Council of Members 15 May 2019
Welcome Dr Jonathan Love, Council of Members Chair
Minutes of the previous meeting: 27 March 2019 Dr Jonathan Love, Council of Members Chair
Question and answer session of CCG Governing Body Practice representatives
Final opening budget framework 2019/2020 2019/20 Malcolm Hines, Director of Finance
Financial settlement for 19-20 and later years (1 / 2) • Since we met in March, contracts have been agreed across SEL with provider Trusts, and other providers of care services. • The settlement for 19-20, and later, is still a significant increase in resources. • Our core services- commissioning budget has increased by 5.98%. • Our Delegated primary care budget has increased by 6.5%, but this has now been reduced back to c. 3.5% by a deduction for the creation of the new Clinical Negligence scheme for GP’s nationally. • Running costs remain static, but with a 12% saving from April 2020. We are aiming to achieve a 10% saving in this year, leading to making the full 12% from April 2020. • Overall this is higher than previously awarded, but has significantly increased commitments attached to it. • Overall the CCG is now seen as 1.75% above its target allocation, and will receive c. 4% uplift in 2020-21.
Financial settlement for 19-20 and later years (2 / 2) • The National pay awards are now funded through this uplift . • The PBR tariff, has increased net by nearly 3% this year, compared to 1% the year before. • Mental Health budgets are expected to be increased through investment in IAPT, CAMHS and other local schemes by 6.7%. • Community services are also to be invested in by 6% extra this year. • The primary care uplift is to take account of the new contract deal, and fund the new Clinical Negligence scheme that applies to Practices(CNSGP). • There are many other commitments, as well as the need to pump-prime to achieve some of our savings initiatives.
Table 1 :Core Allocation increase for 2019-20 and distance from target Allocation increases in SEL 2019-20 CCG Final core % uplift in 19-20 Distance from services target under latest allocation 19-20 formula 327,611 5.98 0.79 NHS Bexley CCG NH Bromley CCG 466,885 5.98 2.17 NHS Greenwich CCG 402,379 6.33 3.44 NHS Lambeth CCG 500,202 5.72 - 3.47 NHS Lewisham CCG 451,617 6.16 2.77 NHS Southwark CCG 439,773 5.98 1.75 OHSEL total 2,588,467 6.01 1.08 5.78 1.37 London
Resources available to Southwark 2019-20 • In 2018-19, we were required to make a surplus of £989k, which will be carried forward on our balance sheet , for future investment, at such time as we are allowed to “drawdown” these funds by NHSE. • For 2019-20, we are asked to achieve a break even position for the year ( taken on its own). • This is as part of a control total position for the whole of SEL, where only Bexley has an agreed deficit position at present. All 6 CCG’s have submitted plans to meet their control total for the year- 5 CCG’s break even, and Bexley a £7.5M deficit target, which when achieved will allow them to get an equal amount of national CSF funding, to then reach break even. • It is essential that we mitigate our savings plan, by obtaining value for money, and procuring quality services from providers.
NB 12% reduction in running costs on all CCG ’ s in 2020. Final Opening Resources available to Southwark CCG in 19-20 and 20-21 2018-19 2019-20 2020-21 Recurrent core 413,881 439,773 459,236 Allocation Delegated 44,749 47,696 49,830 Primary Care Adjustment for -1,373 -1,373 CNSGP Non recurrent 1,355 841 0 sums announced Running Costs 6,533 6,537 5,766 allocation Total Resources 466,518 493,474 513,459 Target surplus 989,000 Break even tba for the year % change over 3.33% 5.78% 4.01% previous year’s Rec.allocation 2018-19 2019-20 2020-21
Budgets and Contracts 2019-20 • Nationally, there was a deadline of 21 March to achieve agreed contracts with NHS providers. We have achieved Block contract agreements with all local Acute and community providers, and with SLAM, and Oxleas, that will deliver improvements, with the new investment monies. • For community services, the discussions are still continuing about the detailed areas to target investment for the new year. • The primary care uplift, will be used to implement the new national contract deal, with an adjustment to this funding , to fund the clinical negligence scheme as mentioned earlier. • All CCGs are currently working to deliver running cost savings, and will soon be considering where some functions can be delivered more effectively by working at scale across a number of CCG’s, or as a whole SEL approach.
QIPP Savings Programme 2019-20 • In 18-19, we set a programme of some £16,550k, after investment to be achieved. We have delivered some £16.1M of this representing c. 95% of our plans. This is much higher than the London wide average 85% delivery. • For 19-20, despite the high uplift, it has been demonstrated that there are many cost pressures, and a high outturn in terms of increased hospital referrals and demand generally, meaning that we need to find savings anew, to balance the overall budget to break even. • The programme for 19-20, is £15,661k, and the CCG have currently identified over 90% of this programme, with much being built into block contracts. • This means the level of in year risk is significantly lower, both around overperformance, and the need for reserves.
Managing risk in 19-20 • We have already stated that we have a number of block contracts for the year, which will reduce in year risk to the CCG, and therefore we can consider what reserves we need to hold, taking account of other risks. • We always have some risk on small contracts, Non – NHS contracts, continuing healthcare, and Prescribing budgets. • We have a national requirement- again- to hold a ½% contingency, this is c £2.5m. • In addition we will be holding another £2m, for local risks and pressures, so in total c.£4.5m. • This compares favourable with our 18-19 start position, where we had £5.4m, but less block contracts in place.
Recommendation Southwark CCG Council of Members are asked to: • Approve the financial framework for 2019-20 • Note the Southwark CCG Control Total target of achieving breakeven in year • Note the ongoing work being done to achieve our financial position • Note the joint SEL work, to agree the achievement of the SEL CCG’s control total for 2019 -20.
Update on planning and priorities for 2019-20 & beyond Ross Graves, Managing Director
2019-20 Planning Update • Our 2019-20 CCG Operating Plan narrative will go to Locality Meetings and our Integrated Governance and Performance Committee next week • In 2019-20 for the first time we have carried out a joined up planning and contracting approach across all of the six CCGs in SEL • This will be a one-year transitional plan which will also form the first year of a five year place-based plan for Southwark , aligned to our NHS Long Term Plan response.
CCG System Reform Update (1 / 2) • At the end of 2018/19 - Our six Governing Bodies agreed that changes to the structure of our CCGs in SEL would be required in order to progress our Integrated Care System (ICS) and best respond to the NHS Long Term Plan • Over March and April 2019 - We have engaged in more than 30 conversations with our partners and members on our thinking to date. From this we have developed a case for change for merger and informed NHSE & NHSI that we would like to consider an application to merge in April 2020 • This is our current intention but the merger application will be based on further engagement and a final Governing Body decision.
CCG System Reform Update (2 / 2) • In late April 2019 - national merger guidance was published. Should SEL CCGs wish to merge we must have plans and an application submitted on 30 September 2019 • Throughout May - we will ask our six Governing Bodies to agree a process for this work • Going forwards - We will regularly communicate with our staff and our membership throughout this programme and engage you in plans. At this stage we are gathering baseline data and information that compares our six separate CCG team structures that will allow us to begin design work for any change in late May 2019 • We are clear that we will need the right capacity at every level of our system - very locally, at borough level, and at SEL level.
Partnership Southwark Ross Graves, Managing Director
Over the next two to three years, health and care partners across Southwark will change the way services are commissioned and delivered in the borough. Within Partnership Southwark we want to do things differently, with and for, our local communities We will work with partners beyond health and care to tackle the causes of inequalities and prevent illness, and improve our use of data and digital technology so we can be more proactive in our approach to delivering care and support.
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