bracknell forest pct board 26 july 2006 subject: financial...

FinancialRecoveryReport0.doc

Bracknell Forest PCT Board 26 July 2006

SUBJECT: Financial Position to 30th June

AUTHOR: Dawn Hines for the East-wide section (Section A) plus the Bracknell Forest PCT element of Section B. Directors of Finance for Slough and WAM for their respective local reports at Section B.

SUMMARY: The format of the attached financial report has been agreed by the Joint East PCTs Forum. The paper presents details of the financial position of the three East PCTs, together with an initial assessment of possible year-end positions. The combined financial position of the East PCTs as at 30th June is an overspend of £0.9m. This is after implementation of the Savings Programme of £8m. In order to reach break-even by the end of the financial year it is currently forecast that an extension of £1.6m to the Savings Programme is required. It is also recommended that a further £0.5m of savings be worked up in outline but not yet implemented. There is a strong management focus on delivering the necessary Savings Programmes and external assistance is being provided to help with this process. Performance of all budgets, net of the Savings Programme, will be closely monitored and any further action initiated, as necessary, in order to achieve a break-even position at the end of the financial year.

KEY MILESTONES / SUCCESS CRITERIA

Directors continue to manage towards a break-even position at the financial year-end, as measured across the three East PCTs.

CONCLUSIONS / RECOMMENDATION: Delivery of the Savings Plan continues to be a major issue for the Board. The scope of the Plan will need to remain flexible to take account of the net forecast over and under spend on budgets being handled by managers. The Board is asked to note the current position and to be assured that the delivery of a financial break-even position across the three East PCTs is a high priority for Directors and that the financial position is under constant review.


SUPPORTING PAPERS / ANNEXES: Narrative and Tables attached

ACTIONS REQUIRED: Agree / Approve / Note / Discuss

To note, discuss the need for an additional Savings Programme, and approve as appropriate.

COMMUNICATIONS: PLEASE DELETE AS APPROPRIATE

Report available to:

Membership party

� Internal Only

External �

F.O.I. Exemption:

Yes No �

June 06 v3


Financial position for the three months April to June 2006

Background This report is presented in the new format agreed at the Joint PCT meetings. It is intended to inform each of the three East Berkshire PCT Boards of the total East-wide financial position. This should help ease the move forward into one Berkshire (East) PCT from 1st October. During the course of preparing this information it has become clear that some aspects regarding process and presentation will lend themselves to improvement and this will be worked on prior to the next formal report to Boards. This particularly affects the non-commissioning budgets. Section A of this paper presents a summary of the financial position across the three East PCTs and is applicable to all three Boards. Section B shows the financial position of each PCTs locally managed budgets and directly provided services, together with a financial commentary from each PCTs Director of Finance or Acting Director of Finance. A, East PCTs combined position Summary At the end of the three months to 30th June 2006 the combined financial position of the three East PCTs showed an overspend of approximately £0.9m. This is measured against budgets that reflect a full quarter’s impact of the majority of reductions stemming from the Savings Programme. It is very early in the year to make reliable forecasts of the year-end position and, therefore, there is a wide range of possible outcomes as currently assessed. The ‘worse case’ is not a forecast position for the economy as a whole but is shown in order to demonstrate the risks that do exist – not that they are all forecast to occur. This ‘worse case’ position reflects the potential £8m risk of which Boards are already. A key risk continues to be that of delivering the Savings Programme. The risk within that is the possible lack of management resource, leading to inadequate priority being given to the Programme. The summary table overleaf indicates that, based on the current forecasts and known risks, the Board should be planning to identify a further £1.6m of savings – beyond the original £8m programme - in order to reach break-even at the year end. It is also recommended that a further £0.5m savings programme should be worked up in outline but not implemented at this stage. For clarification the Savings Programme situation is now as follows:

£m

Initial Savings Programme 8.0

Less already deducted from budgets at the Initial LDP stage (1.3)

Not deducted from budgets at the Initial LDP stage 6.7

Further deductions made from budgets (5.1)

Savings Schemes identified but not yet deducted from budgets 1.6

Further Savings schemes required to be implemented to achieve break-even 1.6

Recommended further schemes to be identified but not yet implemented 0.5

Total of additional savings schemes currently forecast as required 2.1


A review of the Development Programme has identified that some £800k is unlikely to be required this financial year. These resources will be retained within the economy and have already been used to minimise the need for an increased Savings Programme, as above. The table below gives a summary of the position across the East health economy and further details are provided at Tables 1, 2 and 3(a) to 3(c).

Summary of the East PCTs financial position Relative to Revenue Resource Limits (RRLs) as at 30th June

WAMBracknell

ForestSlough Total

Best

case

Most

likely

Worse

case£'000 £'000 £'000 £'000 £'000 £'001 £'000

Commissioning

Berks Providers (123) (148) (107) (378) (334) (1,514) (2,340)

Non-Berks Providers (130) (26) (93) (249) (997) (994) (2,669)

Other Commissioning budgets 37 25 40 102 409 409 (1,573)

Sub total Commissioning (216) (149) (160) (525) (921) (2,099) (6,581)

Specific Grants (280) 429 (241) (92) 158 (369) (1,717)

Primary care budgets (15) (103) (265) (383) 550 0 (1,050)

PCT Directly Provided services

East SLAs 0 0 0 0 0 0 0

Local (over) / under spend v income 198 117 (22) 293 30 0 (150)

Sub total PCT Provided Services 198 117 (22) 293 30 0 (150)

Other PCT budgets 0 4 0 4 660 0 (725)

PCT Corporate Costs 19 (16) 28 31 166 0 (100)

Development Reserves 81 52 72 205 821 821 821

(not yet allocated to budgets)

Savings Plans (272) (104) (44) (420) 0 1,647 1,647

(not yet allocated to budgets)

Totals (485) 231 (631) (886) 1,464 (0) (7,856)

