Agenda item
Brent Clinical Commissioning Group finances
The report outlines Brent’s current position, with a surplus of £26m in 2013/14, and an overview of the key areas and their current spends. Also outlined are 2013/14 QIPPs and investment plans and an overview of the approach to 2014/15 QIPPs and investment plans.
Minutes:
Jonathan Wise (Chief Finance Officer, Brent CCG) introduced the report and outlined Brent CCG’s finances in the context of the national financial framework, explaining that NHS England would be responsible for allocating funding to CCGs for the next two years. Members heard that CCGs’ statutory functions were more restrictive than they had been for primary care trusts. Hospitals received most of their income from CCGs, as well as NHS England and local authorities, through national tariffs. Jonathan Wise drew members’ attention to Brent CCG’s financial position, which was relatively healthy and a surplus budget of £26m had been agreed for 2013/14. Brent CCG had also agreed to be part of two pan-CCG financial arrangements, the first to support the Shaping a Healthier Future implementation and the second an agreement with Harrow and Hillingdon CCGs to be part of an in-year risk share arrangements. Jonathan Wise advised that the supplementary paper circulated prior to the meeting provided an explanation of the process of how risk share arrangement would operate. He informed members that Brent CCG had been awarded the minimum level of growth in 2014/15 and 2015/16 as it had been assessed as being overfunded in 2014/15. He advised that the uplift of 2.14% for 2014/15 and 1.7% in 2015/16 would not keep pace with the estimated 3.4% per annum increase in cost pressures that were expected due to local demand and cost growth.
During members’ discussion, it was queried whether the national tariffs influenced clinical decisions in any way and was there any possibility of local tariffs being applied. In respect of Brent CCG’s agreement with Harrow and Hillingdon CCGs, it was commented that their financial situation was not particularly healthy and why was there no mention of Brent CCG having an agreement with Ealing CCG whose financial position was stronger. An enquiry was made as to whether community and out of hospital services were subject to national tariffs. It was commented that there were significant costs involved that did not actually include costs of commissioning services and treating patients, such as contingency costs, and a further explanation of this was sought. Moreover, it was asked how end of life services would continue to be provided in view that funding on this had been reduced. A member commented that if more patients wished to see out their lives at home rather than hospital, this would impact on resources in social care. Members also queried why NHS England did not fund GP’s IT equipment. In respect of Shaping a Healthier Future, it was asked whether Brent CCG had allocated 2% headroom funding for last year as well as 2013/14 and did other CCGs do the same. Turning to investments, the committee queried whether these would contribute towards primary care network development and achieving better GP outcomes and improving primary care hub access. It was also commented that the proportion of spending on GPs was considerable and what steps were being taken by NHS England to raise GP standards. A member also asked what the Procurement Panel would be recommending to the Governing Body on 29 January with regard to commissioning of all services currently commissioned through a local enhanced service agreement.
In reply to members’ queries, Jonathan Wise advised that nationally set tariffs were expected to be used to pay hospitals, although there could be some circumstances where local tariffs could be used where there had been a prior agreement to do so. In respect of Brent CCG’s agreement with Harrow and Hillingdon CCGs, he explained that each CCG had produced their plans regarding Shaping a Healthier Future at the beginning of the year and once they had agreed the arrangement with NHS England, they were expected to adhere to it. Jonathan Wise added that it was sensible to have a wider geographical sphere and in any case each CCG’s starting point in respect of Shaping a Healthier Future was independent from their overall financial situation. Members noted that Brent CCG had allocated 2% of headroom funding in the last two years and whilst some CCGs had allocated the same, others had not due to their financial situation, in which case consideration would be given as to what the appropriate allocation would be. Jonathan Wise confirmed that 1% of spend per annum was allocated for contingency costs, whilst the CCG also had a financial responsibility in respect of its estate, even where it was under utilised and so the CCG was committed to maximising use of its’ estate. Members noted that an explanation of corporate running costs had been provided in the supplementary report circulated prior to the meeting.
Jo Ohlson added that discussions would take place over what services it would be possible to provide for less and she confirmed that national tariffs did not apply to community and out of hospital services. In respect of end of life services, she advised that this service would be re-configured, including saving costs in hospital admissions, especially as some patients preferred to see their last days at home and they could receive pain relief medicines too. It was noted that hospital admissions in such cases were already reducing. Jo Ohlson advised that GPs were being encouraged to work together and there was a support team to help facilitate primary care network development and there were also incentives for GPs to improve outcomes. Three primary care hubs had also been identified to offer extended opening hours. She explained that whilst funding was being reduced for hospitals, a significant amount of it was being diverted to out of hospital care as GPs were expected to offer more services and a number of procurement exercises were being undertaken during commissioning to run such services. Jo Ohlson added that some spend, such as on Shaping a Healthier Future, was non-recurrent. With regard to the local enhanced service agreement, the Procurement Panel would be recommending that these services continue to be commissioned to help continue to raise standards in out of hospital care.
David Cheesman (Director of Strategy, North West London NHS Hospitals Trust) advised that there was more flexibility in terms of agreeing tariffs for community services. He added that the Urgent Care Centre’s tariffs at CMH had been closer to national tariffs, however lessons had been learnt and their were opportunities to reduce costs in this area. Rachel Donovan advised that NHS England had devolved costs to the CCGs for GP funding, including for IT equipment. With regard to improving GP standards, CCGs had been delegated powers to achieve this through commissioning and improving services locally. Phil Porter (Director of Adult Social Care) advised that in respect of end of life care, those who had chosen to remain at home would have access to prompt healthcare.
The Chair requested more information at a future meeting on end of life services, including details of how those remaining at home had been increased, the number who were looked after and the number who had been re-admitted to hospital. She also stated that Brent CCG finances would be revisited at a future meeting.
Supporting documents:
- 2-CCG Finances - covering report, item 5. PDF 55 KB
- 2-Report to OSC CCG Finances Briefing - 12 Jan 14 FINAL, item 5. PDF 131 KB