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CCGs face cutting services to plug sudden million-pound gaps in budgets

Exclusive CCG leaders are facing multi-million-pound shortfalls as specialised commissioning and social care take huge bites out of their budgets, putting their plans to improve patient care into doubt.

CCG leaders have said that their allocations have been reduced by up to £4m at a stroke, after funding was removed to cover specialist commissioning at hospitals and health and wellbeing boards ringfence funding for social care.

They told Pulse that money saved for non-recurrent spending in 2013/14 was being used to plug sudden gaps in funding, and the uncertainty could lead to plans to improve local services - such as end-of-life care and better integration of services - being abandoned.

The National Audit Office said earlier this month that the data supplied by PCTs regarding funding was inadequate, meaning CCG budgets did not necessarily reflect their spending, and budget allocations were not finalised until July in some cases.

CCGs are not responsible for the commissioning of specialised services, such as treatment for less common cancers and care for people with rare conditions.

But Dr Amanda Doyle, NHS Clinical Commissioners’ leadership group co-chair and chief clinical officer of Blackpool CCG, said budgets allocated to specialist commissioners have led to ‘wide discrepancies’ with many CCGs facing large shortfalls as a result.

‘In Blackpool, the process has meant that, with regard to our contract with Lancashire Teaching Hospitals for example, our allocation was reduced by approx. £5m to account for changes to specialist services definitions, but the contract value only reduced by about £900k, leaving us with more than £4m gap.

‘Overall, in Blackpool, this issue has left us with a more than £7m shortfall- and in the CCG with the worst life expectancy in the country this is funding that is desperately needed to address health inequalities.’

Dr Doyle said that CCGs all over the country are having to modify their plans drastically. She added: ‘There are discussions going on to try to rectify this. But in Blackpool, the shortfall will mean that the CCG´s plans for end-of-life care might be unable to go ahead. In addition, it will soak up the whole of our 2% non-recurrent allocation for the year which was to have been spent on pump-priming plans for integrated care.’

The National Audit Office said earlier this month that the data supplied by PCTs regarding funding was inadequate, meaning CCG budgets did not necessarily reflect their spending, and budget allocations were not finalised until July in some cases.

Dr Clare Highton, chair of NHS City and Hackney CCG, said her budget was suddenly reduced by £9m for specialist commissioning and £10m to fund social care by the health and wellbeing board.

She added: ‘There are still quite a few queries around where money went when the contract was novated. The biggest is the specialist commissioners’ money, although we may get this back depending on contract flows.’

Dr Elizabeth Johnston, chair of South Reading CCG, said: ‘The unpredictability is quite tricky to negotiate. A cold snap or a rise in influenza could change things.

‘It’s tight. And my concern is that we’re already 30% down on PCT running costs and there’s going to be a further reduction of 10% next year. The danger is that we’re forced just to concentrate our efforts on the acute stuff.’

A spokesperson for NHS England said: ‘The move from PCT contracts with providers into CCG and specialised commissioning activities has been particularly complex, and the estimated split which formed the basis of allocations issued in December 2012 has been under significant review and refinement since then.

‘We continue to work closely with providers using a set of defined “identification rules” to confirm and challenge the baseline budgets.’

Readers' comments (12)

  • To my dear colleagues who jumped at the chance to get involved in commissioning....Nah Nah Ne Nah Nah.

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  • I'm getting a Lord of the Rings flashback....Dark Lord LansleyHunt creates CCGs and gives them to mortal men, but it's the illusion of power and brings them all under his control. Either way CCGs aren't really in charge and we're all headed to Mount Doom.

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  • Another way to look at it is that these CCG GPs have found a nice cushy number.It get's them out of the surgery seeing patients and they're well compensated for it.

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  • Bollocks!
    The partners of CCG members are complaining because the "well compensated" remuneration does not cover the cost of a locum to do the clinical work, let alone ther managerial and admin work.
    I know of one practice recently who are suggesting that the lead GP does it in his own time because it is simply not cost effective.

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  • Cutting service to plug million- pound gaps in budgets is not the answer. Start by challenging the errors in secondary care which according to the Audit Commission is £2.25 billion pa across all CCGs. In the case of Blackpool, assuming 50% of its overall budget is for secondary care, this equates to £111,462,000. If the error rate of 8.35% is the same as we identified in one CCG this represents £9,307.077 which the CCG can retain for the benefit of patients.

    Isn't it time to correct this major anomaly in the use of NHS budgets?

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  • and this is why the training budget for practice nurses in out local CCG has been slashed and the (excellently evaluated) programme that would ensure nurses can provide the right care at the right time to the right patients has been dropped. this can only adversely affect patient outcomes and practice incomes.
    Shameful

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  • When will penny drop that being a coal-face clinician and a budget manager are incompatible? The sooner medical CCG members return to their practices, and concentrate on individual patient needs, the better.

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  • I trained to be a doctor and while a little management is OK, I really cannot do what managers do as a full time job. This whole NHS is so bad now, I feel we should do what dentists did and just leave and take our chances in the the big bad world of private provision, much as I hate the idea; I hate this pen pushing rubbish even more.

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  • The blurred, rushed, excitable and naive handover from PCT to CCG was a wonderful time to lose some budget: plausible deniability! Sir Humphrey must be giggling right now. I applied to join our CCG and a good friend (not a medic) who has local senior NHS experience rang me to say "don't do it, as it's set to fail". Thanks for the tip-off. How right. was he! We were keen but have no meaningful engagement with our CCG, and have no say in the decisions it imposes: same old faces (incl a couple of svelte local GPs) who screwed us when they all worked for the PCT last time around!.

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  • I think most GP's who work in CCG's do so with genuine intent; it doesn't mean its working well though. Many of them are trying to make a bad system work for patients, regardless of whatever dogmatic nonsense the 2 main parties have been throwing the NHS 's way over the last 15 yrs.

    It was set up to fail, however the average member of the public is aware where the buck falls - with the politicians and we shouldn't forget that.

    The scary thing is that the labour party plans are even more crazy. The reality is we are heading for privatisation, which I think will be of detriment to our patients.

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