NHS commissioners are slipping behind on their efficiency plans and becoming more pessimistic about whether they will hit their year-end targets, HSJ can reveal.

Figures released under the Freedom of Information Act show performance on the quality, innovation, productivity and prevention programme worsened between quarters 1 and 2 of 2013-14.

Although QIPP is supposed to be about making the NHS more cost-efficient while improving the quality of services through innovation, NHS England centrally monitors only the programme’s financial performance.

Six months into this financial year, the commissioning sector is forecasting a QIPP shortfall of £246.6m, or 12.2 per cent for the end of 2013-14 − more than double the expected shortfall in the first quarter. Much of the deterioration comes from clinical commissioning groups, which are now forecasting a £176.9m shortfall − an increase of more than £100m over the past three months.

Among CCGs, progress against QIPP has worsened in three of the four regions of England − only in the North did the year to date performance improve. The position has also worsened for NHS England, which has to make its own QIPP savings in areas it commissions directly: primary care, specialised services and public health.

Across the country, transactional savings targets (those based on changes to commissioner-provider contracts) are overwhelmingly expected to be realised. The bulk of the shortfall is expected on the “transformational” side − those planned savings that relate to the redesign of services rather than simply paying providers less. The full year target for transformational QIPP savings is £710.9m, although a £170m shortfall is predicted.

Steve Kell, co-chair of NHS Clinical Commissioners leadership group, said that on the transformational side CCGs were focusing on improvements to community services and, through their memberships, primary care. He said these innovations would lead to savings over a longer timescale.

“Contract work has been the focus of QIPP in the past few years,” he said. “Transformational change takes longer.”

NHS England declined to comment on how it would improve QIPP performance, or what it would do if there is shortfall at the end of the year.