Finance Report as at 31st May 2014

Durham Dales, Easington and Sedgefield Clinical Commissioning Group1

Executive Summary as at 31st May 2014

Income & ExpenditureThe CCG is reporting an underspend year-to-date (YTD) and forecast outturn position.

CapitalNo allocations have been announced to date however indications are that minimal funds are available.

CashThe forecast cash drawdown is in line with the anticipated cash limit.

Quality, Innovation, Productivity & Prevention (QIPP) Current QIPP forecasts show full delivery against target.

Better Payment Practice Code (BPPC)The CCG is exceeding its target of paying 95% of valid invoices within 30 days.

Durham Dales, Easington and Sedgefield Clinical Commissioning Group2

YTD Forecast N/A N/A

YTD Forecast £915K £5,490K

YTD Forecast £66,712 £424,023

By Volume By Value Non-NHS 98.19% 97.83%NHS 98.38% 99.79%

Target Forecast£22,755K £22,755K

Budget to Actual Variances as at 31st May 2014

Durham Dales, Easington and Sedgefield Clinical Commissioning Group3

Overview of Financial Position as at 31st May 2014

The current position shows a year to date under-spend of £915K and a forecast outturn under-spend of £5,490K against a total expected allocation of £424,023K. This is in line with the Financial Plan submitted to NHS England.

The CCG’s financial position is under continual review and the current position shows the organisation to be on track to achieve its key financial targets. However for much of the programme activity it is too early to form an accurate position and work is on-going to scrutinise activity and data received.

Notable exceptions to this include Continuing Healthcare and Community Services budgets.

Continuing Healthcare is showing a year to date under-spend due to the risk share arrangements across the County Durham and Darlington CCG’s not currently being transacted.

Pressure is currently being observed within community services, relating to County Durham and Darlington NHS Foundation Trust out of contract items, including continence.

Durham Dales, Easington and Sedgefield Clinical Commissioning Group4

Financial Position as at 31st May 2014

Durham Dales, Easington and Sedgefield Clinical Commissioning Group5

YTD Budget YTD

Actual

YTD Variance (Under)/

Overspend

YTD Variance (Under)/

Overspend2013-14 Budget

Forecast Outturn

Forecast Variance (Under)/

Overspend

Forecast Variance (Under)/

Overspend

Best Case Forecast Variance (Under)/

Overspend

Worst Case Forecast Variance (Under)/

Overspend£000's £000's £000's % £000's £000's £000's % £000's £000's

Commissioned ServicesAcute Services 34,998 34,998 0 209,991 209,991 0 0 0Community Health Services 7,504 7,628 124 45,024 45,024 0 0 0Continuing Care Services 2,954 2,884 (70) 17,727 17,307 (420) (420) 0Mental Health Services 8,727 8,727 0 52,360 52,360 0 0 0Primary Care Services 10,748 10,745 (3) 64,490 64,490 0 0 0Other 1,295 1,295 0 7,769 7,769 0 0 00 0Programme Reserve 0 0 0 14,189 14,609 420 420 0

Total Commissioned Services 66,227 66,278 51 0% 411,550 411,550 (0) 0% 0 0

Running Costs Corporate Costs and Services 1,048 998 (51) 6,291 5,962 (329) (362) (173)

Running Cost Reserve 0 0 0 692 1,021 329 (138) 173

Total Running Costs 1,048 998 (51) -5% 6,983 6,983 0 0% (500) 0

1% Required Surplus 915 0 (915) 5,490 0 (5,490)

GRAND TOTAL EXPENDITURE 68,190 67,275 (915) -1% 424,023 418,533 (5,490) -1% (500) (0)

Acute Commissioning as at 31st May 2014

• Limited data is available at this point in the year as submissions by acute providers are completed as part of the national timetable. It is anticipated that this information will be received in June as per the national activity submission guidelines and will enable the month three position to be reflective of this. In the intervening period, budgets are assumed to perform in line with the planning assumptions on which contract values have been set.

• The majority of acute contracts have financial plans in place and are agreed with providers, although contracts are not formally signed. Contracts with County Durham and Darlington NHS Foundation Trust are not yet finalised and negotiations are ongoing to resolve the outstanding issues.

Durham Dales, Easington and Sedgefield Clinical Commissioning Group6

Acute

Budget Actuals Variance Budget Actuals Variance£'000 £'000 £'000 £'000 £'000 £'000

Acute Commissioning Exluding Independent Sector 32,386 32,386 0 194,318 194,318 0Independent Sector 661 661 0 3,967 3,967 0Ambulance Services 1,621 1,621 0 9,726 9,726 0Non Contract Activity Excluding Independent Sector 330 330 0 1,980 1,980 0

Total Acute 34,998 34,998 0 209,991 209,991 0

YTD Forecast Outturn

Community Services as at 31st May 2014

• As expected at this early stage of the year limited information is available. It is anticipated that information will be available for June 2014 which will facilitate more accurate and detailed reporting. Contractual positions are therefore showing breakeven.

