22
Month 10 Hammersmith & Fulham CCG Finance Report 26th February 2019
Month 10 Hammersmith & Fulham CCG
Finance Report
26th February 2019
Acronym Full Provider Name
ASP Ashford And St Peter's Hospitals NHS Foundation Trust
BLT Bart's Health NHS Trust
C&W Chelsea And Westminster Hospital NHS Foundation Trust
CLCH Central London Community Healthcare NHS Trust
CNWL Central And North West London MH NHS Foundation Trust
EHT Ealing Hospital NHS Trust
ESH Epsom And St Helier University Hospitals NHS Trust
GOSH Great Ormond Street Hospital For Children NHS Foundation Trust
GSTT Guys And St Thomas NHS Foundation Trust
HRCH Hounslow And Richmond Community Healthcare NHS Trust
HUH Homerton University Hospital NHS Foundation Trust
HWP Heatherwood And Wrexham Park Hosps NHS Foundation Trust
ICHT Imperial College Healthcare NHS Trust
KCH Kings College Hospital NHS Foundation Trust
KHT Kingston Hospital NHS Trust
MEH Moorefield's Eye Hospital NHS Foundation Trust
NWLHT North West London Hospitals NHS Trust
RBH Royal Brompton And Harefield NHS Foundation Trust
RMH The Royal Marsden Hospital NHS Foundation Trust
RNOH Royal National Orthopaedic Hospital NHS Trust
RSC Royal Surrey County NHS Foundation Trust
SGT St George's Healthcare NHS Trust
SLAM South London And Maudsley NHS Foundation Trust
SWL&StG South West London And St George's Mental Health NHS Trust
THH The Hillingdon Hospital NHS Foundation Trust
UCLH University College London NHS Foundation Trust
WHH The Whittington Hospital NHS Trust
WLMH West London Mental Health NHS Trust
WMUH West Middlesex University Hospital NHS Trust
Contract Acronyms
Acronyms
Executive summary Page Appendices Page
Executive Summary 2 & 3 Appendix 1.1: Revenue resource limit 1.1
CCG finance dashboard 4 Appendix 2.1: RAG rating definitions 2.1
Best/Likely/Worst Case Outturn Scenarios 4a Appendix 3.1: Corporate Costs 3.1
Appendix 4.1: Acute Contract Activity 4.1
Overall financial position Page
Surplus/deficit : Year to Date and Forecast Outturn 5
Underlying position 6
Risks and opportunities 7
Reserves 10
Quality, Improvement, Productivity Plan 11 - 13
Capital,Creditor payments and Cash 14
Debtors and Creditor Analysis 15
Balance Sheet 16
Acute contracts: year to date performance 17
Contents
1
Status
FORWARD LOOK :
As shown on the QIPP tabs : there is a significant step-up in QIPP forecast for Q4 due to one key FRP scheme (£3.2m). Due to the nature of that item it remains a significant risk to the year, albeit actions agreed with the CCG MD
and socialised at NWL Executive level are being taken forward to deliver the best outcome in relation to these items and a final provider position awaited, subject to which mediation may be required. This is the major Risk shown in
the Risks/Opps position.
Notwithstanding the above, the underlying position of the CCG is a deficit of £30m-£31m, which includes the impact of GP at Hand costs, including their Full Year Effect. Further acute/other pressures will of course make this position
worse.
Following review of allocations, guidance, tariff impacts, and in light of the revised expectation regarding GP at Hand mitigations; and given the degree to which the in year QIPP is transactional and non-recurrent, the view of
2019/20 has been significantly updated.
The previous expectation was that £27m of QIPP would be required in 2019/20 to breakeven, but this has now been revised upwards to £36m. This target would have been below £27m had GP at Hand been fully addressed in
2019/20 allocations, however the published allocations assume that the population of H&F will slightly reduce between 2018/19 and 2019/20, and be at an average list size of 239,546; the 1st February list size is 264,733, which is
already 25,000/10.5% above the figure used for setting allocations. Costs for that excessive growth are already falling to H&F CCG and further list growth would also be expected, especially in view of NHSE's decison to remove
objections and thus allow expansion beyond London.
FRPG is continuing on a weekly basis, to identify QIPP for future periods, and will look to advance schemes to 18/19 where possible. Given the size of the challenge, however, the CCG will need to consider options that include
reduced access/decommissioning of services. A moratorium on investments which do not yield an in year return has been implemented supported by a policy ratified at Governing Body.
Re:GP at Hand, Intra-NWL allocation transfers are being made to neutralise the costs relating to intra-NWL patient/list transfers. The full year forecast for non-NWL cost pressures is £10.2m and this has now been taken to the
CCGs bottom line, increasing the forecast deficit by that value. The full year projection allows for future list growth which is the major variable for costs arising.
The GP at Hand practice has been very active recently with an advertising campaign across London and the list increase of 3,200 from Jan to Feb is the largest increase in 2018/19 and 50% above the monthly average for this year.
This monthly increase is also equivalent to c5% of the entire National list size growth of 64,000 for the same period. GP at Hand is also seeking to expand to other cities in the UK, and NHSE confirmed at the PCCC of 12 February
that its restriction will be lifted, meaning that substantial further list growth and cost pressures are now much more probable. The highest monthly list growth recorded at the practice was 8,000.
Despite the excessive drawdown of cash, which is GP at Hand driven, the detailed forward look confirms that the cash position is sound, subject to receipt of funding related to GP at Hand/mitigation in line with the ACF1 submitted
in September.
