Primary care trusts are already falling behind on their quality, innovation, productivity and prevention (QIPP) plans, analysis by HSJ has found.

Draft plans from each PCT setting out how their local health economies will save their share of the £15bn-£20bn required between April this year and 2014 were due to be submitted to the Department of Health last week.

Prescribing cost cuts make up 29 per cent of one PCT’s QIPP savings target for 2010-11

HSJ has analysed the latest QIPP progress reports from more than 20 PCTs. The majority of those giving details of their progress so far admit they are falling behind, in some cases significantly.

The shortfall PCTs are forecasting on their planned savings at the end of this financial year ranges from 10 per cent at NHS Wolverhampton to 48 per cent at West Sussex. On average PCTs are forecasting to miss their targets by 24 per cent this year.

Other PCTs have not reported on their progress against an annual target but admit they are yet to identify where all their savings will come from.

NHS Norfolk plans to save £38.3m this year and £142m by 2013-14. But its latest QIPP report admits £17m of this year’s savings - 44 per cent - is as yet “unidentified”.

NHS Bassetlaw says it will meet its £2.4m savings by the end of this financial year. However, its board reports show that by the end of August it was 71 per cent behind its plans.

If savings plans continue to be missed at their current rate the £15bn-£20bn efficiency target will be around £5bn short by March 2014.

One of the major obstacles to QIPP savings is the apparent inability of PCTs to substantially reduce their spending in acute hospitals.

NHS Central and Eastern Cheshire plans to save £32.5m this year but says it could miss that by £12.2m, throwing the PCT into a £5.2m deficit.

The PCT’s biggest savings shortfalls are in its contracts with acute trusts. The contract with its main provider Mid Cheshire Hospitals Foundation Trust will overspend its target budget by £4.1m this financial year, despite a £2.3m increase in the budget.

NHS Tameside and Glossop’s September QIPP report reveals similar pressures on acute spending.

This year the PCT plans to save £24.9m, the bulk of which - £13.1m - will come from non-recurrent cuts. Of the remaining target, £6.8m is due to come from regional reforms such as reductions in urgent and planned care.

But by mid-August just £400,000 of that £6.8m had been achieved. The PCT says the likelihood of £4.7m of needed savings not being made by the end of the financial year is “red - high risk”.

Analysis of the plans shows PCTs are relying more than anything else on reducing the amount of emergency care.

For example, of NHS Sheffield’s planned £43m savings between 2010 and 2014, 19 per cent is from “urgent care for the over-75s”.

The largest saving in plans in Manchester, where several PCTs are working together, is a programme for managing referrals and “reducing demand for hospital services”, accounting for 11 per cent of a £231m intended saving.

Elective treatments are also being targeted. NHS Sheffield plans, for example, to save 37 per cent over four years by “reducing variations in elective care”.

NHS Sheffield chief executive Jan Sobieraj told HSJ elective care had been targeted after analysis revealed significant variation in elective care referral rates, in the number of referrals actually admitted and in follow-up appointments.

He said: “This is about driving clinical change. It’s not about some back room spurious cuts. It’s about working out why we have such huge clinical variations.”

A third target is prescribing budgets. NHS East Riding of Yorkshire plans to save £7.3m in 2010-11, of which 34 per cent is from prescribing.

Prescribing cost cuts make up 29 per cent of NHS Central and Eastern Cheshire’s total QIPP savings target for 2010-11.

The PCT hopes to be able to reduce such spending by £8.5m - the equivalent of 9 per cent of its projected prescribing spend.

Although some PCTs have set out where savings will be reinvested, many have not.

King’s Fund chief economist John Appleby said there was a “basic misunderstanding” within the NHS over the nature of the £15bn-£20bn savings target. The sum represented the gap between the rate of growth over inflation the NHS has received over recent years and the real terms near freeze expected from next year.

He said this did not mean the NHS had to cut its spending, but rather that it needed to extract more value from what it had by redeploying funds more efficiently.

PCTs make slow progress with QIPP