• Other NHS above includes out of contract charges relating to County Durham and Darlington Foundation Trust which show as a pressure year to date. Specifically included are Orthotics, Continence and Patient Transport, which are intended to be incorporated into the contract during 2014/15 financial year.

Durham Dales, Easington and Sedgefield Clinical Commissioning Group7

Community

Budget Actuals Variance Budget Actuals Variance£'000 £'000 £'000 £'000 £'000 £'000

County Durham and Darlington NHS Foundation Trust (CDDFT) 5,749 5,749 0 34,494 34,494 0Other NHS 455 579 124 2,730 2,730 0Local Authority Agreements 283 283 0 1,698 1,698 0Independent Sector 702 702 0 4,211 4,211 0Hospices 315 315 0 1,892 1,892 0

Total Community 7,504 7,628 124 45,024 45,024 0

YTD Forecast Outturn

Continuing Healthcare as at 31st May 2014

• Continuing Healthcare (CHC) costs are based on expected year-to-date and forecast outturn from the CHC database.

• The position includes an estimate of growth in packages for the 2014/15 financial year of £947k, which has been reflected in the budget.

• The risk share arrangements for high cost cases within CHC across the County Durham and Darlington CCGs is currently not being applied, pending agreement for the 2014/15 financial year.

• The financial position is based upon 650 approved packages of care which are confirmed as being delivered to patients. There have been 103 new or changed packages so far this year.

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Durham Dales, Easington and Sedgefield Clinical Commissioning Group8

CHC

Budget Actuals Variance Budget Actuals Variance£'000 £'000 £'000 £'000 £'000 £'000

Continuing Healthcare (CHC) 2,442 2,440 (2) 14,650 14,641 (9)Funded Nursing Care (FNC) 513 444 (69) 3,077 2,666 (411)

Total CHC 2,954 2,884 (70) 17,727 17,307 (420)

YTD Forecast Outturn

Mental Health as at 31st May 2014

• As expected at this early stage of the year limited information is available. It is anticipated that information will be available for June 2014 which will facilitate more accurate and detailed reporting. Positions are therefore showing breakeven.

Durham Dales, Easington and Sedgefield Clinical Commissioning Group9

Mental Health

Budget Actuals Variance Budget Actuals Variance£'000 £'000 £'000 £'000 £'000 £'000

Tees Esk Wear Valley NHS Foundation Trust (TEWV) 7,660 7,660 0 45,958 45,958 0Northumberland Tyne and Wear NHS Foundation Trust 324 324 0 1,942 1,942 0Other NHS 25 25 0 150 150 0Independent Sector 387 387 0 2,325 2,325 0Local Authority Agreements 331 331 0 1,985 1,985 0

Total Mental Health 8,727 8,727 0 52,360 52,360 0

YTD Forecast Outturn

Primary Care as at 31st May 2014

• As expected at this early stage of the year limited information is available. It is anticipated that information will be available for June 2014 which will facilitate more accurate and detailed reporting. Positions are therefore showing breakeven.

Durham Dales, Easington and Sedgefield Clinical Commissioning Group10

Primary Care

Budget Actuals Variance Budget Actuals Variance£'000 £'000 £'000 £'000 £'000 £'000

Prescribing 9,352 9,352 0 56,112 56,112 0Enhanced Services 180 180 0 1,078 1,078 0Out of Hours 984 984 0 5,906 5,906 0Other 232 229 (3) 1,394 1,394 0

Total Primary Care 10,748 10,745 (3) 64,490 64,490 0

YTD Forecast Outturn

Other and Programme Reserve as at 31st May 2014

• As expected at this early stage of the year limited information is available. It is anticipated that information will be available for June 2014 which will facilitate more accurate and detailed reporting.

• Reserves include the 2.5% non recurrent spend, earmarked reserves and contingency to be deployed during the course of the year.

Durham Dales, Easington and Sedgefield Clinical Commissioning Group11

Other

Budget Actuals Variance Budget Actuals Variance£'000 £'000 £'000 £'000 £'000 £'000

Patient Transport Services - North East Ambulance NHS Foundation Trust 381 381 0 2,285 2,285 0Patient Transport Services - County Durham and Darlington NHS Foundation Trust 34 34 0 206 206 0Patient Transport - Integrated Travel - DCC 32 32 0 195 195 0Patient Transport 20 20 0 123 123 0Urgent Care-NHS 111 163 163 0 977 977 0Property Charges 299 299 0 1,796 1,796 0Reablement 320 320 0 1,921 1,921 0Commissioning Reserves 0 0 0 14,189 14,609 420Safeguarding 44 44 0 266 266 0

Total Other 1,295 1,295 0 21,958 22,378 420

YTD Forecast Outturn

Running Costs as at 31st May 2014

• Running costs are currently showing a year-to-date underspend of £51k and a break-even forecast outturn position. Approximately £82k of accruals were incorporated into the year-to-date position, mainly in relation to audit fees / external consultancy fees that have not yet been invoiced.