Ov
era
ll S
um
ma
ry
Red
Commentary
IN YEAR :
The CCG's own Forecast (excluding GP at Hand costs) has been held this month at the Most Likely level, but the total Forecast Outturn position has worsened as signalled at M9. This reflects a lack of forecast mitigation for non-
NWL GP at Hand costs, previously shown in Risks at M9. The reported Forecast Outturn position has thus worsened from a £5.2m Deficit to a Deficit of £15.3m, £15.8m worse than plan. Allowing for the Prior Year Drawdown of
£3.9m the true in-year deficit is £19.2m, of which £9m is CCG 'BAU' and £10.2m GP at Hand related. Intra-NWL GP at Hand costs have been and will be mitigated in 2018/19.
A number of pressures have arisen this month, notably in Acute Contracts £0.6m; CHC £0.6m;£0.3m FNC and Primary Care £0.3m; these have been offset by the release of the £1.5m seasonality allowance built into the M9
forecast, as a result of which the CCG has no confirmed reserves or mitigations, albeit detailed Balance Sheet and CHC reviews are ongoing and have the potential to yield value.
QIPP expectations have been reduced to £10.1m (from £10.2m), which is 59% of plan (a shortfall of £72m). YTD QIPP of £5.8m is 52% of plan. The pro-rata QIPP outturn is c£7m - meaning the step-change requirement in Q4 is
c£3.1m which relates to 1 key transactional item which is forecast to yield £3.2m, which has been reported in detail within the FRP.
Following the pressures seen in month, the Best Case scenario is a deficit of £11.3m, a worsening of £9.5m. That movement comprises £7.9m re:GP at Hand (the Best Case scenario retains £2.3m of mitigation for non-London
costs) plus a £1.6m worsening related to CCG driven matters of which £1.1m relates to a reduction in QIPP potential and the balance in month pressures offset by potential new acute challenges and the outcome of the balance
sheet review.
The Worst Case view is a deficit of £20.5m, a variation to plan of £21m.
The reported net Risks/Opps position of £1.4m combines a 'Business As Usual' total risk of £5.3m with a BAU opportunity of £1.6m in addition to which £2.3m has been included as a possible mitigation in relation to non-London GP
at Hand costs. The mechanism by which this mitigation will be transacted remains under discussion with and within NHSE, including at National level.
The YTD position is a deficit of £15.3m, £15.1m worse than plan. This arises from QIPP under-delivery of £5.3m plus non-mitigated GP at Hand costs of £8m plus other pressures (acute and CHC). Given that the QIPP plan was
heavily back-ended to M9-M12, this gap will increase in the near term absent delivery of in-year FRP schemes.
Cash utilisation is £2.8m (1%) worse than plan due to GP at Hand pressures. The CCG's MCD has been increased to reflect the forecast deficit at M9 and a further increase is expected following the further deterioration contained in
the M10 forecast, which would then align with the ACF1 submitted by the CCG at end M9.
Executive Summary
2
Status
Overall
financial
position
Risks and
opportunities
Underlying
position
QIPP
Reserves
Source: Team analysis
Commentary
Continuing Care : FOT shows an overspend of £4.7m/24.2%. Driven by QIPP scheme under-delivery of £3m including CHC and BCF. The £1m adverse FOT
movement is : £0.6m CHC - 14 new CHC cases (13 end of life); £0.3m PHB
The YTD position is £15.1m off plan driven by QIPP under-delivery and a lack of mitigation for non-NWL GP at Hand costs.
The Forecast position reflects the 'Most Likely' view and is a deficit of £15.3m, £15.8m off plan. This is a true in year deficit of £19.2m (offset by £3.9m
of historic drawdown). GP at Hand costs of £10.2m have been taken to the bottom line, of which £8m is in the YTD position. The major Q4 QIPP spike relies on
1 scheme which has been progressing via CFO negotiations. Progress has been made but there remains the possibility of mediation. The scheme is worth
£3.2m. There are significant apparent variances on a gross service line basis but many relate to GP at Hand costs, a revised presentation is being developed for
M11 given the revised position being adopted for GP at Hand costs.
Red
Service Line
Highlights (Net
of GP at Hand)
Net Risks/Opps position. This shows a total net £1.4m Risk. This combines a 'Business As Usual' total risk of £5.3m with a BAU opportunity of £1.6m in
addition to which £2.3m has been included as a possible mitigation in relation to non-London GP at Hand costs. The mechanism by which this mitigation will be
transacted remains under discussion with and within NHSE, including at National level. The 'Worst Case' scenario is a deficit of £20.5m.
The 'BAU' underlying deficit ranges from £30m to £31m, and includes the FYE of costs of GP at Hand.
YTD QIPP achieved is £5.8m, 52% of plan. The FOT anticipates delivery of £10.1m, 58% of plan. This forecast should be seen in conjunction with Risks/Opps;
and the detailed FRP which outlines key dependencies and risks.
All reserves have been released to support the Forecast position, including the 0.5% required by Business Rules, agreed with the NWL CFO prior to
closure of the M4 results. The seasonality allowance included in prior month forecasts has been released this month in view of service pressures noted below.
Community : FOT is off plan by £0.7m driven by non-delivery of QIPP.
