NHS England is predicting it will fall short of its efficiency savings target by 13 per cent in this financial year − a much bigger gap than that expected by clinical commissioning groups.
That is despite the national commissioning organisation setting a less ambitious initial savings target than CCGs.
An internal report obtained by HSJ reveals NHS England is aiming to make savings of 1.4 per cent through the quality, innovation, productivity and prevention programme this year.
CCGs are planning for a 2.6 per cent saving.
NHS England collects and collates the information, to track performance on QIPP and other financial indicators, in an internal document called the Non-integrated Single Financial Environment report.
As of the end of June, NHS England’s savings plan was 9.2 per cent behind target. The shortfall is forecast to rise to 12.9 per cent by the end of the year - a gap of £48.1m in a £374m savings plan.
The main contributor to the gap is primary care, for which NHS England took on responsibility in April. It predicts it will miss its primary care QIPP target by 19 per cent, or £22.5m. It is also predicting a 38 per cent shortfall on public health savings, although these account for a much smaller percentage of the organisation’s budget and QIPP target.
The report also monitors commissioners’ use of the 2 per cent of their budgets that, under national rules, they are required to spend only for non-recurrent purposes.
NHS England reports that, of its own 2 per cent fund, £56m has not yet been allocated, the vast majority of which is classified as for primary care.
One CCG chief executive told HSJ that NHS England’s primary care commissioning had been a “horror story” in the first quarter of 2013-14. The source said NHS England did not have “the basics” in place and added: “I would be surprised if they have the capacity, capability, confidence or relationships to drive significant savings in primary care.”
NHS England Greater Manchester local area team director Mike Burrows said: “Primary care presents particular challenges when it comes to QIPP. The general medical services contract [which funds many GP practices] is population based - so there is not much discretion in how you can make savings.”
CCGs were 11 per cent behind their total QIPP target at the end of June. However, they expect the gap to be only £71.5m, or 4 per cent of the total £1.6bn target, at the end of 2013-14.
The report also shows the split of savings plans between “transformational” and “transactional” changes.
NHS Clinical Commissioners co-chair Steve Kell, also chair of Bassetlaw CCG, said: “This data shows that CCGs are proving their worth.
“If the NHS is to achieve lasting improvements within a tighter financial envelope then it’s critical that CCGs are actively involved in that process.”