Croydon Attachment D1 2012/13 Financial Position and Recovery Plan Month 7 YTD Performance November 2012 0
Index 1. Financial Position Summary 2. Mitigations 3. QIPP Recovery Performance 4. 5 Year Projection (pre-QIPP) 5. Allocations/Population 6. Governance 1
1. Executive Summary • The key risks facing the PCT at Month 7 continue to be: • Acute over-performance (CUH non-elective, ESH/Kings/GST/SLH) • QIPP: unidentified projects and reducing capacity from activity shifts • Contractual/performance issues on UCC and community services • Primary Care/Specialist Commissioning (incl £1.5m risk on 2 nd take) • The PCT has modelled the following outturn scenarios for 2012/13: • Best Case £5.0m deficit (M6: £5.0m) • Mid Case £9.0m deficit (M6: £9.0m) • Downside Case £12.6m deficit (M6: £12.6m) THESE FORECASTS DO NOT INCLUDE CONTINUING CARE RESTITUTION LIABILITIES 2
1.1 Financial Outturn – M7 Forecast Financial Performance Performance Measure Target Forecast Status Trend Target/ Indicator Statutory Break Even Duties Revenue Resource Stay within RRL £595.9m £604.9m Red Limit (RRL) Capital Resource Stay within CRL £2m £2m Green Limit Red Cash Resource Stay with Cash (min. £9.0m £595.9m £604.9m Limit Limit cash support required) Administration Duties Non NHS Payment of valid Better Practice 87% to 80% invoices within 30 90% Amber Payment Policy NHS 82% to days. 96% Other Significant Financial Targets Delivery of QIPP Programme £25m £21m Red Savings Stay within running Running Costs £12m £12m Green cost envelope. 3
1.2 Financial Outturn Scenarios Description Plan Downside Mid Case Best £m Case (Forecast) Case £m £m £m Forecast Outturn before (9.0) (20.2) (20.2) (20.2) Risks/Mitig./Reserves Further Risks- Acute - (1.4) (1.0) - - Out of Hospital - (2.5) (1.8) (1.0) - Delivery of QIPP - (1.0) - - Total Risk (9.0) (25.1) (23.0) (21.2) Mitigations - Acute - 1.4 1.8 2.3 - Out of Hospital - 2.5 3.5 4.5 Net Position pre Contingency (9.0) (21.3) (17.7) (14.4) Contingencies - PCT Local 6.0 5.7 5.7 5.7 - 0.5% Cluster 3.0 3.0 3.0 3.0 Net Financial Position (M7 FOT) 0.0 (12.6) (9.0) (5.8) Net Financial Position (M6 FOT) 0.0 (12.6) (9.0) (5.0) 4
1.3 Financial Performance By Receiver Organisation For Month 7, the estimated CCG component of the adverse FOT performance is £7.6m. It should be noted that adverse variance of 2 nd take specialist commissioning (£1.5m for renal and mental health) is currently shown under CCG. 5
1.4 Financial Performance CCG: ACUTE 6
1.5 Financial Performance CCG: Out of Hospital Services These variances exclude the risk of continuing care restitution settlements which is currently being evaluated. 7
1.6 Financial Performance NCB: Primary Care / Specialist The forecast outturn on specialist services does not reflect “ 2 nd take” services. Currently there is a £1.5m adverse variance on these services (renal and mental health) which is currently reported under CCG acute/mental health. The PCT is working closely with the London Specialist Commissioning Group and providers to disaggregate.
1.7 Financial Performance By GP Network (1 month in arrears) The CCG has established 6 GP Network across Croydon. For the first time the Month 6 position was analysed and presented by GP Network using actual acute and prescribing data, and fair shares for the balance. Whilst no network is in balance, there are individual practices in a surplus position.
