ACS commissioning group re-enters special measures after seven months

Bedfordshire CCG said last week – seven months after it came out of financial special measures – that NHS England had placed it back in the programme.

Its financial problems could threaten the progress of the proposed Luton, Bedfordshire and Milton Keynes accountable care system, which had been due to go live in April. Bedfordshire is the largest CCG in the patch.

The CCG’s most recent finance paper shows it is forecasting an in-year deficit of £7.2m at the end of the current financial year.

This represents a deterioration of more than £18m compared to the CCG’s initial plan for an £11m surplus. It agreed a revised target, to break even, with NHS England in the summer.

The document also reveals that its forecast cumulative deficit at the end of 2017-18 has increased to £55.9m.

A statement on the CCG’s website said as a result of being in special measures “its application to take on delegated commissioning of primary care services in Bedfordshire has been declined”. The statement added: “This means that the CCG will work closely with NHS England, undertaking monthly meetings to ensure the CCG regains a grip on its finances and moves into financial recovery.”

Alvin Low, clinical chair of the CCG, told HSJ: “Financial pressures have arisen following an over performance of our acute trusts, a number of contractual issues and national prescribing cost increases, which have adversely affected our forecasts.” 

Bedfordshire CCG first left financial special measures in June, the same month NHS England named the region as one of the first eight proposed ACSs.

The ACS contract with NHS England commits the area to working towards a single financial control total in 2017-18 as it works towards “full ACS status” from April.

NHS England’s regional director for Midlands and the East, Paul Watson, has warned the footprint that the CCG’s deterioration is the “biggest risk to the STP combined control total”. Minutes of Bedford Hospital Trust’s December meeting said: “Further discussions would take place with Dr Watson regarding mitigating the risk to the STP combined control total.”

Bedfordshire CCG’s financial plan for 2018-19, published in its January governing body papers, say: “It is intended that as a vanguard accountable care system it will move to a single control total.

“However, if this was the case the CCG would have to be satisfied that such a move would support the CCG’s financial recovery plan.

“This would include a different way of managing risk between organisations ie: a move away from [payment by results]; a joint programme of work to take costs out of the system; and an agreement not to worsen individual clinical commissioning organisations’ financial performance due to actions undertaken by the STP.” The proposed CCG control total for 2018-19 is a surplus of £11.4m.

Dr Low added: “Bedfordshire CCG continues to be a member of the vanguard ACS and we are working with partners to find an STP-wide solution to delivering financial balance and sustainability across the whole STP area.”

The commissioner was first given legal directions by NHS England in 2015, after recording large deficits.

Ben Jay, the CCG’s then chief financial officer, said in June that 2017-18 would be a “significant stretch for the organisation”. It was tasked with delivering a surplus so it could start repaying the cumulative deficit, which Mr Jay called a “substantial burden”.

This story was amended on 24 January to clarify that Ben Jay is no longer the chief finance officer at the CCG. The position is now held by Jim Hayburn. Mr Jay left last autumn to take up a role at NHS England.