Acute Contracts : FOT shows an overspend of £6.9m/4.4%. The driver of this pressure is reduced QIPP schemes of which the Non Elective scheme is the
largest deficit to plan (FOT is £2.2m below plan). There is also an increasing level of activity driven overperformance, particularly in out of sector contracts. This
month the underlying position worsened by £0.6m re:ICH, due to reduced challenge expectation and a critical care patient.
Prescribing : Ignoring GP at Hand variances, FOT is on plan but has deteriorated marginally.
Mental Health : Given GP at Hand costs are £1m below plan, there is a true overspend of £1m/2.6%. This arises from £0.6m of pressure at SWLStG and
CNWL (including £0.3m tariff impact), plus increasing pressure from NCAs and placements.
Executive Summary
3
On plan
Take note
Action required
Indicator Plan
Actual/Forec
ast
Rating this
month Comment
In Year surplus/deficit £387k (£15,273k) (£15,660) Reflects 'Most Likely' position. Includes drawdown of £3,879k and £10.2m GP at Hand non-NWL costs
Program Spend : Forecast Outturn £299,913k £315,573k (5.2%) GP at Hand costs; QIPP under-delivery; Acute, CHC and Mental Health pressures, partly offset by reserve releases.
Running Costs : Forecast Outturn £3,901k £3,901k 0.0%
QIPP year to date £11,048k £5,753k (47.9%) NEL (£1.4m); CHC (£0.9m); Primary Care (£0.7m) main drivers
QIPP forecast outturn £17,289k £10,127k (41.4%) NEL (£2.2m); CHC (£2.2m) and Primary Care (£1.7m) main drivers of shortfall
Risks and Opportunities £0k (£1,413k) (5.0%) Indicator of current view of worst case scenario outturn. Includes £10.2m re:GP at Hand.
Creditors - Better Payment Practice Code 95% 100% 5.4% % of invoice value paid in 30 days
Cash year to date £258,773k £261,589k (1.1%) Drawdown vs profile : is driven by GP at Hand costs
Key
CCG Finance Dashboard
4
Key Message
There are a number of key dependencies in the Forecast Outturn position. A summary of potential outturn scenarios is as presented below :-
2018/19 : Best; Most Likely; Worst Case Positions
Best Likely (=Forecast) Worst
GP at Hand Mitigation 2,266 0 0
Estates Costs 3,183 3,183 0
BCF QIPP Delivery 535 411 411
Contract Performance : Variance to FOT 600 0 (1,666)
Balance Sheet Review 500 0 0
CWHHE - Correction 69 0 0
CLCH - Pembridge 200 0 0
Other QIPP Delivery 200 0 (178)
CHC - Placements Review 0 0 (236)
Total Delivery 7,553 3,594 (1,669)
Resultant Deficit (11,314) (15,273) (20,536)
Variance to Plan (11,800) (15,759) (21,022)
Variance Previously Reported (2,265) (5,636) (20,982)
Movement (9,535) (10,123) (40)
MONTH 10 : Best; Most Likely (= Forecast); Worst Case Scenarios
GP at Hand (7,895) (10,161) 0
Acute Performance (551) 0 (292)
UCC Challenge (1,119) 0 0
Other 30 38 252
Total (9,535) (10,123) (40)
Excl GP at Hand (3,905) (5,598) (10,861)
GP at Hand (7,895) (10,161) (10,161)
Total (11,800) (15,759) (21,022)
Key Items Moving
Plan Variance
4a
5 6 6
Key message
At Month 10 the CCG forecast is off plan by £10.6m due mainly to costs for GP at Hand from outside NWL and QIPP slippage but with some acute (£2m), CHC (£1.6m) and Mental Health (£0.8m) pressures also, offset partly by reserves
which have been fully released.
Surplus/Deficit - CCG Position YTD and Forecast
Revenue Position : Total CCG Position - Including GP at Hand Costs
Budget Actual Variance Annual Forecast Forecast FOT
YTD YTD YTD Budget Actual Variance Change
£000's £000's £000's £000's £000's £000's £000's CommentsPROGRAMME
*Acute* 131,062 135,195 (4,133) 155,333 162,236 (6,903) 963 Overperformance of £6.9m/4.4% Including back ended QIPP of £0.2m; FOT
Variances : £1.3m GP at Hand costs; £4.9m QIPP driven plus activity pressures.
In month £0.9m improvement is release of £1.5m provision offset by
worsening position in acutes, driven by ICH at £0.6m including lower
challenges and £0.2m Critical Care patient
Community Health 27,693 26,968 726 33,099 32,391 709 746 Overperformance £0.7m/2.1%. £0.8m is QIPP driven. FOT change driven by
reduced expected costs for NCA (£0.1m); lower MSK costs (£0.2m); CLCH QIPP
(£0.1m); CLCH Mkt Rent correction (£0.1m)
Continuing Care 16,632 19,954 (3,322) 19,287 23,955 (4,669) (965) Overperformance £4.7m/24.2%. Driven by QIPP scheme under-delivery of
£3m including CHC and BCF. The £1m adverse FOT movement is : £0.6m CHC -
14 new CHC cases (13 end of life); £0.3m PHB
Mental Health 31,605 31,636 (31) 38,119 38,041 78 (427) Overperformance £1m allowing for lower GP@H costs. Driven by £0.6m
SWLStG/CNWL incl £0.3m unplanned tariff increase plus higher NCA's £0.2m.
Shift in month largely NCA driven.
Prescribing 19,340 16,443 2,898 23,525 20,154 3,371 (108) On track despite £0.6m NCSO pressures.
