Exclusive GPs who have taken over budgets from PCTs under the Government's NHS reforms are sliding millions into the red, according to financial assessments that lay bare the scale of the challenge facing clinical commissioning groups.
A Pulse investigation into CCG budgetary control across 55 PCTs raises questions over their capacity to constrain costs and deliver planned savings, with two-thirds of those reporting figures currently missing their financial targets.
GP commissioning leaders warned the deteriorating financial situation might force them to toughen up restrictions on referrals from practices, despite new figures showing GP referrals fell by 4% last quarter compared with a year ago.
Overall, 29% of PCTs are currently behind budget for 2011/12, with just 9% forecasting they will not meet their financial targets by April 2012.
But among 29 CCGs able to provide figures, 66% were behind budget, while four of the 20 making end-of-year forecasts said they would still be in deficit at the end of the financial year even after bringing in tough measures to catch up.
The CCG analysis included overall financial figures from NHS Cumbria, NHS Northamptonshire and NHS Cambridgeshire, where all or most budgets are already in GPs' hands. Among the worst hit areas is NHS West Sussex, where the PCT is £15m behind budget and its two CCGs £9.1m and £13.6m behind due to an overspend on acute care. The PCT said it would only meet end-of-year targets by finding a further £26m in savings, and has appointed a turnaround director.
Elsewhere, NHS Barking and Dagenham is £2m behind budget overall, with its component CCGs behind by £2.5m, £1.4m and £106,000 respectively.
GPs in commissioning hotspots NHS Cumbria and Bexley Care Trust are £714,000 and £2.2m behind target respectively due to acute over-activity. Both said they expected to meet targets by the end of the year, with Cumbria initiating a CCG-led recovery plan involving ‘a number of remedial financial measures'.
Other flagship CCGs have had more success. In NHS Northamptonshire, where Nene Commissioning has full budgetary responsibility in shadow form, the trust is currently £4.1m ahead of budget and forecasting being £7m ahead by the end of 2011/12. Bassetlaw CCG and Dudley CCG are also ahead by £325,000 and £471,000 respectively. But overall the 29 CCGs with figures are facing a net shortfall of £28m – an average of £967,000 each. Click here to find out how CCGs are faring in your area.
Dr Peter Weaving, joint chair of NHS Cumbria's clinical senate and a GP in Brampton, said the CCG had faced an ‘extreme financial challenge' and was improving the budgetary balance: ‘We don't have a referral centre but we expect individual clinicians to take responsibility and follow local guidelines, and we've got a whole shedload of things we're implementing to reduce the call on unscheduled care.'
Dr Amit Bhargava, chair of North West Sussex Commissioning Association CCG, said: ‘There will be increased pressure on CCGs to enforce more pressure. We need to create demand-led savings to ensure the need for services reduces.'
But Dr Chaand Nagpaul, GPC negotiator, said the Government's focus should be on reforming the ‘perverse' payment system which encouraged overactivity: ‘Costs are generated through modifications in coding and re-referrals.'
The Department of Health said: ‘We do not think this represents a realistic picture. The DH is ensuring organisations in deficit have recovery plans.'
