132,498 Risk Reserves 35,726 QIPP -25,160 Contingency 84,260 Total Reserves 227,324 The overall primary care delegated position remains positive with a forecast year-end variance of a 250k underspend. 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.