1. 1 REPORT OF:Joanne Newton DATE OF PAPER:26 June 2013 SUBJECT:Financial Position at 31 st May 2013 IN CASE OF QUERY, PLEASE CONTACTJoanne Newton Joanne Downs PURPOSE OF PAPER: This paper provides an update to the North Manchester CCG Board on the financial position for the first two months of 2013-14.

2. 2 Contents 1.Financial Performance 2.Contract Performance 3.QIPP 4.Running Costs 5.Reserves 6.Risks 7.Conclusion and Recommendations

3. 3 1Financial Performance Annual Budget £'000 YTD Budget £'000 YTD Expenditure £'000 YTD Variance £'000 Forecast outturn £'000 Forecast Variance £'000 Acute Services Acute - NHS£122,501£20,417£20,415-£2£122,501£0 Acute - Private Providers£5,040£840£841£1£5,040£0 Acute - NCA£1,050£175 £0£1,050£0 Total Acute Services£128,592£21,432£21,431-£1£128,592£0 Mental Health Mental Health - NHS & non NHS£33,751£5,625 £0£33,751£0 Mental Health - NCA£2,092£349 £0£2,092£0 LD£2,292£382 £0£2,292£0 Total Mental Health£38,135£6,356 £0£38,135£0 Prescribing£32,190£5,365£5,373£8£32,190£0 Community£22,523£3,754£3,793£39£22,523£0 Primary Care£2,759£459£512£52£2,759£0 CHC / FNC£10,317£1,719 £0£10,317£0 Other Programme£2,844£474£472-£2£2,844£0 NHS Property Services Recharge£970£162 £0£970£0 Total Other CCG Programme£71,602£11,934£12,032£97£71,602£0 Programme Overheads£1,026£171£167-£4£1,026£0 Administration Overheads£4,469£745£728-£17£4,469£0 Total Overheads£5,495£916£895-£21£5,495£0 Planned Surplus£1,258£210£0-£210£0-£1,258 Reserves£17,295£2,883£2,806-£77£17,295£0 CCG Total£262,377£43,730£43,520-£212£261,118-£1,258

4. 4 1Financial Performance North Manchester CCG is set to achieve its forecast surplus of £1.3m for the year and meet the requirement to deliver recurrent balance. The year to date (YTD) position at Month 2 is showing an underspend of £212k, further detail is provided on the summary table on page 3. There are minimal variances due to the fact that only April information has been received from Acute Trusts and Prescribing data for April had not been received when this financial position was compiled.

5. 5 2 NHS acute contracts

6. 6 Contract assumptions are based on April 2013 data only. Due to this and the issues that acute providers are working through with regards to assigning the correct new commissioner codes to episodes of care, all contracts are forecast to break even at year end. This will remain the case until the accuracy of the data can be relied upon and there is sufficient data from which to build a robust forecast. Pennine Acute NHST Contract The Pennine Acute financial performance is break even based on the April data received. The key variances are: Planned admissions £114k under performance – April was anticipated to be a low month for planned admissions due to the Easter break and actual activity has been lower than anticipated. High Cost Drugs £78k over performance – High Cost Drugs is an area of huge change in terms of responsible commissioners. The provider will undertake a review of the appropriateness of the charges and therefore this over performance is likely to reduce significantly. Central Manchester FT Contract Central Manchester FT is under performing against plan by £234k based on the April 2013 data received. The key variances based on month one include: Planned admissions £124k under performance – As noted with the Pennine Acute section above, April was anticipated to be a low month but has been lower still. Critical Care & Rehab £121k under performance – These are episodes of care paid for on discharge and lower overall utilisation of this trust by the CCG may be linked to this under performance. Outpatient follow up attendances £59k over performance – The specialties with the largest over performance are Ophthalmology, Trauma and Orthopaedics and Nephrology with over performance of £16k, £14k and £11k respectively.

7. 7 2NHS acute contracts Salford Royal FT Contract Salford Royal FT is under performing YTD by £17k based on the April data received. The only ‘point of delivery’ with any significant variance is excluded drugs and devices, £15k, but as noted within the Pennine Acute section this could be subject to change due to the complexity of applying the correct commissioner. Other Contracts Other contracts includes other NHS trusts with smaller value contracts, such as NWAS Emergency Ambulances and non NHS acute contracts. Based on the information received in April 2013, there are no significant under or over spends against these contracts to date.

