The financial challenge to Hertfordshire health services
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The financial challenge to Hertfordshire health services Alan Pond Director of Finance NHS Hertfordshire Interim Chief Executive Herts Valley CCG. Commissioning for Patients – future funding flows. Groups of GP practices will commission most local NHS services

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The financial challenge to Hertfordshire health servicesAlan PondDirector of Finance NHS HertfordshireInterim Chief Executive Herts Valley CCG

Commissioning for patients future funding flows

Commissioning for Patients – future funding flows

Groups of GP practices will commission most local NHS services

Two Shadow Clinical Commissioning Groups (CCGs) in Hertfordshire

Herts Valleys CCG

East & North Herts CCG

The new national NHS Commissioning Board will commission GP, dentistry, pharmacy and ophthalmic services, specialised services and prison health services

Commissioning for patients

Commissioning for Patients

Clinical Commissioning Groups

Will be statutory bodies with own senior staff

All practices must be part of a CCG

NHS Commissioning Board will support by developing commissioning guidelines, model contracts and tariffs

CCGs will be able to employ staff directly or buy in services from external organisations

CCGs can decide which aspects of commissioning activity they undertake themselves and which aspects they share

Hertfordshire Integrated Commissioning Support Service being developed to support CCGs

Commissioning for patients1

Commissioning for Patients


The NHS Commissioning Board will initially calculate practice-level budgets from the current PCT budgets and allocate these resources directly to CCGs

New weighted capitation formula will provide target allocations for each CCG

Pace of change policy will drive how quickly funding is moved to get CCGs to their target

Commissioning budget will be separate from surgery income

CCGs will receive a maximum management allowance to directly employ staff or buy in services. Indicative amount is £25 per head

Details on how any over/underspends will be managed is yet to be agreed with the DH and the Treasury

Commissioning for patients2

Commissioning for Patients

Proposed implementation timetable

In 2012/13

CCGs formal committees of NHS Hertfordshire Board

Formal establishment of CCGs and NHS Commissioning Board

Approvals process for CCGs in phased approach

CCGs receive indicative budgets and must prepare commissioning plans

In 2013/14

CCG statutory bodies and where authorised will receive funding allocation and holdcontracts

Transparency in outcomes

NHS targets focus on measuring outcomes

New outcomes framework for 2012/13 created

Framework to be structured around five areas:

Preventing people from dying prematurely

Enhancing the quality of life for people with long-term conditions

Helping people to recover from episodes of ill health or following injury

Ensuring people have a positive experience of care

Treating and caring for people in a safe environment and protecting them from avoidable harm

Transparency in outcomes

There are over 500 performance indicators which the PCT is responsible for reporting on (by provider and by CCG/PCT)

Transparency in outcomes 2

NHS Operating Framework – Key Priorities

Dementia and care of older people


Military and Veterans Health

Health visitors and family nurse partnerships

SHA Ambitions

Eliminate pressure ulcers

Every patient contact counts

Quality/Safety in Primary Care

Strengthened NHS/Local Government partnerships

Improve patient experience

Transparency in outcomes 2

Qipp financial context
QIPP – Financial Context

White Paper sets out £20bn efficiencies over next 4 years

Links to Operating Plan, Framework & Outcome Framework

Size of QIPP Challenge £276m

Projected Funding

Projected Expenditure

Without QIPP

Financial picture 2012 13

Hertfordshire system in balance at 31st March 2012

Managed to deliver circa £100m efficiencies in 2011/12 across Hertfordshire

Funding used non-recurrently to drive change and deliver efficiencies

PCT funding for 2012/13 £1.76bn

Significant challenge across the system in 2012/13 to 2014/15 and beyond…

Financial Picture – 2012/13

Financial picture 2012 131
Financial Picture – 2012/13

Illustration of how the PCT income is spent (2010/11)

Maintaining performance

Managing Change

Set out the vision – DQHH puts Hertfordshire ahead of other areas

Created early momentum, delivered first year of QIPP

Minimise fear to avoid distraction

Prioritise performance areas to concentrate on

Dedicated resource for transition

Talent management

Maintaining Performance