A clutch of clinical commissioning groups ended 2014-15 expecting deficits up to three times higher than planned, even as the majority saw their outlook for the year improved by a funding rebate.
HSJ analysis of the latest published finance reports for England’s 209 CCGs found 16 groups were forecasting deficits totalling £228.9m for the financial year just ended.
That figure is up more than a quarter on the gross deficit of £178.4m that was planned by 19 groups at the start of 2014-15.
Five CCGs had planned for deficits forecast surpluses by the latter months of 2014-15, and a further five expected improvements against their plan. But these improvements were offset by steeply declining forecasts for other CCGs, including two expecting large unplanned deficits.
Bedfordshire was forecasting an unplanned deficit of up to £40m by the end of January, while Surrey Downs’ most recent forecast shows a £10.7m unplanned deficit.
Northern, Eastern and Western Devon saw its position plummet from a £29.3m planned deficit to a forecast overspend of £41.6m by the end of February.
Enfield CCG’s forecast deficit has more than tripled, from a £5.6m plan at the beginning of the financial year to £19m in January. A spokeswoman for the CCG said this was largely driven by increased hospital activity. It is working on a financial recovery plan.
East Surrey CCG saw its forecast deficit grow from a start of year plan of £5.9m to £15.5m by the end of 2014-15.
This was partly caused by not meeting its “challenging” quality, innovation, productivity and prevention savings targets, a spokeswoman said, leaving the CCG with a £6m savings hole.
She added: “We have had an underlying recurrent structural deficit since our establishment in April 2013. To date, our QIPP delivery has simply slowed down the worsening of the deficit, rather than helping to reduce it.”
Julie Wood, director of NHS Clinical Commissioners, said CCGs were “already feeling their financial positions were high risk” and had concerns that they would not be able “to deliver on the 2015-16 financial plan in order to meet the needs of their patients and local populations”.
She added: “They now face additional financial pressures arising from the delayed tariff negotiations and outcome, mixed with the impact from increased demand facing the provider sector, and pressures to deliver against immediate performance targets.”
The sharp deterioration in finances among a minority of CCGs came as most groups had expected to finish the year in a better position than planned.
Overall, the sector forecast a £135m underspend against plan by the end of January, according to NHS England’s latest finance report.
The improvement came after an assessment found that only £94m of the £250m that had been top-sliced from CCG budgets to settle retrospective continuing healthcare claims would be needed in 2014-15.
The rebate of the remaining funds in the “risk pool” allowed 148 CCGs to increase their forecast surpluses.
NHS England has encouraged CCGs to increase their surpluses where possible because of the worsening finances in the acute sector.
Some CCGs’ finance reports warned that their end of year finances might worsen due to the withdrawal of anticipated referral to treatment funding, which has been reallocated in some cases.
Coastal West Sussex CCG had expected to receive £3.4m referral to treatment funding. A spokeswoman for the group said NHS England had reclaimed a “significant portion” of its allocation.
NHS England allocated the £250m RTT fund to CCGs last year to pay providers to treat long waiting patients.
However, it has since carried out two reviews to identify how much of the money was spent and where. Following these reviews, it redistributed the funding to match the actual expenditure by commissioners.
This means that in some instances, allocations were reduced for commissioners that spent less than NHS England originally estimated, and were transferred to those that spent more.
According to NHS England’s latest finance report, all CCGs at risk of failing to deliver their financial plans were “receiving support from their local NHS England teams” and “the five most significant deviations from plan – which together account for £82m of shortfall in the forecast position” were subject to “in-depth regional oversight of their recovery plans, supplemented by national support and review”.