FINANCE: NHS England has imposed legal directions on two clinical commissioning groups after they built up large deficits.

Surrey Downs CCG had an unplanned deficit of £10.7m in 2014-15. It has planned for a £28.6m cumulative deficit this year, according to the latest board papers.

Enfield CCG had a £19m deficit last year and has planned for a cumulative deficit of £33.4m in 2015-16.

A turnaround director, approved by NHS England, will be appointed to Surrey Downs and the CCG will have to consult with the national body over any executive appointments it wishes to make.

NHS England is commissioning an independent “capability and capacity” review into Surrey Downs.

The group will have to produce a financial recovery plan to show how it will operate within its budget for 2016-17 and how it will remain in balance. All figures used in the plan will require “independent scrutiny” by an organisation appointed by NHS England and it will need to include a “full analysis” of how the CCG plunged into deficit unexpectedly in 2014-15. It will also need to do a “full review and revision” of its governance arrangements and provide information to NHS England on a monthly basis.

Enfield CCG already has a turnaround director. NHS England has stipulated that if a replacement is required or if the CCG wants to appoint senior board members they should be approved by it.

The CCG has also been asked to produce an improvement plan that sets out how the “capacity, capability and governance” of the CCG is “made fit for purpose”.

East Surrey hospital

Surrey Downs CCG plans to have a £28.6m cumulative deficit this year

This includes a financial recovery plan showing how the group can operate within its budget from 2015-16 to 2019-20, including a schedule for repayment of debt. This plan was agreed by the CCG this week.

NHS England also issued directions to Northern, Eastern and Western Devon CCG this week.

Simon Stevens has indicated he will take a tougher approach to CCGs that are struggling.

In an interview with HSJ in June, the NHS England chief executive said “more vigorous support mechanisms” were needed beyond just changing the leadership of a CCG.

This could include another CCG, local authority or integrated provider taking over a struggling CCG’s responsibilities

Claire Fuller, clinical chair of Surrey Downs CCG, said it faced “significant financial challenges as a result of increased demand for healthcare, and changes to our funding allocation”.

She added: “We have already taken urgent steps to rectify the situation… however, given the scale of the challenge, and that we are required to achieve breakeven during 2016-17, we will need support from NHS England in order to achieve this, whilst maintaining high standards of patient care.”

Enfield CCG chair Mo Abedi said: “We will be working with NHS England and partners in our local health and social care economy in order to deliver a realistic and sustainable financial improvement plan that maintains the safety and quality of the services that we commission for our local population.”

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