NHS England has already overspent by £225 million on services it directly commissions for this financial year, papers for its next board meeting have revealed.
The figures, presented in the NHS England performance report to be discussed on Tuesday, also shows that CCGs are on course for an overspend of just £15.6m on all their functions.
Clinical commissioning leaders said NHS England had ‘questions to answer’ about its overspend on the direct commissioning, which includes spending on primary care, specialised commissioning, public health, and secondary and community dental care.
The board paper said one of the ‘key themes’ in the financial year to date was the ‘overspends in specialised commissioning – £225m (or 3.1%) in year to date, and £214m (or 1.6%) in the full year’.
It added that the improvement in the full-year forecast was ‘driven almost entirely by the application of central reserves in the second half of the year. Unaffordable growth in activity remains the key driver’.
NHS Clinical Commissioners president Dr Michael Dixon said CCGs had done ‘remarkably well’ in in their financial management, but that NHS England had ‘questions to answer’ about its performance.
Dr Dixon, a GP in Collumpton, Devon, said: ‘NHS England has been breathing down the necks of CCGs to appraise them, but CCGs have not been able to appraise NHS England. Is it that NHS England commissioners are not being especially careful about what they are commissioning or not checking bills and getting value for money? In some ways CCGs should be holding NHS England to task.’
Dr Dixon added: ‘The fundamental problem is that in our system CCGs pay hospitals according to activity rather than outcomes, so the hospitals don’t necessarily hold back on activities. Some acute trusts have been playing hardball on this, which inflates the amount CCGs have to pay. The overspends are linked to a fundamental flaw in the system, rather than a lack of good financial management by CCGs.’
The NHS England board meeting papers state: ‘In aggregate the CCG financial position is on track, though individual financial health varies significantly. Forty-eight CCGs are forecasting a higher surplus than planned, and 141 CCGs are forecasting to deliver a surplus of 1% or more.’