A partnership of Primary Care Trusts in Bromley, Greenwich, Lambeth, Lewisham, Southwark and Bexley Care Trust

1. A partnership of Primary Care Trusts in Bromley, Greenwich, Lambeth, Lewisham, Southwark and Bexley Care Trust

2. Contents Financial Plan QIPP Impact Commissioning intentions Risk assessment

3. Financial Plan 2011-15Summary The six SEL PCTs have submitted Operating Plans for 2011/12 which are in line with Operating Framework guidelines and NHS London financial planning guidance. The Operating Plans are fully integrated in the medium term financial plan for the Cluster developed for the Commissioning Strategy Plan. This delivers the following surpluses after QIPP over the plan period: 3

4. Cluster CSP and OperatingPlan process The SEL CSP model consolidates the 6 PCTs 5 year financial plans and includes the following assumptions: 2009/10 finance and activity outturn used as the baseline adjusted for 2010/11 forecast outturn (as at m11) Local growth and tariff assumptions � see Appendix 1 1.5% Net tariff deflation for acute and non acute provider contracts Management cost savings accelerated to 2011/12 Required contingencies (0.5% of RRL) and non recurrent reserves (2% of RRL) for each PCT each year All PCTs achieve at least 1% surplus each year Pay inflation assumptions per NHS London guidance (0% in 2011/12 and beyond with some local assumptions on increments) The CSP has been reconciled to the March Operating Plan submission. The submissions have also been quality assured by the Cluster through a financial planning stocktake which has checked the consistency and completeness of planning assumptions for all PCTs, in line with the Operating Framework guidance. Updated notification of Revenue Resource Limits including adjusted for social care funding, learning disabilities and cancer drugs Operating Framework investments including health visitors, re-enablement funding and share of �150m, GP development fund, (�4 per head of population) dementia and IAPT. The plans reflect the PCTs views of the latest position on contract negotiation for 2011/12 with providers. 4

5. CSP Case for Change gap 28 March 2011 Before the impact of planned QIPP schemes is taken into account, the SEL PCTs baseline financial position worsens from 2010/11 to 2014/15 due to significant forecast growth in demand for acute and non acute services as well as the requirement to retain 2% non recurrent reserves. 5

6. PCT Annual Revenue and Surplus/(Deficit) before QIPP  Whilst the revenue resource limit is forecast to grow each year in the period by between 2 and 2.6%, this is not sufficient to offset increasing annual expenditure driven by planning assumptions (see appendix 1). 6

7. Key drivers of the annual financialgap at 2014/15 (before QIPP) 7

8. PCT Spend by category 8

9. Underlying Financial Position2010/11 to 2011/12 9

10. QIPP Plans 2010-15: Summaryof new schemes by theme  10

11. QIPP Plans 2010-15: Total Savings  11

12. Impact of QIPP initiatives on annual gap at 2014/15 (graph)  12

13. QIPP provider analysissummary of cumulative impact 13

14. Provider analysis � acute expenditure budgets2010/11 to 2011/12 14

15. QIPP provider analysisannual impact 15

16. SEL Strategic commissioning intentions � QIPP Reforming urgent care Reforming Planned Care Reforming primary care Specialist services � cancer, cardiac and stroke Reforming maternity services Mental health Staying healthy End of life services

17. Urgent Care

18. Planned Care Our model for planned care will deliver care closer to home for minor procedures, diagnostic, regular attendees and outpatients whilst concentrating complex care in specialist units.

19. Primary Care

20. Cancer and Cardiac vascular services

21. Mental Health

22. Maternity

23. Staying Healthy

24. End of Life

25. QIPP Risk AssessmentSummary - update 25

26. QIPP Closing the Gap The results of the Cluster challenge process was as follows: Very mixed in terms of planning processes and A lack of mature implementation plans in some cases There was a need to inject capacity at BSU level A need to engage more with providers A need to clarify responsibilities for delivery of QIPP schemes at BSU and Cluster level. The following steps are being taken to close the QIPP gap: Locally: Revisit Green rated schemes to see if stretch targets could be achieved Revisit Amber and Red Schemes to establish reason behind the rating and use local 2% to assist in delivery Review 2012/13 schemes to identify potential for bringing forward into 2011/12 Review LES schemes Significant work with GP Commissioners re decommissioning and demand management delivery to secure �buy-in� Develop further plan B schemes by end of May 2011. Cluster: Develop acceleration of estate and running costs rationalisation to deliver an average Commissioner running cost of �55 per head which will produce a c�15m reduction in 2011/12 Ensure Cluster projects have capacity to deliver and consider means of early delivery Develop further Plan B schemes by end of May 2011 26