(Over) under spend

Budget category

Year to date variance Forecast year-end variance

(Over) under spend


A commentary on key aspects of the financial position is given below: Details of financial position (Table 1) Resource movements Any virement between budgets is visible by comparing the ‘Initial budget’ and ‘Current budget’ columns shown at Table 1 All budgets are net of Savings Plans where they have been identified and agreed, and performance is being monitored against those reduced budgets. Commissioning The overriding issue is that of delivering the Savings Plan without significant reduction in service levels or access times and whilst continuing to move towards national targets. Key points for attention are as follows: a) The East Commissioning Team has held discussions regarding the level of

activity and related financial costs with all providers with whom the PCTs hold a Service Level Agreement (SLA) and the majority of SLAs have been agreed. Not all of the SLAs have been signed but those that have been signed represent some 75% of the contracts, in value terms. In Table 1, the value of an SLA has been inserted only where the SLA figure is clear and, in the case of East / West risk-shared SLAs, only where there is a clear division of risk between East and West PCTs. In all other cases the SLA values have been left blank.

b) At present, discussions with the West Commissioning Team regarding budget

splits and risk-shares are still ongoing. c) Until such time as the remaining SLAs are finalised, payments are being made to

providers at last year’s agreed SLA value with the exception of certain SLAs where Provider Trusts have provided a split by PCTs.

d) The West Commissioning Team has agreed the Royal Berkshire Hospitals SLA,

on behalf of the East PCTs, with a value of £13.3m. However, current indications are that activity from the East PCTs is likely to cost only £11.8m. Negotiations are continuing to redress this imbalance.

e) There is a financial risk of approximately £750k with Mount Vernon Hospital

concerning issues around payment for the development costs of Linacs. This is not yet resolved.

f) Thames Valley (TV) SHA has instructed that all non-elective activity within TV be

paid as a block contract based on 2004/05 activity. This is likely to result in the East PCTs paying some £130k more than it would have done under the normal ‘Payment by Result’ rules. This is mainly due to activity in the north of the patch at Buckinghamshire Hospitals.

g) Services for Cancer will be a major risk this financial year with costs continuing to

escalate. SLAs between the PCTs and Royal Marsden, Hammersmith, Royal Surrey, and East & North Hertfordshire all increased primarily due to increased costs associated with cancer.

h) A review of commissioning risk based on the May activity data has indicated a

much more favourable position that for the same period in 2005/06, although there remains a risk that those SLAs not yet agreed may create financial pressure when they are finalised.


Specific Grants Within the LDP, the Continuing Care budget was assembled with the underlying assumption that £2m of additional demand, over last years forecast outturn, could be expected. This assumption continues to represent the most likely scenario although it will require constant review. The Savings Plan includes an intended budget reduction of £500k from the Continuing Care budgets. Until a firm plan of action is agreed this amount has not been deducted from the Continuing Care budget and it remains as an adverse balance on the Savings Programme at 30th June. It is too early to make a robust assessment regarding the degree to which savings measures will be effective and, for the purpose of the ‘most likely’ forecast outturn, it is assumed they will be achieved in their entirety on the Continuing Care budget. This work on savings is being undertaken on an economy wide basis and involves the Unitary Authorities. It is being lead by Daphne Obang at Bracknell Forest Borough Council. For the Learning Disability Services Grant paid to the local unitary authorities in Berkshire, the LDP allowed for the East element of the Grant budget to be rolled forward with an inflationary uplift and a reduction of £250k as part of the Savings Programme. The ability to deliver the Savings Programme is partly reliant upon the extent of any additional client care requirements which will require funding. The division of this Berkshire–wide budget also requires review with the West PCTs, assuming that Disaggregation of this budget does go ahead as planned this financial year. This may bring further risk that is not included in the present assessment. Progress on this will be reported to future Board Meetings. Development Reserve The Development Reserve contains a number of investment areas which have not been allocated to budgets until the development commences. This ensures that the benefit of any delay in implementation is retained within the overall economy. More than £800k of the programme has already been used in this way to contribute towards the overall financial position. Savings Plans still to be deducted from budgets The position of the Savings Programme is summarised on page 1 of this report. The £1.6m currently shown as not deducted from budgets is comprised as follows:

• Continuing Care - £0.5m (to be shared across the three East PCTs) (see earlier paragraph on Specific Grants)

• WAM £1.087m - to be deducted from locally managed budgets Other issues In preparing this information for the first time across all three East PCTs it has become clear that further work is required to obtain a consistent and comparable division of locally managed PCT budgets between ‘directly provided services’ and ‘other PCT budgets’. Also, at the financial year-end, the outturn on the Grants budget is risk-shared whilst in-year reporting is not shown in that way. The presentational arrangements for the Grant budgets – principally Continuing Care and Learning Disabilities Grants to local Unitary Authorities - will be reviewed in future reports to ensure that in-year reporting is consistent with the year-end risk-share treatment.

TABLE 1 Overview of the East PCTs financial position relative to Revenue Resource Limits (RRLs) as at 30th June

Note: The analysis of commissioning budgets and spend across PCTs is based on historic formulae rather than current actual usage


Total Var

Initial

Annual

Budget per

LDP

Current

Annual

Budget

Annual SLA

contracted

agreement

values

East total

(over) /

under

spend to

date

WAM BF Slough WAM BF Slough WAM BF Slough Total

Best

case

Most

likely

Worse

case

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Commissioning budgets

Berkshire Provider Trusts

HWWP 119,613 121,673 121,673 12,657 5,446 12,499 12,643 5,440 12,485 14 6 14 34 135 135 (130)

RBBH 11,835 11,835 0 915 1,249 795 1,005 1,372 873 (90) (123) (78) (291) 0 (1,165) (1,365)

RBAT 7,439 7,439 0 791 445 624 791 445 624 0 0 0 0 15 0 (250)

BHCT 29,877 29,877 0 2,891 1,932 2,646 2,938 1,963 2,689 (47) (31) (43) (121) (484) (484) (595)

BHCT (NEPTS) 325 323 0 32 21 28 32 21 28 0 0 0 0 0 0 0

Total Berks Providers 169,089 171,148 121,673 17,285 9,092 16,593 17,408 9,240 16,700 (123) (148) (107) (378) (334) (1,514) (2,340)

