Rising demand for acute services has emerged as a key threat to commissioners’ efficiency schemes, many of which are aimed at reducing urgent, elective and outpatient activity.

HSJ’s analysis of the QIPP tracker found demand management initiatives in all 53 local plans, accounting for savings potentially worth £2.3bn. However, only £810m of these were proceeding according to plan.

Rising activity for hospital services was particularly prevalent in the Midlands and South of England. The West Mercia cluster was given a “red” rating by NHS Midlands and East as activity was over plan. It described activity as being “above plan” in Cambridgeshire and Peterborough, while demand for services was “largely red”, although mitigated for the time being, in Lincolnshire.

North Essex and Suffolk both reported activity over plan in all areas, while there was a “risk to delivery” in all three South Central clusters ”as a result of activity levels”.

In Manchester, a plan to save £6.5m through cutting emergency admissions is described as “unlikely to achieve more than 63 per cent of the target”. Another workstream was at risk because it would take “longer than expected” for Salford Royal Foundation Trust to be able to “deflect A&E attendances back to GPs and self care”.

Some QIPP plans highlighted difficulties with the transition to the new NHS structure. Two plans were at risk due to difficulties clinical commissioning groups were experiencing recruiting a dedicated project manager.

West Mercia’s plan said: “CCG reform and authorisation requirements is diverting some of their focus away from delivering the QIPP challenge.”

In the Black Country, a plan to cut elective care activity was at risk as “not enough resource exists to ensure that the strategic change programme will be managed and delivered effectively”. CCGs were “focused on authorisation process [while] local authorities are looking at NHS Commissioning Board footprints, which is impacting on time to work on change programme functions”.

The same plan bemoaned a “lack of clarity about the precise role of the [NHS] commissioning board” affecting medicines management plans.