• No risks have been identified at month two but budget and actual spend will be regularly monitored to ensure that any potential risks are promptly identified.

• There is a budget of £692k in the General Reserve to be deployed on CCG priorities throughout the year.

Durham Dales, Easington and Sedgefield Clinical Commissioning Group12

Budget Actual Variance Budget Actual Variance£'000 £'000 £'000 £'000 £'000 £'000

Income (3) (3) (0) (20) (20) 0Pay 288 247 (42) 1,731 1,717 (15)Non Pay 103 94 (9) 620 306 (315)NECS Contract 660 660 (0) 3,959 3,959 0Running Cost Reserve 0 0 0 692 1,021 329

Total Running Costs 1,048 998 (51) 6,983 6,983 0

YTD Forecast Outturn

Quality Innovation Productivity & Prevention (QIPP) as at 31st May 2014

Durham Dales, Easington and Sedgefield Clinical Commissioning Group13

The table below summarises the latest forecast savings by key programme areas as at 31 st May 2014, compared to the original QIPP plan for the year. A number of red rated schemes remain owing to ongoing contract negotiations. This has slowed QIPP delivery against plan for the first two months of the year, although forecasts remain at target levels.

Original Plan Latest Forecast Schemes RAG BreakdownRed Amber Green Total

Area of QIPP Savings £'000 £'000 £'000 £'000 £'000 £'000Acute / Ambulance 5,064 4,687 1,442 1,513 1,731 4,687Mental Health / LD 200 200 0 200 0 200Community Services 581 581 581 0 0 581CHC / FNC 0 377 0 0 377 377Prescribing 629 629 0 0 629 629Primary Care 0 0 0 0 0 0Running Costs 187 187 0 0 187 187

Total Allocative QIPP 6,660 6,660 2,023 1,713 2,924 6,660Technical QIPP 16,095 16,095 0 0 16,095 16,095Grand Total QIPP 22,755 22,755 2,023 1,713 19,019 22,755

RAG Percentages - Total QIPP 9% 8% 84%RAG Percentages - Allocative QIPP 30% 26% 44%

Notes:1. Allocative QIPP plan comprises £6,170k recurring, plus £490k non-recurring = £6,660k Total2. Technical QIPP = Effi ciency removed from tariff/prices paid to providers (4% in 14/15)3. Allocative QIPP - Effi ciency driven out of the healthcare system by commissioners, e.g. pathway changes

Total QIPP

Allocative QIPP

Better Payment Practice Code (BPPC) at 31st May 2014

The Better Payment Practice Code (BPPC) requires NHS organisations to pay all invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.

Durham Dales, Easington and Sedgefield Clinical Commissioning Group14

Better Payment Practice Code - 30 Days Number £000's

Non-NHSTotal Non-NHS Trade Invoices Paid in the Year 1,272 5,032Total Non-NHS Trade Invoices Paid Within 30 Day Target 1,249 4,923Percentage of Non-NHS Trade Invoices Paid Within 30 Day Target 98.19% 97.83%

NHS Total NHS Trade Invoices Paid in the Year 432 54,825Total NHS Trade Invoices Paid Within 30 Day Target 425 54,708Percentage of NHS Trade Invoices Paid Within 30 Day Target 98.38% 99.79%

Prescribing Analysis 31st May 2014

Durham Dales, Easington and Sedgefield Clinical Commissioning Group15

Total (per PPA) Apr / May Accrual Anticipated YTD YTD BudgetYTD Over

/(Under) Spend CCG FOT Annual BudgetFOT Over

/(Under) SpendScheme £000's £000's £000's £000's £000's £000's £000's £000's

DDES Practice Prescribing Total 0 8952 8952 8952 0 53710 53710 0Central Charges PPA to Jan 0 236 236 236 0 1417 1417 0Nutricia (Enteral Feeds) 103 103 103 0 616 616 0Meds Mgmt CSU 18 18 18 0 110 110 0Meds Mgmt Ind Sector 9 9 9 0 54 54 0Prescribing Incentive Scheme 33 33 33 0 200 200 0N Tees Prescribing Spec Procurement 1 1 1 0 6 6 0

9352 9352 9352 0 56112 56112 0