East Commissioning Team (major SLAs)

Frimley 9,898 9,898 0 132 2,337 6 132 2,337 6 0 0 0 0 0 0 (211)

Royal Brompton & Harefield 6,680 5,485 0 653 214 503 653 214 503 0 0 0 0 0 0 0

Hammersmith & Charing Cross 3,415 3,415 0 385 162 307 385 162 307 0 0 0 0 0 0 (266)

Bucks NHST 1,822 1,822 0 424 14 18 453 15 19 (30) (1) (1) (32) (127) (127) (381)

Ashford NHST 3,805 3,689 3,689 862 28 32 862 28 32 0 0 0 0 0 0 (706)

Mount Vernon / East & North Herts 1,081 1,081 0 124 23 123 210 39 208 (86) (16) (85) (188) (750) (750) (943)

Sub total (East major SLAs) 26,701 25,390 3,689 2,580 2,778 989 2,696 2,795 1,076 (116) (17) (86) (219) (877) (877) (2,508)

East Commissioning Team (other SLAs) 8,586 6,650 1,213 705 646 311 719 655 318 (14) (9) (6) (29) (120) (117) (130)

West Commissioning Team (major SLAs)

Oxford Radcliffe 2,392 2,392 0 184 84 330 184 84 330 0 0 0 0 0 0 0

Oxford Mental Health - Littlemore 1,164 1,164 0 124 70 98 124 70 98 0 0 0 0 0 0 0

Nuffield Orthopaedic Hospital 378 378 0 46 26 22 46 26 22 0 0 0 0 0 0 0

Oxfordshire LD 441 441 0 47 26 37 47 26 37 0 0 0 0 0 0 0

University College London 819 819 0 101 68 35 101 68 35 0 0 0 0 0 0 0

Sub total (West major SLAs) 5,193 5,193 0 502 274 522 502 274 522 0 0 0 0 0 0 0

West Commissioning Team (other SLAs) 4,025 3,903 0 340 371 265 340 371 265 0 0 0 0 0 0 (31)

Total Non-Berks Providers 44,506 41,136 4,902 4,127 4,069 2,088 4,257 4,095 2,181 (130) (26) (93) (249) (997) (994) (2,669)

Local Specialist Commissioning Group

Specialist SLAs 0 0 0 0

SLA exclusions & Commissioning Reserves 22,827 20,301 0 2,127 1,230 1,535 2,090 1,205 1,495 37 25 40 102 409 409 (1,573)

Total Commissioning Budgets 236,422 232,585 126,575 23,539 14,391 20,216 23,755 14,540 20,376 (216) (149) (160) (525) (921) (2,099) (6,581)

Actual (year to Date)

Locality actuals

Budget heading

Locality budgets

Budget (year to Date)

East total Forecast variance (East total)

Forecast year-end variance

(over) / under spend, against

budget

Locality variances

Variance year to date (over) /

under spend, against budget

TABLE 1 (Cont’d) Overview of the East PCTs financial position relative to Revenue Resource Limits (RRLs) as at 30th June (Cont’d)

Note: The analysis of commissioning budgets and spend across PCTs is based on historic formulae rather than current actual usage


Total Var

Initial

Annual

Budget per

LDP

Current

Annual

Budget

Annual SLA

contracted

agreement

values

East total

(over) /

under

spend to

date


Best

case

Most

likely

Worse

case

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Specific Grants

Continuing Care 11,069 11,069 978 1,038 752 1,033 1,051 734 (55) (13) 18 (50) 77 (200) (730)

LD Grant 10,598 10,348 642 1,574 371 875 1,137 637 (234) 437 (266) (62) 0 (250) (1,000)

All other Grants 684 855 89 52 72 81 47 66 9 5 7 20 81 81 12

Total Specific Grants 22,351 22,271 0 1,708 2,664 1,195 1,989 2,235 1,437 (280) 429 (241) (92) 158 (369) (1,717)

Non-Commissioning budgets

Primary Care

GMS and PMS 36,141 38,356 4,385 2,285 3,346 4,353 2,319 3,261 32 (34) 85 83 50 0 (550)

Quality & Outcomes Framweork (QUOF) 7,737 7,214 493 327 514 540 299 644 (47) 28 (130) (149) 0 0 0

Out Of Hours (OOH) 1,807 3,065 311 202 253 311 202 253 0 0 0 0 0 0 0

NHS Direct 416 416 22 47 36 22 47 36 0 0 0 0 0 0 0

Prescribing 50,612 48,430 5,668 2,753 3,671 5,668 2,850 3,890 0 (97) (219) (316) 500 0 (500)

Sub total Primary Care 96,714 97,480 0 10,878 5,614 7,819 10,893 5,717 8,084 (15) (103) (265) (383) 550 0 (1,050)

PCT directly provided services

Commissioned from East PCTs 38,695 37,765 3,722 2,127 3,441 3,722 2,127 3,441 0 0 0 0 0 0 0

Adjust for net (over) under spend 0 (530) 0 0 0 198 117 (22) 198 117 (22) 293 30 0 (150)

Sub total PCT Provider services 38,695 37,235 0 3,722 2,127 3,441 3,524 2,010 3,463 198 117 (22) 293 30 0 (150)

Other PCT budgets 20,303 16,703 7,276 2,326 1,755 7,276 2,322 1,755 0 4 0 4 660 0 (725)

PCT Corporate Costs 5,730 8,739 1,300 537 866 1,281 553 838 19 (16) 28 31 166 0 (100)

Total Non-Commissioning budgets 161,442 160,157 0 23,176 10,604 13,882 22,974 10,602 14,140 202 2 (258) (54) 1,406 0 (2,025)

Development Reserve 2,595 3,104 277 252 246 196 200 174 81 52 72 205 821 821 821

(not yet allocated against budgets)

Savings Plans (6,709) (1,587) (272) (104) (44) 0 0 0 (272) (104) (44) (420) 0 1,647 1,647

(not yet allocated against budgets)

Overall total 416,102 416,530 126,575 48,429 27,807 35,496 48,914 27,577 36,127 (485) 231 (631) (886) 1,464 (0) (7,856)

Locality budgets

Budget heading Budget (year to Date)


(over) / under spend, against

budget

Actual (year to Date)

Locality actualsEast total

Variance year to date (over) /


Forecast variance (East total)Locality variances


Summary of PCTs Directly Provided Services and locally managed budgets (Table 2) Table 2 identifies, in summary format, the budgeted income streams for PCTs Directly Provided Services. Expenditure for those services is also shown in a summarised format with an analysis between pay and non-pay costs. It can be seen that the combined East-wide Directly Provided Services are currently operating within their budgeted income and that the most-likely year-end position is, at present, forecast to be breakeven. A further analysis of expenditure on Directly Provided Services is shown at Tables 3 (a) to (c) for each of the PCTs together with a commentary from the responsible Director of Finance. Those Tables also show the financial position on other ‘non-commissioned’ budgets.

