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NHS England makes savings in primary care despite huge overspend overall



NHS England made a surplus of £30m more than planned for primary care commissioning, despite an overspend of £347m in its total commissioning budget, its end of year finance reports show.

The board paper reveals that NHS England had planned to end 2013/14 with a £98.3m surplus in primary care commissioning, but ended up with a surplus of £128.2m.

Overall, however, it spent a total of £27.42bn on direct commissioning services – which includes specialised commissioning services along with primary care services – compared with a planned budget of £27.08bn.

GP commissioning leaders said it was ‘worrying’ that so much money being spent on specialist commissioning.

The paper revealed that CCGs had a £97m surplus on their first anniversary, and just 19 CCGs ended the year in deficit – five fewer than predicted at the start of 2014, but seven more than forecast deficits before the start of the financial year.

The report also shows CCGs failed to meet the £2.01bn savings target for the year through the Quality, Innovation, Productivity and Prevention (QIPP) programme, only making 85% (£1.7bn) of the target.

The report states that ‘transformational’ schemes accounted for £235m of the QIPP shortfall and that it would require ‘significant focus’ by CCGs in future, which comes after a group of influential MPs warned in February that the QIPP may not be sustainable and criticised the ‘fragmented’ nature of commissioning.

The report concludes that financial delivery was ‘strong’ overall but that funding would be tighter in future, as year one included ‘a number of mitigations that were either planned or that arose in year that will not recur in future years.’

These include historical surpluses and a non-recurrent budget to fund the changes brought in by the Health and Social Care Act.

It states: ‘We face a challenging financial environment in 2014/15 and beyond, and this will be made significantly more acute in 2015/16 when £1.9bn additional investment is made from CCG allocations into the Better Care Fund.’

Dr Charles Alessi, chair of the National Association of Primary Care, told Pulse: ‘Clearly we need to look very, very carefully at how we expend our resources, in the NHS and certainly in the out of hospital sector. As I said, if anything we’ll need to increase the percentage [funding allocation], not decrease.’

‘We are aware that there’s a significant overspend in specialist commissioning, which is very well know, and if that means there is even more money going towards specialist care and the hospital sector it’s worrying.’

He added: ‘There is enough to spend the money on in primary care. If we’re going to spend this resource, we need to be very careful with how we spend it. We need to spend it intelligently.’