Primary Care 4,817 5,956 (1,140) 5,971 7,748 (1,777) 64 Overperformance £1.8m/29.8%. Reflects QIPP under-delivery by £1.4m plus
activity pressures and MH investment.
Primary Care Medical Services 25,124 23,708 1,416 31,152 29,431 1,720 (300) On plan allowing for lower than planned GP@H costs. £0.3m worsening due
to QOF adjustment and higher enhanced services. Fulham Cross costs have
been included but offset by releasing the £0.2m resilience provision.
Other Commissioned Services (9,217) 3,846 (13,063) (12,347) 5,134 (17,481) (10,793) Variance to plan reflects mainly £0 GP at Hand mitigation. In month
movement of £10.8m is £10.2m re:GP at Hand; £0.2m CWHHE higher costs;
Commissioning Reserves 561 0 561 5,774 0 5,774 0 All reserves released to cover pressures, including 0.5% release authorised
by NWL CFO
Prior Year 0 (952) 952 0 (3,517) 3,517 250 YTD and FOT values reflect release of Milson Road provisions (£0.6m) plus
historic estates costs (£2.3m) and other provision releases.
TOTAL 247,617 262,754 (15,137) 299,913 315,573 (15,660) (10,570)
ADMIN
Running Costs 3,274 3,274 (0) 3,901 3,901 (0) (0)
TOTAL 3,274 3,274 (0) 3,901 3,901 (0) (0)
GRAND TOTAL 250,891 266,027 (15,137) 303,814 319,474 (15,660) (10,570)
ALLOCATION
In Year Allocations 250,684 250,684 0 304,201 304,201 0 0 Includes £3,879k drawdown
TOTAL 250,684 250,684 0 304,201 304,201 0 0
In Year Surplus : Inc Drawdown (206) (15,343) (15,137) 387 (15,273) (15,660) (10,570) Memo : Total GP at Hand Costs :
In Year Surplus : Exc Drawdown (3,492) (19,152) YTD : £9.1m vs Plan £13.7m; FOT £11.6m vs £18m Plan
5
2018/19
Budget2018/19 FOT Drawdown
Other NR
Allocations
MFF
Smoothing
NWL GP@H
Mitigations
Non-
recurrent
spend (-/+)
18/19 Non-
Recurrent
QIPP (-/+)
Full Year
Effect of
QIPP (-/+)
Other Full
Year Effects (-
/+)
GP at Hand
Cost FYE
Forecast Exit
Run Rate
Recurrent QIPP
To Go
Forecast Exit
Run Rate - Excl
Future QIPP
Revenue Resource Limit (£000) 304,201 304,201 (3,879) (2,994) 799 (1,442) 296,685 - 296,685Non-recurrent Non- Full Year Other Full
2017/18 Budget 2017/18 Budget Non-recurrent Non- 17/18 Non- Full Year Other Full Programme
Acute Contracts 147,952 152,262 (1,713) 847 2,764 154,161 403 154,564
Acute Reserve / CEP - - - - -
Other Acute Commissioning 7,381 9,974 (167) 20 9,827 - 9,827
Continuing Care 19,287 23,955 (81) 23,874 153 24,027
Community 33,099 32,391 (75) (665) 31,651 41 31,692
Mental Health Commissioning 38,119 38,041 (60) (44) 615 153 38,705 39 38,744
Prescribing 23,525 20,154 324 20,478 150 20,628
Primary Care 5,971 7,748 (655) (588) 196 6,701 6,701
Delegated Primary Care Commissioning 31,152 29,431 632 30,064 30,064
Other Non Acute Commissioning 1,758 1,745 (153) - 1,592 1,592
Corporate & Estates (14,105) 3,389 1,107 4,496 4,496
Subtotal before Reserves 294,139 319,090 - (2,688) - - (648) 1,303 (200) 817 3,873 321,548 786 322,334
Reserves and Contingency
0.5% Non Recurrent Reserve 5,774 - 1,352 1,352 - 1,352
Prior Year Flexibility - (3,517) 3,517 - - -
Subtotal Reserves 5,774 (3,517) - 1,352 - - - 3,517 - - - 1,352 - 1,352
Total Programme Cost 299,913 315,573 - (1,336) - - (648) 4,820 (200) 817 3,873 322,900 786 323,686
Running Cost 3,901 3,901 3,901 - 3,901
Total CCG Cost 303,814 319,474 - (1,336) - - (648) 4,820 (200) 817 3,873 326,801 786 327,587
Surplus/(Deficit) incl Drawdown 387 (15,273) (3,879) (1,658) 799 (1,442) 648 (4,820) 200 (817) (3,873) (30,116) (786) (30,902)
At M10 the CCG is forecasting a deficit of £30.116m. - After adjusting for non recurrent spend and the full year effects of other items we arrive at the underlying position, the opening position for 2019/20, albeit that is before considering annual growth and cost pressures.
This includes GP at Hand costs. The major factors that may vary and move the forecast underlying position are activity/cost pressures (typically recurrent arising from contracts) and the degree to which QIPP may be delivered, and whether it is delivered recurrently or
non-recurrently. Annual growth and planning assumptions will further worsen this as we head into 2019/20.
Key Message
Forecast Underlying Position
6
The reported net Risks/Opps position of £1.4m combines a 'Business As Usual' risk of £5.3m with a BAU opportunity of £1.6m in addition to which £2.3m has been included as a possible mitigation in relation to non-London GP at Hand costs.