TABLE 2 Summary of the financial performance of the East PCTs Directly Provided Services as at 30th June


Total Var

Initial

Annual

Budget per

LDP

Updated

Annual

Budget

SLA

contracted

agreement

values

East total

(adverse) /

favourable

to date


Best

case

Most

likely

Worse

case

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Income

SLAs (East PCTs) 22,340 22,154 3,722 2,127 3,441 3,722 2,127 3,441 0 0 0 0

Other income (East PCTs) 2,312 242 390 258 242 389 258 0 (1) 0 (1)

SLAs (West PCTs) 1,632 1,618 55 373 32 55 373 32 0 0 0 0

Other NHS income 2,735 584 477 183 584 449 214 0 (29) 31 2 45 31 (25)

Sub total NHS Income 23,972 28,819 0 4,603 3,367 3,914 4,603 3,337 3,945 0 (30) 31 1 45 31 (25)

Local Authorities (SLAs) 0 0 0 0

Other income from Local Authorities 950 90 155 81 90 139 81 0 (16) 0 (16)

Other Non-NHS income 112 192 17 11 210 34 11 18 17 0 35 5 0 (5)

Sub total Non-NHS Income 0 1,062 0 282 172 92 300 174 92 18 1 0 19 5 0 (5)

Total income 23,972 29,881 0 4,885 3,539 4,006 4,903 3,511 4,037 18 (28) 31 21 50 31 (30)

Expenditure

Pay & non-pay

Pay 15,860 19,996 2,679 2,577 2,341 2,580 2,528 2,387 99 49 (46) 102 (20) (31) (92)

Non-pay 3,490 4,400 587 425 666 522 329 673 65 96 (7) 154 0 0 (28)

Sub-total pay & non-pay 19,350 24,396 0 3,266 3,002 3,007 3,102 2,857 3,060 164 145 (53) 256 (20) (31) (120)

Other costs

Depreciation 554 699 358 39 136 341 55 136 17 (16) 0 1 0 0 0

Recharges from other NHS bodies 3,050 3,845 653 307 655 654 306 655 (1) 2 0 1 0 0 0

Management costs 200 252 0 5 58 0 5 58 0 0 0 0 0 0 0

Capital charges 818 1,031 309 108 150 309 93 150 0 15 0 15 0 0 0

Sub-total other costs 4,622 5,827 0 1,320 459 999 1,304 459 999 16 0 0 16 0 0 0

Total expenditure 23,972 30,223 0 4,586 3,461 4,006 4,406 3,316 4,059 180 145 (53) 272 (20) (31) (120)

Net (deficit) / surplus 0 (342) 0 299 78 0 497 195 (22) 198 117 (22) 293 30 0 (150)

Forecast variance (East total)

Budget heading Budget (year to Date) Actual (year to Date)

Variance year to date

(adverse) / favourable,

against budget


(adverse) / favourable

East total Locality budgets Locality actuals Locality variances


B.1. Financial report for Windsor, Ascot & Maidenhead PCT Revenue Budgets Primary Care budgets - See Table 1 Primary Care Primary Care is showing a slight over spend at month 3 due to expenditure not yet incurred on enhanced services which has been offset by higher anticipated QUoF achievements. It is anticipated that this area will breakeven in the full year despite experiencing a number of cost pressures which include premises with rent reviews agreed at 10% or more than existing levels without a similar rise in the budget. Prescribing On a straight line basis prescribing is currently on budget, and the PPA is yet to issue its first year-end forecast. The current position is based upon the LDP settlement and makes no allowances for the ongoing rebasing work currently being undertaken across East Berkshire. Additionally, no account has been taken for the effects of the savings plans produced by the 3 PCT prescribing advisors. It is hoped that the above 2 issues will bring this budget in on target at 31st March 07, however the Board should be aware of the underlying risk of this assumption especially given that budgets will be set at below last years outturn levels and further savings may need to be targeted in this area. Dental This is a new area of directly managed budgets for the PCT this financial year. Contracts have been set based upon historic activity, which also formed the basis for the Trusts allocations. Dental is currently within budget on the assumption that the target level of charges collected will be met by practices. The major risk is that the PCT must cover any reduction in the real level of patient charge income, and, as data is only available up to May from the BSA it is too early to quantify In addition there are likely to be further pressures resulting from a lack of capacity towards the end of the year that could result in further costs. The East Berkshire economy is monitoring and managing this business sector as a whole and more information will be brought to the Board to clarify risk as it becomes available. PCT Corporate Costs At the end of M3 staff budgets are showing an under spend but this is not anticipated to continue as contained within the budget are annual pay increases which have not been actioned to date. Non pay budgets are over target and this is being investigated. Other Local Budgets These items, that include locally managed PDF schemes, were zero based for budget setting purposes; at M3 there is no new information to suggest any variance from plan, either positive or negative.


