FINANCE: The country’s biggest clinical commissioning group will have to take immediate action to prioritise patient access to services in the face of unaffordable increases in demand, it has warned.

In a highly unusual move, chief officer of Northern, Eastern and Western Devon CCG Rebecca Harriott wrote to providers last week to warn services would “suffer” if the CCG did not implement measures straight away.

She said confidence that the CCG could meet its financial plan for 2014-15 and end the year with a deficit of £14.6m had “gradually declined as the situation has become clearer”.

“In short, demand for services is outstripping what we can afford,” the letter said.

Man looking at x-ray

Orthopaedics and stroke services in the country have experienced particularly high demand

“Whatever the actual cause of the increase in demand, it is having a serious effect on the financial position of our organisation. If we fail to deal with it now, as the area’s main commissioner, services will suffer.”

NEW Devon and its two main acute providers – Plymouth Hospitals Trust and Royal Devon and Exeter Foundation Trust – are predicting a combined deficit of almost £45m this year. The CCG has a turnover of £1.1bn.

Devon was named one of the 11 most financially challenged health economies by NHS England, Monitor and the NHS Trust Development Authority earlier this year.

The national bodies funded support from consultancy PwC to develop a system wide plan which included an acknowledgement that the system could not afford to provide everything it currently does.

The letter, which was also published on the CCG’s website, said newly introduced demand management measures - such as requiring smokers to quit for six weeks prior to routine surgery, and a ban on procedures of low clinical value - were “not enough”.

It said the CCG was “working up a series of measures to prioritise those patients most in need, while at the same time, increasing efficiency in the wider system and the CCG itself”.

NEW Devon is working with NHS England on cost cutting proposals which will be submitted to its governing body meeting next week.

Speaking to HSJ, Ms Hariott said “everything was on the table” except for “people most in need and the NHS constitution requirements”.

These include waiting time targets for elective care, and accident and emergency.

She said the CCG was “testing out” what else it could do and would agree proposals at a meeting on Wednesday.

Royal Devon chief executive Angela Pedder told HSJ high levels of demand were driven by the county’s ageing population which in some areas was at levels not expected to be seen in the rest of the country until 2075.

She said: “We accept this is a system wide problem; it’s not just the CCG’s problem. It’s an incredibly challenging time for them and for us in terms of the demand that we have on our services.”

Ms Pedder said elective orthopaedics and stroke services were experiencing particularly high demand but rejected the suggestion the extra pressure was being caused by cuts to social care.

“Our experience of the patients presenting [at Royal Devon] is they are extremely sick and need to be in hospital,” she said.