The mechanism by which this mitigation will be transacted remains under discussion with and within NHSE, including at National level.
- Risks : Relate to QIPP delivery and possible further contract overperformance - including possible extra bed pressure.
Key Message
Risks and Opportunities
7
Area Description
Budget
18/19
£000
YTD Plan
£000
YTD Actual
£000
YTD
Variance
£000
FOT
£000
FOT
Variance
£000
Comments
Commissioning
Reserves
General Contingency 1,352 0 0 0 0 1,352
Commissioning
Reserves
General Reserve 4,422 561 0 561 0 4,422
Reserves Total 5,774 561 0 561 0 5,774
Key Messages
General reserves have been released to offset QIPP non-delivery and other pressures.
Reserves
10
Sum of Total Schemes Identified at Outset (£k) Green Amber Red
Grand
Total
Business as usual changes 1,143 1,250 2,393
Service Changes 1,405 18 9,872 11,295
Transactional 2,429 1,003 3,871 7,303
Grand Total 4,977 1,021 14,993 20,991
Sum of Forecast (£k) Green Amber Red Grand Total
Business as usual changes 1,396 411 1,807
Service Changes 1,983 15 497 2,495
Transactional 4,830 829 167 5,825
Grand Total 8,208 843 1,075 10,127
Sum of Net Risk (£k) Green Amber Red Grand Total
Business as usual changes 1,296 411 1,707
Service Changes 1,569 15 420 2,004
Transactional 1,647 829 167 2,642
Grand Total 4,511 843 998 6,353
Key Messages
At the start of 2018/19 the identified QIPP schemes totalling £20,991k, whilst the Financial Plan required QIPP of £17,289k. The forecast recognises delivery
of £10,127k (59%). A further £6,353k of risk is reflected below, mostly re:1 scheme, and will be subject to future negotiation.
RAG Rating of Schemes : Is on the NHSE basis namely :-
- Green : FOT Delivery 95%+
- Amber : FOT Delivery 75%-95%
- Green : FOT Delivery <75%
Quality, Improvement, Productivity plan (QIPP)
11
Key Messages
Plan/Forecast Profile : The M12 spike of primarily relates to Contract Challenges (scheme FOT £5.9m in M12).
Quality, Improvement, Productivity plan (QIPP)
0
1000
2000
3000
4000
5000
6000
7000
M01 M02 M03 M04 M05 M06 M07 M08 M09 M10 M11 M12
2018-19 Total Plan (£20.9m) Vs Forecast (£10.1m)
Total Forecast- All Schemes Total Actuals- All Schemes Total Plan- All Schemes
0
1000
2000
3000
4000
5000
6000
M01 M02 M03 M04 M05 M06 M07 M08 M09 M10 M11 M12
2018-19 Total CCG Schemes Plan (£17.3m) Vs Forecast (£10.1m)
Total Forecast- Local Schemes Total Actuals- Local Schemes Total Plan- Local Schemes
-500
0
500
1000
1500
2000
M01 M02 M03 M04 M05 M06 M07 M08 M09 M10 M11 M12
2018-19 Total NWL Scheme Plan (£3.6m) Vs Forecast (£1.6m)
Total Forecast- NWL Schemes Total Actuals- NWL Schemes Total Plan- NWL Schemes
12
Program Area Recurrent/ Non YTD Plan (£k) YTD Actual (£k) YTD Var (£k)
Gross Scheme
(£k) Forecast (£k)
Forecast Var
(£k)
Acute R £4,651 £507 (£4,143) £5,955 £820 (£5,135)
Acute Total £4,651 £507 (£4,143) £5,955 £820 (£5,135)
Community R £738 £157 (£581) £1,038 £189 (£849)
Community Total £738 £157 (£581) £1,038 £189 (£849)
Continuing Care R £2,229 £673 (£1,557) £3,079 £861 (£2,218)
Continuing Care Total £2,229 £673 (£1,557) £3,079 £861 (£2,218)
Estates NR £263 £893 £630 £4,113 £4,128 £15
R £362 £362 £0 £362 £362 £0
Estates Total £625 £1,255 £630 £4,475 £4,490 £15
Mental Health NR £33 £0 (£33) £50 £0 (£50)
R £538 £540 £1 £577 £579 £2
Mental Health Total £572 £540 (£32) £627 £579 (£48)
Other Commissioned Services NR £0 £240 £240 £240 £240 £0
R £388 £349 (£39) £597 £424 (£173)
Other Commissioned Services Total £388 £589 £201 £837 £664 (£173)
Prescribing R £1,210 £1,509 £300 £1,437 £1,589 £152
Prescribing Total £1,210 £1,509 £300 £1,437 £1,589 £152
Primary Care NR £1,312 £65 (£1,247) £1,889 £196 (£1,693)
R (£29) (£13) £16 (£35) (£15) £20
Primary Care Total £1,283 £53 (£1,230) £1,854 £181 (£1,673)
Other Acute Services R £366 £275 (£91) £439 £343 (£96)
Other Acute Services Total £366 £275 (£91) £439 £343 (£96)
Continuing Care Servies R £1,042 £196 (£846) £1,250 £411 (£839)
Continuing Care Servies Total £1,042 £196 (£846) £1,250 £411 (£839)
Grand Total £13,102 £5,753 (£7,349) £20,991 £10,127 (£10,864)
Key Messages
Summary of schemes by program area.