1.8 YTD QIPP Performance Graph Please note The YTD and FOT figures for the Long Term Conditions and GP Support for Care Homes projects have been reduced to zero due to the lack of monitoring information available. In previous reports, these projects were reporting to plan. 10
1.9 RAG Rating of QIP Schemes PMO RAG Number of Annual Plan Forecast Variance Rating Projects (£000) Saving (£000) (£000) Green 20 13,760 16,827 3,067 Amber 7 1,698 1,342 (356) Red 16 7,078 3,156 (3,922) Unidentified 2,464 - (2,464) Total (M6) 43 25,000 21,325 (3,675) Total (M5) 43 25,000 21,896 (3,104) The Patient Navigation Service (£0.4m QIPP) has won the HSJ Efficiency in Commissioning Support Services Award for 2012 and has been shortlisted as a finalist for the prestigious HSJ Awards 2012 for Secondary Care Service Redesign (with Croydon Health Services NHS Trust) 11
2. Mitigating Actions • Capacity • Addressing Acute Overperformance • Closing QIPP Gap • Other Actions 12
2.1 Actions - Capacity • All CCG Directors appointed as of 1 September 2012 • Lay members, nurse and secondary care clinician to be appointed by end of November 2012 • Recruiting to Deputy Director of Strategy • Secured interim resource to cover strategy and transformation functions • Considering additional time commitment from clinical leaders, recognising the challenging agenda • Migrating to using CSU Offer (finance, informatics etc) 13
2.2 Actions – Acute Overperformance Trust (M7 FOT) POD Action • All / General Planned Care Rollout of CReSS referral management system by March 2013, especially northern practices (1 Oct 2012) re Kings/GST • Waiting List validation on a 8 weekly basis by GPs • QIPP includes a number of project to provide alternative settings of care to reduce activity in acute. • Manage benefit of NHS 111 implemented in 11/12 – lower OOH All / General Non Elective • Care Implementing UCC new model of care at CUH from April 2012 • Progress transfer of satellite UCC services to GP provision • Joint programme with borough to invest reablement funds to reduce admissions and readmissions • QIPP scheme on long term conditions, EOLC and COPD Hot Clinic CUH • Development of Long Terms Conditions strategy to avoid inappropriate admissions, incl risk stratification across all practices in 2012/13 • CUH Non elective Above:ACU validating appropriateness of short stay • (£2.9m Adv) Maternity ACU reviewing ratio of non-deliveries/deliveries • High Cost Drugs CCG Prescribing team validating against SWL policy • Borough Team pursuing year end deal with Trust • ESH(£2.2m Adv) Non elective Support negotiation of year end deal • SWLEOC Referral management via CReSS system. St George’s (£0.7m) • Critical Care CCG support risk share and counter proposal. King’s Healthcare • Maternity ACU ratio of non-deliveries/deliveries • (£2.4m Adv) OP Proc Roll out of CReSS to northern practices to manage referrals Guy’s and St Thomas • Non elective See above on non elective care • ( £1.9m Adv) Critical care CCGs consider risk sharing in 13/14 14
2.3 Actions – QIPP Gap • QIPP Governance Arrangements in place • Maximise impact of existing schemes during 2012/13 • Long Term Conditions (incl Risk Stratification) and Urgent care are key opportunities to be pursued for Q4. • Review of local, London and national QIPP case studies • Participation in NHS Benchmarking Network (longer term) • Facilitating South London wide QIPP leads network (in disucssion with CSU Finance) 15
2.4 Actions - Other • GP Engagement - 6 x GP networks – development continues - eQuIPPed newsletter to practices on QIPP Actions - Finance Team attending GP Networks to present practice level financial performance (see 1.7) • Secure and Maximise Opportunities - £2/head funding (incl 11/12) (£1.1m) - year-end accruals - investment (£6.5m) minimised/deferred - Financial impact of actual CQUIN Performance 16
2.5 Actions - Timeline 1. PIDs completed 3. Three year plan 5. Integration work for Remaining ‘in stream begins in (3YP) development 7. 3YP broken 9. Implementation progress’ projects, begins with CCG earnest with down into in-year & mobilisation of followed by appointment of prog. leadership & borough plans for the next year 2 QIPP implementation and team, followed by lead assuming receipt three years schemes begins monitoring detailed modelling of funding. 1 3 5 7 9 Oct 2012 Jan 2013 Apr 2013 Jul 2012 Apr 2012 On-going development of Clinical Commissioning Group and support structures 10 2 6 4 8 4. Appointment of 2. Work completed 10. CCG assumes 6. 3YP completed 8. QIPP schemes on other potential in- borough MD followed control of bulk of with key output being for the remaining by restructuring of commissioning year QIPP schemes; shape of the health two years devised with PID completion borough team, to agenda, subject to economy by end of from the in-year include additional authorisation and sign off where 2014/15. elements of the 3YP recovery resource appropriate caveats 17
3. Recovery/QIPP Performance • £25m recovery target (net after investment) • £22.5m Net Savings Plans Agreed (90%) • Opportunities to close gap (£1.0m) • Risks on Forecast outturn: • Non delivery on agreed schemes (£1.2m) • Non delivery to be identified (£2.5m) 18
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