8. 8 3QIPP Savings Summary Analysis Category 2013-14 Forecast savings (May 2013 ) £'000 % of total 2013-14 Forecast savings (30 June 2013) £'000 % of total 2014-15 Forecast savings (30 June 2013) £'000 % of total Urgent Care00.0%0 53045.0% Planned Care3527.3%1172.5%38032.3% Prescribing2,49051.9%2,55455.2%26622.6% Acute services1,43229.8%1,43230.9%00.0% Citywide52510.9%52511.3%00.0% Total4,799100.0%4,628100.0%1,176100.0% Target5,149 (Under) / over delivery-350-521 Delivery confidence RAG Rating Risk: 2013-14 forecast savings (May 2013) £'000 % of total Risk: 2013-14 forecast savings (June 2013) £'000 % of total Risk: 2014-15 forecast savings (June 2013) £'000 % of total Red77516.1%60513.1%84471.8% Amber54711.4%54811.8%20717.6% Green3,47772.5%3,47575.1%12410.6% Total4,799100.0%4,628100.0%1,175100.0%

9. 9 3QIPP Summary The CCG’s 2013/14 QIPP target is £5,149k, or 2% of recurrent allocations. At present, the CCG has QIPP plans valued at £5,804k, of which £4,628k is forecast to deliver in 2013/14 and £1,176k in 2014/15. Of the 2013/14 savings, £3,475k (75.1%) is rated ‘green’. The remaining £1,153k mostly reflects prescribing initiatives (largely ‘amber’ rated) and city wide schemes (all ‘red’ rated). The CCG has further QIPP plans of £1,176k that are forecast to be realised in 2014/15. £844k of these are presently rated ‘red’ as schemes need to be developed further. Due to the nature of some acute contracts in 2013/14, QIPP plan savings cannot be released in year. Where this is the case, the emphasis is on developing plans sufficiently to ensure these are realised in 2014/15.

10. 10 4Running Costs On the basis of the above, the CCG is forecast to deliver its target of £25 per head for 2013-14. Annual Budget £'000 YTD budget £'000 YTD Spend £'000 YTD Variance £'000 Forecast £'000 Forecast Variance £'000 ADMINISTRATION & BUSINESS SUPPORT£133£22£38£16£133£0 BUSINESS INFORMATICS£63£11 £0£63£0 CEO/ BOARD OFFICE£224£37£41£4£224£0 CHAIR AND NON EXECS£213£35£10-£26£213£0 COMMISSIONING£457£76£65-£11£457£0 COMMUNICATIONS & PR£148£25 £0£148£0 CONTRACT MANAGEMENT£924£155£154-£0£924£0 CORPORATE COSTS & SERVICES£341£57 £0£341£0 CORPORATE GOVERNANCE£115£19 £0£115£0 EQUALITY AND DIVERSITY£26£4 £0£26£0 ESTATES AND FACILITIES£345£58 £0£345£0 FINANCE£540£90 £0£540£0 HUMAN RESOURCES£68£11 £0£68£0 IM&T£439£73 £0£439£0 IM&T PROJECTS£0 PATIENT AND PUBLIC INVOLVEMENT£56£9 £0£56£0 PROCUREMENT£83£14 £0£83£0 RECHARGES£0-£0£0 MEDICINES MANAGEMENT£65£11 £0£65£0 GENERAL RESERVE£23£4£0 £23£0 ADMIN PROJECTS£178£30 £0£178£0 Total included in £25 per head£4,440£741£720-£16£4,440£0 REFERALL GATEWAY£469£78 £0£469£0 CLINICAL CONTRACT MANAGEMENT£117£19 £0£117£0 MEDICINES MANAGEMENT CLINICAL£261£43£40-£3£261£0 SAFEGUARDING£234£39 £0£234£0 Total not included in £25 per head£1,081£180£176-£3£1,081£0 Total£5,521£921£896-£19£5,521£0

11. 11 5Reserves The CCG’s reserves assume budget commitments in respect of national financial planning requirements, including, 2% non-recurrent expenditure and a 0.5% contingency. Commissioning reserves include specific amounts for known and planned commitments and developments in 2013/14. Annual Budget £'000 YTD budget £'000 YTD Spend £'000 YTD Variance £'000 Forecast £'000 Forecast Variance £'000 COMMISSIONING RESERVE£12,241£2,040£1,967-£73£12,241£0 NON RECURRENT RESERVE£5,031£839 £0£5,031£0 GENERAL RESERVE£23£4£0-£4£23£0 Total Reserves£17,295£2,882£2,806-£77£17,295£0

12. 12 6Risks The main risk facing the CCG in 2013/14 is in respect of potential allocation adjustments relating to the specialist services migration to the National Commissioning Board from 1 April 2013. Work in ongoing with the Area Team to understand this risk and resolve potential allocation pressures.

13. 13 7Conclusion and recommendations The Board is asked to note the contents of the report. The CCG is forecasting that it will achieve its financial duties by 31 March 2014.