NHS Erewash Clinical Commissioning Group

1. NHS Erewash Clinical Commissioning Group Board report October 2011 – Finance Charlotte Allen-Neale senior finance officer BETTER CARE BETTER HEALTH BETTER VALUE www.nhserewash.com Chair: Dr Avi Bhatia Chief Operating Officer: Rakesh Marwaha

2. Current Financial Position As previously stated NHS Erewash CCG is one of the five CCG’s that make up the Cluster PCT Financial Position. The Cluster PCT must achieve a breakeven financial position over the next two years to meet its, and our, statutory obligations. The PCT Cluster remains on target to achieve financial balance at M6 and is utilising the PCT’s non-recurrent Risk Reserve in order to balance the PCT’s Financial position in light of the emerging overspend positions in Secondary Care and Prescribing. NHS Erewash CCG’s Financial Position is attached using M5 activity information from the CUBE. This shows that the CCG is currently under-spending by £1,013k (Prescribing and Acute). As previously stated although this provides a useful snapshot, the CCG needs to look at the projected forecast outturn using the contract information to date. Shown below are the key secondary care contracts and prescribing forecast outturn for the CCG. This shows an overspend of £1m, which will be managed by use of the PCT’s Risk Reserve.

3. CUBE position Practices are able to view M5 actuals against practice level budgets on the CUBE. The CUBE position at M5 shows that inpatients are £1,017k underspent, which is £351k more underspent compared to M4 data whilst the position on outpatients is £161k worse at £97k overspent at M5. The trend in inpatients is following the underspend experienced in outpatient firsts a few months ago. As the outpatient firsts position worsens, this activity will be seen in electives in a few months time. Non Elective The year to date position is showing as £209k under-spent at month 5 with the main under spending specialities being General Medicine, Trauma and Orthopaedics and Urology this is mirrored by the current underperformance at NUH. Within the under spend there are a small number of specialities that are overspending; Cardiology, Clinical Oncology and Gynaecology again this is mirroring the current position in the Nottingham University Hospitals contract. Similarly Derby FT is underspent on day cases and electives - as consultants have left. In order to meet 18 weeks activity is to be transferred to Barlborough, Nottingham ISTC and The Nuffied and so this activity will catch up. Non elective non – emergency The month 5 position is showing an under-spend of £291k. General Medicine is the main area that is under-spending currently; this is most likely due to a reduction in the number of stays in community hospitals; however this could well change in future months where there is an expected increase due to the winter pressures. Obstetrics activity continues to overspend within this POD which is in line with the rest of the county . Non Elective short stay An under-spend is being seen with the main specialities being General Medicine and General Surgery again reflecting the current under-spend seen at NUH..

4. Running Costs NHS Erewash CCG is working with colleagues across the CCGs t establish a baseline for running costs. The running costs across the PCT Cluster is at £22.50 (not including CCG & PBC monies) NHS Erewash is making early use of the DH Running Cost Ready Reckoner, in conjunction with analysis of non-pay commitments that will be passed from the PCT, whilst acknowledging that staff are still moving between CCG’s and responsibilities are not yet finalised. The CCG recognises that there is not a nationally agreed figure for running costs. Discussions are ongoing with the Cluster PCT / other CCG’s / business stakeholders regarding risk sharing arrangements and collaborative working with our providers on large contracts and common services.

5. 2013/14 and beyond – update In 2013/14, CCGs becomes a Statutory Bodies that ‘stand alone’. Operating Framework – 24th November 2011. Allocations for CCG’s will form part of the Operating Framework. Although the funding of CCG’s is not clear, recent data collections to inform allocations have gathered historic spend. Therefore it is anticipated that allocations will be based on historic spend with a movement to target fair share funding over time. Achievement of financial balance and QIPP priorities will cement the financial standing of NHS Erewash CCG.