Financial evaluations demonstrate that GPs who have taken over budgets from PCTs under the Government’s NHS reforms are sliding millions into the red. According to a Pulse analysis of financial data reported by CCGs across 55 primary care trusts, two-thirds of shadow clinical commissioning groups (CCGs) reporting figures are currently missing their financial targets.

The analysis raises questions over the GPs capacity to save costs and deliver planned savings. At present 29% of all PCTs are behind budget for 2011/12 and only 9% predict they will not meet their financial targets by April 2012.

Of the 29 CCGs who provided figures, 66% reported to be behind budget, whilst 4 of the 20 CCGs who make end-of-year forecasts reported they would still be in deficit at the end of the financial year despite having introduced tough measures to achieve their target.

The CCG analysis contained overall financial figures from NHS Cumbria, NHS Cambridgeshire and NHS Northamptonshire. All or most budgets in these counties are already GP controlled. NHS West Sussex is amongst the worst hit areas, with the PCT being £15m behind budget and because of overspending on acute care; its two CCGs are £9.1m and £13.6m behind budget. According to the PCT end-of-year targets would only be met providing a further £26m can be made in savings and by appointing a turnaround director.

In other counties NHS Barking and Dagenham are behind budget by a total of £2m. Their constituent CCGs is behind by £2.5m, £1.4m and £106,000 respectively.

Because of acute over-activity in commissioning hotspots like NHS Cumbria, GPs run £714,000 behind target and £2.2m in Bexley Care Trust. Both reported they expected to meet targets by year-end. Cumbria has initiated a CCG-led recovery plan, which involves ‘a number of remedial financial measures’.

More success has been registered in other showcase CCGs, as for example in NHS Northamptonshire, where Nene Commissioning has full budgetary responsibility in shadow form. At present, Northamptonshire’s trust is £4.1m ahead of budget with predictions of being ahead by £7m by the end of 2011/12. Bassetlaw CCG is also ahead by £325,000 and Dudley CCG by £471,000.

In total, the net-shortfall for the 29 CCGs with figures amounts to £28m, which translates into an average shortfall per CCG of £967,000.

According to Dr Peter Weaving, joint chair of NHS Cumbria’s clinical senate and a GP in Brampton, the CCG had to face ‘extreme financial challenges’ but was improving to balance the budget.

He stated:

“We don’t have a referral centre but we expect individual clinicians to take responsibility and follow local guidelines, and we’ve got a whole shedload of things we’re implementing to reduce the call on unscheduled care.”

Chair of North West Sussex Commissioning Association CCG, Dr Amit Bhargava predicted: “There will be increased pressure on CCGs to enforce more pressure. We need to create demand-led savings to ensure the need for services reduces.”

According to Dr Chaand Nagpaul, a negotiator for the GP committee of the BMA: “Costs are generated through modifications in coding and re-referrals.” He stated that the Government should concentrate on reforming the ‘perverse’ payment system that has encouraged over-activity.

A Department of Health spokesperson declared:

“We do not think this information regarding shadow CCGs’ financial positions represents a realistic picture. As described in the 2011/12 NHS Operating Framework, we expect PCTs and developing CCGs to work together to ensure that financial control and balance is maintained in 2011/12 and 2012/13. The DH is ensuring organizations forecasting a deficit have plans in place for financial recovery, while continuing to improve the quality of services to patients.”

The editor of Pulse, Richard Hoey commented:

“Many GPs have been skeptical from the start about whether the profession has the financial skills and capacity to take over NHS budgets at a time when health spending is being so severely constrained. Our figures certainly throw the financial challenge facing the new clinical commissioning groups into stark relief, and suggest GPs will only be able to get back to balanced budgets by taking some incredibly tough decisions about the funding for patient care. There will be some GPs who ask – is this really what I trained as a doctor to do?”

Written by Petra Rattue