Quality, Improvement, Productivity plan (QIPP)
13
Capital • No Capital Spend YTD or planned
•
Invoice
Count
Invoice
Count
(Passed)
% Passed BPPC
Amount
Invoice
Amount
(Passed)
% Amount
Passed
NHS 398 387 97.2% 19,312,863 19,347,899 100%
Non NHS 482 479 99.4% 2,802,675 2,797,220 100%
Total 880 866 98.4% 22,115,538 22,145,119 100%
• Maximum Cash Drawdown Plan: £310,528 Drawn Down to Date: £261,589
Percentage of MCD Utilised: 84.2% Percentage of Months Completed: 83.3%
Key message
Creditor
payments
Cash
The 2018/19 MCD has been calculated by NHS England based on M10 RRL less balance of cash left over at the end of the previous financial year, depreciation
and planned surplus/ deficit. The CCG is currently 1% (£2.8m) over its planned drawdown, this decrease compared to M9 2.5% (£7.7m) is mainly due to the
increase in cash limit as a result of increase in overall deficit for 1819.
Capital, Creditor Payments and Cash
70.0%
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
M01 M02 M03 M04 M05 M06 M07 M08 M09 M10 M11 M12
NHS Number
NHS Amount
Non NHS Number
Non NHS Amount
14
Current Overdue 1-30 Overdue 31-60 Overdue 61-90
Overdue 91-
120
Overdue 121-
180 Overdue 181-360
Overdue
361+
Total Due and
OverdueCommentary
NHS CLINICAL COM GROUPS 117,783 543,335 46,057 33,758 54,344 262,345 136,513 287,676 1,481,811 £1.1m relates to UCC only out of which £253k is
pre 17/18, PID data is being sent regularly, chaser
letter signed by CFO has been sent and there has
been slight reduction ,with more expected before
year end, credit note also been issued where
appropriate so balance on invoice can be paid.
Ealing is the biggest CCG owing due to lack of
authorisation of invoices which we are urgently
chasing.
NHS ENGLISH TRUSTS 0 0 0 202,778 0 0 0 0 202,778 Q1 and Q2 - 18/19 Psychiatric Liaison, we are
chasing Imperial to get this paid in M11
NON NHS LOCAL AUTHORITIES 372,055 0 0 0 25,000 0 0 0 397,055 LB of H&F confirmed to be paid in M10
NON NHS COMPANY 5,023 122,380 0 0 0 0 0 0 127,403 Finance is working with commissioner in chasing
End of Life Care
NON NHS HEALTH BODIES 0 0 0 0 0 39,314 0 0 39,314 North End Medical Centre £39k been resolved by
Primary Care Team
NON NHS INDIVIDUAL 0 0 0 0 0 0 3,616 2,681 6,297 Sal overpayments and Season Ticket, 1 individual
left on monthly payment plan, 1 to be recalculated
as last date of service was incorrect, last one still
been chased by SBS as indiviudual has challenged
this, Last resort would be to escalate to CCI.
NON NHS WELSH SCOTS+NI BODIES 0 0 0 0 0 0 0 2,124 2,124 UCC, backup info sent again as requested, possible
credit note to be raised before year end.
NON NHS PHARMACY TRADING 3,861 3,143 0 0 0 0 0 0 7,003 Prescription charges to be paid in M11
Grand Total 498,722 668,858 46,057 236,536 79,344 301,659 140,129 292,481 2,263,785
22% 30% 2% 10% 4% 13% 6% 13% 100%
Bad Debt Allowance : At the end of 17/18 we estimated £353k as potentially non recoverable - this remains on the Balance Sheet at this time
The NWL Policy covers non-NHS debts above 1 year past due
Aged Creditors by Profile Current Overdue 1-30 Overdue 31-60 Overdue 61-90 Overdue 91+ Total (£)
NHS
3,611,579 2,419,956 4,970 50,365 72,371 6,159,243
INTER-COMMISSIONING - - 595 - -627 -32
INTER-COMMISSIONING NHSE-CCG - - - - -342 -342
NON-NHS OTHER 4,395 - - - - 4,395
NON-NHS TRADE
199,938 76,520 1,555,126 3,230 -43,689 1,791,124
Grand Total 3,815,912 2,496,476 1,560,691 53,595 27,713 7,954,388
48.0% 31.4% 19.6% 0.7% 0.3% 100.0%
Amounts Receivable
Amounts Payable
£3.1m is relating to M11 inv - ChelWes, LAS, Guy's and St Thomas, The bulk of the over 90+ Hillingdon NHSFT
£40k and Royal Free £30k, payment is expected to be in Feburary once validated.
Commentary
NELCSU , credit issued awaiting backing data so validation can be done
NW Surrey CCG refund requested for credits as no new invoices has been received so far.
