• Inadequate rated Kernow CCG forecasting £37m deficit
  • Chief finance officer says CCG should not submit undeliverable plan
  • Patient choice and waiting times could have been put at risk under proposed finance plan in June

A clinical commissioning group that is in the capped expenditure process has said it has “no viable plan” to hit its control total this financial year.

In its latest governing body papers, Kernow CCG said it will be unable to find a way of closing a £17.7m gap in its finances in 2017-18.

It means the CCG, which was allocated £765m this year, is set to breach some of the legal directions imposed by NHS England in December 2015 for not hitting its financial targets.

The CCG, which is rated inadequate, was set a control total deficit of £19.9m for this year despite forecasting a £37.6m deficit – resulting in the CCG being included in the CEP.

But in a report to the governing body, chief finance officer Simon Bell said: “Subsequent correspondence has limited the scope of options that can be considered within the CEP, and at this point there is no viable plan to reduce spending to the control total level.”

The admission comes after the CCG presented a financial plan to regulators in June, which it accepted could impact patient choice and waiting times, governing body minutes reveal.

The main focus of that plan was a “significant downsizing of elective capacity”, but this was “stalled” following NHS Improvement chief executive Jim Mackey saying CEP plans should not breach patients’ constitutional rights over elective care.

The minutes said Mr Bell was “clear that the CCG should not submit a plan that was not clearly deliverable”.

A spokeswoman told HSJ that attempts to jointly agree plans with the “health community” to close the in year gap had failed.    

In his September report, Mr Bell said the CCG continued to liaise with NHS England over the implications of not hitting the control total.

But he added: “Focus must remain on reducing our spend as far as possible (whilst maintaining appropriate quality and safety at all times), in both the short and medium terms to return the CCG (and the wider health community) to a secure and sustainable financial basis.”

There is also an “unresolved net risk” worth £5.4m that the CCG needs to address, the report said. 

The CCG attributed its financial pressures mainly to costs of acute activity, prescribing, continuing healthcare and out of county mental health placements.

The CCG’s savings target this year is £29.6m, which equals around 3.8 per cent of its allocation.

Mr Bell warned that the rate of savings, which is “marginally ahead of plan”, needs to “accelerate” throughout the rest of the year as savings accrued so far include a one off benefit from VAT recoveries worth £731,000.

Mr Bell said: “Timeliness of payments is being maintained… but over the course of the year we will need to liaise with NHS England over the continued availability of cash since our projected spend is in excess of the control total.”

The spokeswoman added to HSJ: ”We would expect that NHS England will increase the cash allocated to the CCG to reflect the likely forecast later in the year, matching cash availability to need across the NHS. 

“Details of the arrangements for reviewing cash allocated to individual CCGs have not yet been circulated for 2017-18.”

Since achieving small surpluses in 2013-14 and 2014-15, the CCG’s finances have rapidly worsened and its cumulative deficit stood at £54.2m at the end of 2016-17.

HSJ asked NHS England if it could take further regulatory action and what would happen to the control total, but it did not respond by the time of publication.

  • Article updated at 10.45am to include CCG response