Primary care trusts with some of the toughest financial challenges in England are handing responsibility for the huge savings they must make this year to pathfinder commissioning consortia.

An HSJ analysis of the latest PCT quality, innovation, productivity and prevention plans has revealed how rapidly savings need to be accelerated and the vital role of consortia in delivering them.

Warrington Health Consortium will be charged with delivering £20m of the £25m QIPP savings NHS Warrington needs in 2011-12. In the last financial year the PCT managed to make recurrent savings of £15m but was forced to suspend all non-urgent GP referrals for eight weeks to contain costs.

Consortia have also taken on responsibility for £24m of NHS West Sussex’s £59m QIPP programme for this year, the PCT’s draft operating plan shows.

NHS West Essex, which like West Sussex was showing an in-year deficit one month before the end of 2010-11, plans to hand consortia responsibility for its £24.2m QIPP programmes over the course of 2011-12.

The findings come as health secretary Andrew Lansley’s plan to hand control of £60bn of the NHS budget to commissioning consortia is put under renewed pressure. Critics of the Health Bill fear accountability arrangements for consortia will be too weak.

PCT Network director David Stout said: “If you’re in significant financial difficulty, that implies you’re going to need significant clinical engagement [with QIPP plans]. You need either referrals or the design of the service to change, all of which needs clinical leadership to give you a fighting chance of delivering it.”

He added: “If you’ve got pathfinder consortia that are ready, and have put their heads above the parapet and said they want to get involved, then using that enthusiasm and engaging them in one of the most significant challenges facing the NHS seems like the right thing to do.”

The draft 2011-12 business plans presented to PCT boards in March give some indication of how significant that challenge is likely to be.

For example, a plan published by the Birmingham and Solihull PCT cluster anticipates that the rate of efficiency savings the local health economy has to make this year will increase to £219m, from £77m in 2010-11.

The cluster’s PCTs will need to make savings of 5.6 per cent, on top of the 4 per cent efficiency savings imposed on providers through reductions to the NHS tariff, to meet their control totals, the plan states.

For some commissioners already in financial difficulty, the big reduction in the rate of funding growth for the NHS this year appears to leave a gap which they are struggling to bridge with efficiency saving plans.

The 2011-12 draft budget for NHS Haringey in London says it is moving towards agreeing contracts with its providers which would leave the PCT with a deficit of £22.2m, despite planned savings of £29.4m.

A report to NHS Barnet’s board on 10 March also said it was “unlikely” that the PCT would identify sufficient savings to fill the £53.5m gap between funds needed to meet anticipated demand and its resources for 2011-12.

A 31 March report to the outer north east London PCT cluster on its £40m draft QIPP plan for this year found that its “risk assessed” value was just £22m.

It added that since the three PCTs started producing their plans in September last year their finances had “deteriorated” by approximately £15m across the sector, and a “number of additional decommissioning decisions will need to be made by boards”.

A spokeswoman for NHS West Sussex said: “Our QIPP plans reflect an NHS in transition, most significantly the shift to GP led clinical commissioning.

“We are fortunate that West Sussex GP commissioners have been recognised with pathfinder status, and they are now fully involved in our work, contributing to our QIPP plans for 2011-12 in partnership with public health and the Joint Commissioning Unit with West Sussex County Council.” The PCT expects to achieve a surplus for 2010-11.

HSJ’s analysis focused on the 25 PCTs which a previous investigation found were reporting in-year deficits at or around the eighth or ninth month of 2010-11. Of those, 17 had information about draft budget or QIPP plans in their latest published board papers.

PCTs under pressure

Primary care trusts are accelerating QIPP schemes this year to cope with rising demand for healthcare and real terms cuts in their available resources. Commissioners’ draft plans show the huge gaps to be filled, and the dependence of some PCTs on newly formed commissioning consortia

  • £15m: Total estimated savings commissioner NHS Warrington made in 2010-11  
  • £20m: Total QIPP savings pathfinder Warrington Health Consortium will have to make in 2011-12


  • £77m: Estimated total QIPP savings needed in Solihull and Birmingham, 2010-11
  • £219m: Estimated total QIPP savings needed in Solihull and Birmingham, 2011-12


  • £40m: Value of savings in outer north east London’s draft QIPP plan for 2011-12
  • £22m: Value of the same QIPP plan, adjusted for risk of non-delivery