Clinical commissioning groups are being told to set aside more than £2bn of their budgets in their first year of operation.
Leaders from several groups have been told that in 2013-14 they will need to plan to make a 1 per cent surplus and to set aside a further 2 per cent contingency, which they will not be able to spend on routine services.
The figures have been described to CCGs as “expectations” by regional finance chiefs. The NHS Commissioning Board will publish the financial and planning framework, which is likely to confirm the figures, next month.
Similar rules have been in place for primary care trusts since 2010. However, some leaders had believed they would not apply to CCGs, which have been promised more autonomy.
The requirements come amid controversy over the return of part of the overall Department of Health surplus to the Treasury in 2011 and 2012.
Where PCTs have achieved a surplus, it has formed part of the overall DH surplus, although part of it has generally been carried over to their budget for the following year. For CCGs the 1 per cent would amount to about £647m.
CCGs have also been told to set aside a further 2 per cent, which would amount to about £1.3bn nationally. They have not been told how it would be handled and enforced in the new system.
Some CCGs have been told they may be required to plan for a minimum 0.5 per cent internal contingency, giving an additional £323m nationally. This means they would need to set aside £2.26bn next year.
Since 2010, 2 per cent of PCTs’ budget has in most cases been topsliced and retained by strategic health authorities. Sums have generally been released when PCTs specify non-recurrent spending plans.
It is thought a significant part of the funds has been spent on managerial redundancies. The money has also formed a pool for bailing out struggling providers and PCTs.
One CCG finance director said the commissioning board’s options included retaining the sums itself, and encouraging or directing CCGs to create their own regional funds.
Bedfordshire CCG chief operating officer John Rooke, commenting on the plans, said groups should be treated as “mature organisations”, which could decide for themselves how to use the funds.