PCT Directly Provided Services – See Table 2 The Provider budgets now reflect the tasked £440k savings attached to the benchmarking community staffing levels. The YTD position shows an underspend of £198k, which is due again to pay increases and back pay included in budgets but not yet actioned and the phasing of budgets such as St Marks Nursing Centre spot bed purchases where the majority of the expenditure occurs during the 3rd qtr. At this point we forecast year-end position of break-even. Workforce – See Table 3 (a) (i) The workforce return has been updated for the above mentioned savings and reflects the under spends as mentioned above. Capital – See Table 3 (a) (ii) Schemes have been identified to use the total capital available to the PCT. As is usual in the early months of the year there has been little spend to date and the majority of the costs are incurred in the last quarter of the year. Cash Management – See Table 3 (a) (iii After a poor start in April due to workload pressures the PCT is meeting its efficiency targets. The cash Limit will be achieved in year and the Better Payment Policy for non-NHS is improving but the NHS has deteriorated and is being investigated. Balance sheet – See Table 3 (a) (iv) The major changes on the Balance sheet include the application of annual indexation to the fixed assets which results in an increased of £3.7m. The reduction of yearend Debtors and Creditors as payments has now been issued. Julie Hill 14/07/2006

TABLE 3 (a) (i)


WINDSOR, ASCOT AND MAIDENHEAD PCT

2006/07 WORKFORCE PLAN

2006/07 Workforce Plan by QTRSPlan YTD Actual YTD

Jun-06 Jun-06 Sep-06 Dec-06 Mar-07 2006/07

Total Staff WTE 332.79 335.74 335.29 336.29 338.29 338.29

Total Staff Pay (£k) 3,085 3,006 6,203 9,358 12,525 12,525

Total Bank, Agency & Additional Hours WTE 10.11 11.31 10.11 10.11 10.11 10.11

Total Bank, Agency & Additional Hours (£k) 85 84 169 254 339 339

Total WTE 342.90 347.05 345.40 346.40 361.05 361.05

Total Paybill (£k) 3,170 3,090 6,548 9,611 12,863 12,863

FORECAST AS AT

TABLE 3 (a) (ii)


WINDSOR ASCOT AND MAIDENHEAD PCT CAPITAL PLAN 2006/07

£'000

Initial Allocation 1023

Choose & Book Incentive 55

Capital Limit 1078

NPFit Accrued 140

Total Available 1218

SCHEMES APPROVED Jun 06

Plan/Forecast Actual Variance

£'000 £'000 £'000

Health & Safety 20 0 -20

IT 711 0 -711

Medical Equipment 200 79 -121

Security 16 0 -16

Estates strategy 271 1 -270

TOTAL 1,218 80 -1,137

SCHEMES FOR CONSIDERATION Jun 06

Plan Actual Variance

£'000 £'000 £'000

Estates strategy 0 0 0

Others 0 0 0

TOTAL 0 0 0

Total Schemes 1,218 80 -1,137

Under/over(-)spend 1,218 80 -1,137

TABLE 3 (a) (iv)


CASH MANAGEMENT REPORTS APRIL 2006 T0 March 2007

UNDER/(OVER)SPEND AGAINST CASH LIMIT

Full Yr

Total

Apr-06 May-06 Jun-06

£000s £000s £000s £000s

Net forecast discretionary cash drawn down from DH 139,176 14,310 11,429 15,211 98,226

PPA recharges 22,908 1,721 1,922 1,717 17,548

Dentistry recharges 2,994 2,994

Total charge to cash limit 165,078 16,031 13,351 16,928 118,768

Cash Limit 165,078 16,031 13,351 16,928 118,768

Under/(over)spend against cash limit 0 0 0 0 0

EFFICIENCY OF CASH FORECASTS AND REQUISITIONS

DISCRETIONARY Actuals

Apr-06 May-06 Jun-06

£000s £000s £000s £000s

Planned opening balance at OPG 0 0 0 0

Actual opening balance at OPG (1) 15 (1) (5)

Main cash requisition for the month (as per form FIS3) 11,027 11,429 15,211 98,226

Adjustments to the main cash requisition in month (as per form FIS4) 3,283 0

Total cash available 14,309 11,444 15,210 98,221

LESS net payments at OPG (14,294) (11,445) (15,215) (98,221)

Closing Balance 15 (1) (5) 0

0

Performance Indicator 1: Actual : Planned Opening Balances [( ) indicate Actual > Planned] 1 (15) 1 5

Performance Indicator 2: % Variance of Cash Requisition/Actual Opening Balance : Net Payments -22.9 0.0 0.0 0.0

BETTER PAYMENT PRACTICE CODE

Non-NHS Trade Creditors

Number £'000s Number £'000s

Total bills paid in the year 1588 1772 6463 6380

Total bills paid within target 1462 1543 5585 5749

Percentage of bills paid within target 92.07% 87.08% 86.41% 90.11%

NHS Creditors

Number £'000s Number £'000s

Total bills paid in the year 219 2103 686 5401

Total bills paid within target 83 849 381 4102

Percentage of bills paid within target 37.90% 40.37% 55.54% 75.95%

April 06 - June 06 April 05 - March 06

Forecast Remainder

of Year

Jul 06 - Mar 07

April 06 - June 06 April 05 - March 06

Actuals

Forecast Remainder

Jul 06 - Mar 07

TABLE 3 (a) (iv)


Windsor, Ascot & Maidenhead PCT

BALANCE SHEET AS AT

31st March 2007

31 March

06

Balances

£000 £000 £000

FIXED ASSETS

Intangible assets 0

Tangible assets 44,320 41,742

TOTAL CURRENT ASSETS 1,662 7,288

TOTAL CREDITORS (8,560) (15,161)

NET CURRENT ASSETS / (LIABILITIES) (6,898) (7,873)

TOTAL ASSETS LESS CURRENT LIABILITIES 37,423 33,869

PROVISIONS FOR LIABILITIES AND CHARGES (642) (655)

TOTAL ASSETS EMPLOYED 36,781 33,214

FINANCED BY:

TAXPAYERS EQUITY

General Fund 23,021 22,212

Revaluation reserve 13,759 10,999

Donated asset reserve 1 3

TOTAL CAPITAL AND RESERVES 36,781 33,214


B.2. Financial report for Bracknell Forest PCT Revenue budgets The net variance on all local PCT budgets, excluding Commissioning budgets and Grants, at the end of June 2006 is a £2k underspend. Primary Care budgets (see Table 1) The primary care budgets are over spent by £103k at the end of June. The over spend against the GP other budgets is partly offset by under spend in quality and outcome framework budgets (QUOF). The QUOF variance is only on the aspiration payments made to date which only accounts for 60% of budgets. The achievement payments are made at the end of the financial year, hence the budgets for those are profiled into March 2007. The prescribing forecasts were not available at the time of closure of the ledger. The overspend of £97k is solely due to the impact of the Savings Programme which, for the purpose of this report, have been deducted from the prescribing budget. However it should be recognised that this is an area where the budgetary allocation between the 3 PCTs has yet to be finalised and there is, therefore, a potential risk associated with this budget across all 3 PCTs and specifically to Bracknell Forest where the potential reduction in budget could be as high as £387k. It is anticipated that this will be agreed by the end of the month and the budgets adjusted accordingly. However, for the purpose of this Board Report the potential savings have been reflected as a deduction from budgets whilst the details of this are being finalised. PCT Directly Provided Services (see Table 2 & Table 3 (b) (i) The provider services are under spending by £117k before the application of the workforce savings target. This underspend can be further broken down into:

• Shortfall in income target £28k

• Underspend on pay budget £49k

• Underspend on non-pay budget £96k. The income shortfall relates to dental access and CTPLD, which is offset by reduction in expenditure against these budgets. The other under spends within provider services, before savings were applied, come from a number of areas, the most significant of which are:

• Intermediate care £43k

• Dental CDS £33k

• Occupational therapy £27k

• Speech and language therapy £22k

• CTPLD team £19k

• Podiatry £11k

• Smoking Cessation £11k


The PCT has identified its required workforce saving of £280k and this is reflected above. Overall recharges from other organisations and capital costs are reporting a break even position. However, within that there has been an increase in depreciation costs which has been offset by more or less similar under spends on other capital costs. PCT Corporate Costs The overspend of £16k mainly relates to non achievement of savings targets rolled forward from last financial year and recent reviews of some posts under Agenda for Change resulting in arrears back dated to October 2004. Forecast Outturn The finance department is currently liaising with all budget managers to ensure that savings are identified and to provide an accurate forecast of expenditure. The PCT is fully committed to ensuring that it achieves a break even position and will take all steps necessary to achieve this. Balance Sheet and Cash Management statement These are attached at Tables 3 (b) (ii) and 3 (b) (iii) respectively Dawn Hines 14/7/2006

TABLE 3 (b) (i) Directly Provided Services – Bracknell Forest PCT


Most

Pay Non-pay Total Pay Non-pay Total Pay Non-pay Total Best likely Worst

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Expenditure

Speech & Language Therapy 366 17 382 349 9 358 17 8 25

Physiotherapy 306 15 321 310 3 313 (4) 11 8

District Nursing 278 7 285 279 2 281 (1) 5 4

Health Visitors Nursing 214 0 214 214 0 214 0 0 0

Podiatry 178 15 193 170 13 182 8 3 11

Mobility 42 114 155 42 113 155 (1) 1 0

Dietetics 162 6 168 160 7 167 2 (1) 1

Bracknell CTPLD 124 7 132 96 7 103 28 1 29

Smoking Cessation 43 29 72 54 6 60 (12) 23 11

Community Services Management 67 5 72 62 5 67 5 0 6

Community Nursing- General 10 29 39 11 37 48 (1) (8) (9)

School Nursing 54 2 56 50 4 53 4 (1) 3

Occupational Therapy 78 3 81 55 1 57 23 2 25

Domiciliary Intermediate Care Team 69 1 70 37 1 37 32 0 33

SH & GHHC 21 11 31 26 9 36 (6) 1 (5)

Community Matrons 0 0 0 0 0

Recharges from other Health Orgs 0 454 454 0 454 454 0 0 0

Dental Services 466 159 625 449 112 561 17 46 64

Out of County Income 0 0 0 0 0 0 0 0

Heatherwood - Ward 15 0 0 0 0 0 0 0 0 0

The Bridgewell Centre 170 12 182 164 6 170 6 5 12

Total expenditure 2,647 884 3,532 2,528 788 3,316 119 96 215 0 0 0

Savings to be attributed to budgets (70) (70) 0 (70) 0 (70)

Income variance (28)

Net total 2,577 884 3,462 2,528 788 3,316 49 96 117 0 0 0

Previous period:

(April 2005 to March 2006)

(Over) / under spend (55)

TOTAL Forecast year-end variance

(over) / under spendBudget heading Budget (year to date) Actual (year to date)

Variance year to date, (over) /


TABLE 3 (b) (ii)


Bracknell Forest Primary Care TrustBracknell Forest Primary Care Trust

BALANCE SHEET AS AT

30-Jun-2006

Movement As at 30 June

2006 2006

£000s £000s £000s

FIXED ASSETS

Intangible assets 0 0 0

Tangible assets 5,983 225 6,208

5,983 225 6,208

CURRENT ASSETS

Stocks and work in progress 97 (0) 97

Debtors 9,504 458 9,9620

Cash at bank and in hand 0 0 0

TOTAL CURRENT ASSETS 9,601 458 10,059

CREDITORS : Amounts falling due within one year (17,785) (81) (17,866)

NET CURRENT ASSETS / (LIABILITIES) (8,184) 377 (7,807)

TOTAL ASSETS LESS CURRENT LIABILITIES (2,201) 602 (1,599)

CREDITORS: Amounts falling due after more than one year 0 0 0

PROVISIONS FOR LIABILITIES AND CHARGES (93) 1 (92)

TOTAL ASSETS EMPLOYED (2,294) 603 (1,691)

FINANCED BY:

TAXPAYERS EQUITY

General Fund (4,079) 231 (3,848)0

Revaluation reserve 1,785 371 2,156

Donated asset reserve 0 0 0

Government Grant Reserve 0 0 0

Other reserves 0 0 0

TOTAL CAPITAL AND RESERVES (2,294) 603 (1,691)

As at 1 April

TABLE 3 (b) (iii)


APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR TOTAL

£ £ £ £ £ £ £ £ £ £ £ £ £

Forecast Forecast

Opening Cash Book Balance 22.59 249.86 933.40 0.00

Bank Giro Credits - Debtor 0.00 0.00 0.00 0.00 0.00

Bank Giro Credits - Nominal 3,090.00 11,904.89 3,478.86 5,000.00 23,473.75

Sales Ledger Income 134,769.39 878,661.43 230,670.99 476,372.00 1,720,473.81

Funding 6,241,000.00 5,058,000.00 7,603,000.00 7,312,000.00 26,214,000.00

TVPCA Funding 1,600,000.00 750,000.00 750,000.00 850,000.00 3,950,000.00

Additional Funding 2,924,000.00 2,924,000.00

SLA's - Berkshire 11,288,007.00 11,273,998.00 11,323,538.00 11,323,538.00 45,209,081.00

SLA's Other 57,093.61 57,093.61 57,093.61 57,093.61 228,374.44

ITT's 0.00 0.00 0.00 0.00 0.00

Bracknell Recharges 0.00 1,011,284.00 0.00 0.00 1,011,284.00

Revokes / OODs 254.76 4,331.08 325.00 2,000.00 6,910.84

Salary Recalls / Rejections 0.00 764.96 2,910.44 2,000.00 5,675.40

Misc / One Off's 782,284.00 12,792.13 4,062.00 3,000.00 802,138.13

Cash rebasing 0.00

TOTAL INCOME 23,030,498.76 19,058,830.10 19,975,078.90 20,031,003.61 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 82,095,411.37

LOCAL BROKERAGE 338,000.00 801,400.00 114,000.00 600,000.00 1,853,400.00

GRAND TOTAL INCOME 23,368,498.76 19,860,230.10 20,089,078.90 20,631,003.61 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 83,948,811.37

APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR TOTAL

£ £ £ £ £ £ £ £ £ £ £ £ £

Creditors Bacs 1,063,653.22 295,416.29 1,154,106.54 400,000.00 2,913,176.05

Creditors PO's 57,220.09 30,218.38 31,282.14 30,000.00 148,720.61

Creditors RFT1's 305,037.15 282,952.40 121,480.24 300,000.00 1,009,469.79

Manual PO's 2,171.88 3,994.37 1,335.00 2,000.00 9,501.25

SLA's 18,401,072.00 16,410,924.00 15,390,729.00 15,390,729.00 65,593,454.00

Payroll 613,346.90 609,299.99 624,865.42 615,000.00 2,462,512.31

Tax/NI & Supann 407,522.78 402,953.64 395,198.75 405,000.00 1,610,675.17

ITT's 0.00 0.00 0.00 0.00 0.00

Reading recharges 0.00 327,908.00 0.00 0.00 327,908.00

Slough Recharges 0.00 243,054.00 0.00 0.00 243,054.00

Wokingham Recharges 0.00 5,600.00 0.00 0.00 5,600.00

WAM recharges 39,543.00 0.00 0.00

Newbury recharges 3,288.00 0.00 0.00

Bank Charges 229.47 235.31 242.37 250.00 957.15

TVPCA Payment runs 1,600,000.00 750,000.00 750,000.00 850,000.00 3,950,000.00

Section 28a LD Grant Payments 0.00 2,633,000.00 2,633,000.00

Misc / One Offs 906,618.00 2,159.18 4,583.00 5,000.00 918,360.18

Cash Rebasing 0.00

East Berks Primary Care Service (out of Hours) 0.00

0.00

TOTAL EXPENDITURE 23,356,871.49 19,407,546.56 18,473,822.46 20,630,979.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 81,826,388.51

LOCAL BROKERAGE 11,400.00 452,000.00 1,616,000.00 2,079,400.00

GRAND TOTAL EXPENDITURE 23,368,271.49 19,859,546.56 20,089,822.46 20,630,979.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 83,905,788.51

Net Payments -10,764,772.73 -5,807,316.46 -8,353,743.56 -8,161,975.39 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Closing Cash Book balance

before Brokerage -326,350.14 -348,466.60 1,502,189.84 -599,975.39 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Total Deficit

Closing Cash Book Balance

After Brokerage 249.86 933.40 189.84 24.61 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Funding 6,241,000.00 5,058,000.00 7,603,000.00 7,312,000.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26,214,000.00

TVPCA Funding 1,600,000.00 750,000.00 750,000.00 850,000.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,950,000.00

Additional Funds 2,924,000.00 2,924,000.00

PPA Charges 897,000.00 1,035,000.00 901,000.00 2,833,000.00

Charge to Cash Limit 11,662,000.00 6,843,000.00 9,254,000.00 8,162,000.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35,921,000.00

Cululative Charge to Cash Limit 11,662,000.00 18,505,000.00 27,759,000.00 35,921,000.00 35,921,000.00 35,921,000.00 35,921,000.00 35,921,000.00 35,921,000.00 35,921,000.00 35,921,000.00 35,921,000.00

Cash Limit 108,615,000.00

Add: Anticipated Allocations

FORECAST BASED ON KNOWN PAYMENTS/INCOME e.g. PAYROLL, TAX & NI, RECHARGES AND INFORMATION ALREADY RECEIVED BY CLIENT.