Credits to be resolved in M11 - Bondcare £5k, Canberra ( now merged) £11k, Cygnet £13k , CHP £8k,
Independent Comm Care Mngt £8k all awaiting further invoices / approval. The £1.5m relates to LB of H&F to
be paid in Feb as per agreement
Debtors and Creditor Analysis
15
Statement of Financial Position
31-Jan-19 31-Mar-18
£'000 £'000
Non-current Assets
Property, Plant & Equipment 917 1,085
Total Non-current Assets 917 1,085
Current Assets
Trade & Other Receivables 3,890 6,464
Other Financial Assets 0 0
Cash & Cash Equivalents 14 118
Non-current Assets held for Sale 0 0
Total Current Assets 3,904 6,582
Total Assets 4,821 7,667
Current Liabilities
Trade & Other Payables: (39,542) (36,697)
Borrowings (121) (121)
Provisions (423) (983)
Total Current Liabilities (40,085) (37,801)
Total Assets less Current Liabilities (35,264) (30,133)
Non-current Liabilities
Borrowings (843) (917)
Provisions (495) (1,125)
Total Non-current Liabilities (1,338) (2,042)
Total Assets Employed (36,603) (32,175)
Financed by Taxpayers’ Equity
General Fund (36,603) (32,175)
Total Taxpayers’ Equity (36,603) (32,175)
Balance Sheet
16
Provider Plan Actual Mitigations Mitigated
Actual
Mitigated
Variance
Plan Mitigated
Actual
Mitigated
Variance
Plan Mitigated
Actual
Mitigated
Variance
In Sector
Chelsea And Westminster Hospital NHS Foundation Trust 29,118 30,169 (222) 29,947 (828) 32,442 33,394 (952) 38,706 39,711 (1,005) 243 (762)
The Hillingdon Hospitals NHS Foundation Trust 629 581 (36) 545 84 701 610 91 836 727 109 21 130
Imperial College Healthcare NHS Trust 63,679 63,294 305 63,598 80 70,956 70,992 (36) 84,667 84,957 (290) 394 103
London North West Healthcare NHS Foundation Trust 1,544 1,934 (102) 1,832 (288) 1,720 2,043 (322) 2,052 2,411 (359) 75 (284)
Royal Brompton and Harefield NHS Foundation Trust 745 976 0 976 (231) 830 1,090 (260) 990 1,313 (322) 6 (316)
Out of Sector
Guy's And St Thomas' NHS Foundation Trust 1,146 2,146 (1) 2,144 (998) 1,279 2,396 (1,117) 1,527 2,852 (1,325) 507 (818)
King's College Hospital NHS Foundation Trust 353 505 0 505 (152) 393 564 (170) 470 671 (202) 138 (64)
Moorfields Eye Hospital NHS Foundation Trust 620 788 0 788 (168) 691 881 (190) 825 1,056 (231) 56 (175)
Royal Free London NHS Foundation Trust 355 732 0 732 (377) 396 820 (424) 472 974 (501) 210 (291)
St Georges University Hospitals Nhs Foundation Trust 507 833 (1) 832 (325) 565 929 (363) 675 1,106 (431) 198 (233)
The Royal Marsden NHS Foundation Trust 681 850 0 850 (169) 760 951 (191) 908 1,131 (223) 12 (211)
University College London Hospitals NHS Foundation Trust 1,401 2,149 (2) 2,148 (747) 1,561 2,400 (839) 1,863 2,820 (957) 351 (606)
Other Out of Area Providers 1,426 2,763 (7) 2,757 (1,330) 1,591 3,079 (1,488) 1,899 3,670 (1,771) 4,961 3,190
Acute SLA Contract Total 102,205 107,720 (66) 107,654 (5,449) 113,887 120,148 (6,261) 135,891 143,400 (7,509) 7,172 (337)
Key Messages
M9 YTD SLAM M10 YTD Position Full Year Outturn Position
The year to date contract position at month 10 is based on the activity data received for month 9, less £0.07 mitigations and extrapolated forward.
The forecast overperformance of £7.51m includes £7.2m of GP at Hand costs, without which contracts would be on plan, despite QIPP under-delivery
GP at
Hand :
Costs
(Straight
line)
Variance
net GP at
Hand
Acute Contracts: Year to Date Performance
17
Key Messages
Month Recurrent / non
recurrent
Allocation In Year
£'000s
Historic
£'000s
Total £'000s
1 Recurrent 18/19 Opening Position between 08C and X24 - HRG 4 1,428 1,428
1 Recurrent 18/19 Opening Position between 08C and X24 - IR (740) (740)
1 Recurrent 18/19 Opening Position between 08C and X24 -1819 Opening 1819 Recurrent Allocation 263,664 263,664
1 Recurrent Additional Resource 2018-19 2,069 2,069
1 Non Recurrent 18/19 Paramedic Allocations 167 167
1 Recurrent Market Rent 86 86
1 Non Recurrent HSCN 39 39
1 Non Recurrent 2017/18 Brought Forward Surplus/Deficit 6,565 6,565
1 Non Recurrent Surplus Carry Forward - Drawdown (3,879) (3,879)
1 Non Recurrent Surplus Carry Forward - Drawdown 3,879 3,879
3 Non Recurrent Moved from Delegated to Programme - GPFV 239 239
3 Non Recurrent Digital Diabetes Pilot - 1st Trance Payment for LHEs 13 13
3 Non Recurrent GP WIFI Maintenance 2018/19 11 11
4 Non Recurrent Transformation - M04 IAT Adjustment for IR Changes (680) (680)
4 Non Recurrent GP at Hand Q1 68 68
4 Non Recurrent £2m IAP (2,000) (2,000)
4 Non Recurrent MFF SUPPORT 18-19 (799) (799)
4 Non Recurrent S&T CONTIBUTION (1,753) (1,753)
4 Non Recurrent GP at Hand Q1 20 20
4 Non Recurrent GP at Hand Q1 17 17
5 Recurrent AfC Pay award uplift - Programme 5 5
6 Non Recurrent CSS pay award distribution 5 5