Less: Charge to Cash Limit 35,921,000.00 WHERE CREDITORS PAYMENTS/DEBTORS INCOME FORECAST IS CONCERNED, THESE FIGURES ARE PURELY BASED ON PREVIOUS TRENDS

Balance of Cash Limit 72,694,000.00

BRACKNELL PCT 06/07

ANALYSIS OF RECEIPTS

ANALYSIS OF PAYMENTS


B.3. Financial report for Slough PCT B.3. Financial report for Slough PCT Revenue budgets Primary Care budgets - See Table 3 (c) GMS The PCT has applied the TVHA guidance in setting the GMS/PMS budgets. The impact of the new Enhanced Services cannot be fully quantified at this time, the worst case scenario of full achievement, could expose the PCT to a risk estimated at £250k. The current forecast assumes that the PCT receives the historic non-recurrent allocation from the DoH, estimated at £96k. Currently, our local assumption is that the Out Of Hours service will be managed by the lead commissioner (Bracknell Forest PCT) to a break-even position at 31st March 07. Prescribing On a straight line basis prescribing is currently £219k overspent, and the PPA is yet to issue its first year-end forecast. The current position is based upon the LDP settlement and makes no allowances for the ongoing rebasing work currently being undertaken across East Berkshire. Additionally, no account has been taken for the effects of the savings plans produced by the 3 PCT prescribing advisors. It is hoped that the above 2 issues will bring this budget in on target at 31st March 07, however the Board should be aware of the underlying risk of this assumption. PCT Corporate Costs At the end of Q1 staff budgets are broadly on target. Non pay budgets are under spending by £33k, this variance is being investigated. Other Local Budgets These items, that include locally managed PDF schemes, were zero based for budget setting purposes; at the end on Q1 there is no new information to suggest any variance from plan, either positive or negative. Dental This is a new area of directly managed budgets for the PCT this financial year. Contracts have been set based upon historic activity, which also formed the basis for the Trusts allocations. There are risks as follows:- Maternity Cover

Patient Charge Income Contracts in Dispute

The major risk is that the PCT must cover any reduction in the real level of patient charge income, and, as data is only available up to May from the BSA it is too early to quantify


The East Berkshire economy is monitoring and managing this business sector as a whole and more information will be brought to the Board to clarify risk as it becomes available. DAT This is a ring-fenced allocation which is passed to the Unitary Authorities, as hosts of the local DAATs as required by the NTA. As such, both the YTD and FOT are break -even with low risk; any variances should not impact on the PCT’s position. PCT Directly Provided Services – See Table 2 & Table 3 (c) The Provider budgets once again present a significant challenge to the PCT. Since the Board approved the settlement, a further £800k of income has been secured through negotiations around the LDP process. Additionally, the PCT has been tasked with finding a further £500k savings, 50% through benchmarking community staffing levels and 50% non-pay costs associated with the Upton reprovisions and general overhead efficiencies. The above have all been broadly profiled in twelfths, and as such, the YTD position reflects real achievements against savings targets. The Board are reminded that the baseline assumptions included £700k of pay savings through the removal of vacancies previously discussed and agreed. The YTD position shows a deficit of £22k. At this point we forecast year-end break-even; a worst case scenario is estimated at an overspend of £150k. This would occur if the PCT could not turn-round the small YTD deficit and address its underlying causes, and if the PbR income assumptions built into the baseline did not crystalise. Philip Murray 14/07/2006

TABLE 3 (c) Primary Care and Directly Provided Services – Slough PCT


Summary Financial Report for Slough PCT - For the period April to June 2006

For the period April to June 2006

Central

Plan Local Total YTD YTD YTD Best Most Worse

Budget Description Budget Adj Budget Budget Actual Var. Case Likely Case

£000's £000's £000's £000's £000's £000's £000's £000's £000's

Directly Controlled Primary Care Budgets

GMS/PMS

Main GMS / PMS Budgets 13,684 96 13,780 3,346 3,261 85

QOF 2,057 2,057 514 644 -130

OOH - (Combined with pooled Economy Budget) -397 -397

15,741 -301 15,440 3,860 3,905 -45 50 0 -250

Prescribing

PPA Prescribing 13,490 13,490 3,373 3,592 -219

Other Prescribing Budgets 1,193 1,193 298 298 0

14,683 0 14,683 3,671 3,890 -219 0 0 -500

PCT Corporate Costs

Pay Budgets 2,762 2,762 791 796 -5

Non Pay Budgets 300 300 75 42 33

3,062 0 3,062 866 838 28 75 0 -50

Other Directly Managed Budgets

Local PDF Schemes 176 176 44 44 0

Other Developmental Schemes 154 154 39 39 0

Elderly Intermediate Care 196 196 49 49 0

Bracknell Beds 65 65 16 16 0

LD Development budget 97 97 24 24 0

PIP 361 361 90 90 0

ECMS 22 22 6 6 0

Childcare Coordinator 25 25 6 6 0

1,096 0 1,096 274 274 0 10 0 -25

Dental 4,365 4,365 1,091 1,091 0 0 0 0

DAT (National Treatment Agency) 1,559 1,559 390 390 0 0 0 0

Total Directly Controlled Primary Care Budgets 40,506 -301 40,205 10,152 10,388 -236 135 0 -825

Directly Provided Services

Pay Budgets (Net of Income variances for Staff Costs)

Finance and Service Delivery 198 198 50 51 -1

Older People's Services 3,490 3,490 883 913 -30

Sexual Health 1,768 1,768 442 434 8

CTPLD 313 313 78 75 3

Health Promotion 59 59 15 14 1

Human Resources 139 139 25 25 0

Chapel Medical Practice 84 84 21 18 3

Walk In Centre 672 672 168 175 -7

Project for Homeless 23 23 6 5 1

Bilingual Health Advocacy 0 0 0 0

Community Services 2,486 2,486 653 649 4

9,232 0 9,232 2,341 2,359 -18 10 0 -72

Non Pay Budgets (Net of Income variances)

Finance and Service Delivery 3,920 3,920 978 1,033 -55

Older People's Services 342 342 86 62 24

Sexual Health 2,010 2,010 503 501 2

CTPLD 16 16 4 2 2

Health Promotion 7 7 2 1 1

Human Resources 14 14 4 1 3

Chapel Medical Practice 10 10 3 -1 4

Walk In Centre 79 79 20 18 2

Project for Homeless 3 3 1 0 1

Bilingual Health Advocacy 11 11 3 3 0

Community Services 245 245 61 49 12

6,657 0 6,657 1,665 1,669 -4 20 0 -78

Total Directly Provided Services 15,889 0 15,889 4,006 4,028 -22 30 0 -150

Local budgets overall total 56,395 -301 56,094 14,158 14,416 -258 165 0 -975

Sign Convention - (Over) / Under Spend

Forecast Year End Variance

bracknell forest pct board 26 july 2006 subject: financial...

Documents