6 Recurrent GP at Hand Q1 18/19 61 61
6 Recurrent Funding of Flu Vaccination (135) (135)
6 Non Recurrent Reimbursement re CSS Comms, datawarehouse and travel 141 141
6 Non Recurrent PC workforce recruitment and retention (GP retention) 32 32
6 Non Recurrent Practice resilience 35 35
6 Non Recurrent GP at hand 108 108
6 Non Recurrent Extended Access 359 359
6 Non Recurrent GP at Scale 89 89
6 Non Recurrent 2nd & Final payment – NHS Digital Diabetes Prevention Pilot 12 12
7 Non Recurrent GP at hand Q2 125 125
7 Non Recurrent Risk share 2,000 2,000
7 Non Recurrent GP at Hand balance Q1 and Q2 55 55
7 Non Recurrent Excess Treatment Programme. Gateway ref: 08385 & 08594 (7) (7)
8 Non Recurrent GP at Hand 46 46
8 Non Recurrent TCP Estimated Costs 29 29
8 Non Recurrent Charge Exempt Overseas Visitor (CEOV) Adjustment 1,422 1,422
8 Non Recurrent Funding for STP GPN 10 Point Plan work 18/19 51 51
9 Non Recurrent GP at Hand Q3 and Q4 funding 248 248
9 Non Recurrent GP at Hand 103 103
9 Non Recurrent Net Q3 GP at Hand Adjustment 42 42
9 Non Recurrent GP at Hand - Q3 & Q4 60 60
9 Non Recurrent GP AT SCALE FUNDING 18/19 -TRANCHE 2 89 89
9 Non Recurrent GP at Hand NWK Risj Share M8 Update 180 180
9 Non Recurrent Quality Premium Tranche 1 Measures 2 - 6 306 306
9 Non Recurrent M09 - AfC adjustments - L Hampson 6 6
10 Non Recurrent GP at Hand 2018-19 223 223
10 Non Recurrent Funding for STP GPN 10 Point Plan work 18/19 (51) (51)
10 Non Recurrent TCP Funding Transfer 151 151
10 Non Recurrent RE: REVISED CONTRIBUTIONS 85 85
10 Non Recurrent LD transforming care additional support funding 38 38
Programme allocation total 278,206 (3,879) 274,327
1 Recurrent 18/19 Opening Position between 08C and Q71 - Co Commissioning 28,812 28,812
3 Non Recurrent Moved from Delegated to Programme - GPFV (239) (239)
5 Non Recurrent GP at hand QTR 1 86 86
Primary Care 28,659 0 28,659
1 Recurrent 18/19 Opening Position between 08C and X24 - Running Costs 3,861 3,861
1 Non Recurrent HSCN - running Costs 4 4
5 Recurrent AfC Pay award uplift 55 55
6 Non Recurrent CSS pay award distribution 8 8
9 Non Recurrent M09 - AfC adjustments - L Hampson (27) (27)
Running cost allocation 3,901 0 3,901
Total RRL 310,766 (3,879) 306,887
Source: Financial ledger
In Month Transfers:
£446k of allocations were received in Month10. These include £223k that was received from NWL CCGs for GP at Hand and £151k received for TCP. £85k was provided
for the S&T transfer and £38k was provided for LD transforming care. £51k funding was removed for the STP GPN 10 Point Plan.
Appendix 1.1: Revenue resource limit
1.1
The RAG rating definitions are as follows:
1. Financial position in month - Red is greater than or equal to 2%, Amber is less than 2% but greater than 0% and green is less than or
equal to 0%.
2. Financial position year to date - Red is greater than or equal to 1%, Amber is less than 1% but greater than 0% and green is less than or
equal to 0%.
3. Financial position forecast outturn - Red is greater than or equal to 0.5%, Amber is less than 0.5% but greater than 0% and green is less
than or equal to 0%.
4. Running costs forecast outturn - Red is greater than or equal to 0.5%, Amber is less than 0.5% but greater than 0% and green is less
than or equal to 0%.
5. QIPP year to date / QIPP forecast outturn / Investment plan - Red is greater than or equal to 20%, Amber is less than 20% but greater
than 5% and green is less than 5%.
6. Risks and opportunities - Red is greater than or equal to 0.5%, Amber is less than 0.5% but greater than 0% and green is less than 0%.
7. Creditors - Better Payment Practice Code - Red is less than or equal to 92.5%, Amber is less than 95% but greater than 92.5% and green
is greater than or equal to 95%.
8.Capital outturn -Red is greater than or equal to 10%, Amber is greater than 0.5% but less than 10% and green is less than 0.5%.
9. Cash drawn down to date - Red is less than or equal to 85%, Amber is less than 95% but greater than 85% and green is greater than or
equal to 95%.
Appendix 2.1: RAG rating definitions
2.1
8 9
Key message
The table below shows the CCG corporate costs split by local H&F CCG, CSS teams shared across the 8 NWL CCGs and CWHHE teams shared across the 5 CCGs. The running cost allocation (admin) is based on CCG population size which means
H&F CCG being the smallest CCG has the lowest allowance. The forecast variance of £553K is being driven by a £241K and £75K overspend on central CWHHE and CSS costs that are charged to H&F CCG which indicates that the 10% savings
target is not being achieved. The £226K overspend within Local CCG costs is due to unrealised 10% saving.
Corporate Costs
3.1
Acute Contract Activity : Gross
4.1
