REPORT TO MERTON CLINICAL COMMISSIONING ......2016/01/26 · digestive system procedures. • Queen Mary’s – YTD under spend of £153k is owing to mainly to rehab services. •

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REPORT TO MERTON CLINICAL COMMISSIONING GROUP GOVERNING BODY

Date of Meeting: 26th January 2016 Agenda No: 6.3 Attachment: 07

Title of Document: Finance Report – Month 8

Purpose of Report: For Agreement

Report Author: Faiza Waheed

Lead Director: Cynthia Cardozo

Contact details: [email protected] or [email protected]

Executive Summary: NHS Merton CCG is reporting achievement of plan for the eight months to 30th November 2015.

A full year forecast over spend of £3.1m is reported on acute commissioning. The over performance is

mostly seen at St George’s, Kingston and Epsom and St Helier NHS Trusts.

A full year under spend of £1.3m is forecast on non-acute commissioning and a full year over spend of

£0.5m is reported on prescribing.

The forecast over spends are offset by slippage on investments, utilisation of the contingency fund, an

assumption that critical care and outpatient activity will not continue to increase at the same rate and

an assumption that Merton’s contribution to the SWL risk pool will be returned.

Key sections for particular note (paragraph/page), areas of concern etc: Entire report

Recommendation(s): Approve the finance report

Committees which have previously discussed/agreed the report: Finance Committee

(14.12.15)

Financial Implications: As per finance report, reporting to plan as at Month 8.

Implications for CCG Governing Body: Financial indicators are part of the CCG assurance framework used by NHS England – For Month 8 the financial performance is rated as amber green.

How has the Patient voice been considered in development of this paper: N/A

mailto:[email protected]

mailto:[email protected]

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Other Implications: (including patient and public involvement/Legal/Governance/Risk/Diversity/ Staffing) None

Equality Assessment: N/A

Information Privacy Issues: N/A

Communication Plan: (including any implications under the Freedom of Information Act or NHS Constitution) N/A

NHS Merton CCG

2015-16 Finance Report Month 8 – as at 30th November 2015

1

Governing Body 26th January 2016

Contents Slide Number

EXECUTIVE SUMMARY 3

INCOME AND EXPENDITURE POSITION 4

IN YEAR POSITION 5

UNDERLYING POSITION 6

QUALITY, INNOVATION, PRODUCTIVITY AND PREVENTION (QIPP) 7

ACUTE PERFORMANCE 8 – 15

NON ACUTE PERFORMANCE 16

PRESCRIBING AND PRIMARY CARE 17

RISKS AND MITIGATIONS 18

APPENDICES 19 – 27

2

Finance Report – Month 8

EXECUTIVE SUMMARY

3

Eight months to 30th November 2015

• For the eight months to 30th November 2015 NHS Merton CCG is reporting a year to date and full year surplus performance to target.

• Acute commissioning is reporting a year to date over spend of £2.4m and a full year forecast over spend of £3.1m. St George’s

University Hospitals NHS Foundation Trust is reporting a year to date over spend of £1.9m and full year over spend of £2.9m primarily

in critical care and outpatients. A year to date over spend of £0.3m and full year over spend of £0.5m is reported at Epsom and St Helier

NHS Trust mainly in outpatient activity and critical care. A year to date over spend of £0.4m and full year over spend of £0.8m is

reported at Kingston Hospital NHS Foundation Trust mainly in outpatient activity.

• Non acute commissioning is reporting a full year forecast under spend of £1.3m, this is an adverse movement of £0.5m compared to

previous month. The movement is owing to increased forecast spend for mental health placements and continuing care in Month 8. The

full year forecast under spend is mostly owing to a delay in the roll out of some Better Care Fund Schemes and under spends on

investments.

• Prescribing is reporting a full year forecast over spend of £0.5m owing to higher prescribing rates and an increase in the price of some

items.

• Running costs are forecast to break-even.

• The forecast over spends are being offset by under spends on investments, utilisation of the 0.5% contingency fund and an assumption

that critical care and outpatient activity will not continue to increase at the same rate. The activity from St George’s University Hospitals

NHS FT is also expected to transfer to the Nelson Health Centre to offset the minimum income guarantee. In Month 8, the position on

non acute services has worsened by £0.5m and the forecast delivery of the surplus to target assumes return of Merton’s £0.5m

contribution from the SWL risk pool.

• QIPP – A year to date over performance of £0.3m and a full year achievement of target is forecast.

• The Better Practice Payment Policy is above target for both the number and value of invoices paid in the month.

Recommendation

• Governing Body are asked to approve the Month 8 Finance Report and note the risks on slide 18.

INCOME AND EXPENDITURE

4

Commentary

• Year to date (YTD) and full year (FY)

surplus is on target.

• The resource limit has increased by

£0.1m in Month 8 for a non recurrent

allocation adjustment of £132k for

Latent TB.

• The in year forecast surplus position

and underlying position are reported on

slides 5 and 6.

• Risks to the position are detailed on

slide 18.

Nov-15

Budget Actual Variance In £000's Budget Actual Variance

1 159,042 159,042 0 Income 237,894 237,894 0

Expenditure

2 85,485 87,889 (2,403) Acute 127,965 131,113 (3,149)

3 15,100 14,966 134 Mental Health 22,649 22,448 201

4 14,017 13,051 967 Community 21,026 19,865 1,161

5 14,772 14,795 (23) Other non acute 22,158 22,189 (31)

6 15,333 15,651 (318) Prescribing 23,000 23,474 (475)

7 3,425 3,115 311 Primary Care* 5,138 4,672 466

8 5,826 5,877 (50) Corporate and estate 8,740 8,835 (95)

9 3,506 2,123 1,383 Reserves 4,852 2,930 1,922

10 157,465 157,465 0 Total Expenditure 235,528 235,528 0

11 1,577 1,577 0 Surplus 2,366 2,366 0

*Out of Hours , Local Enhanced Services , GP Led Health Centre and Col laborative Fees

Year to date Forecast

IN YEAR POSITION – NHS ENGLAND DASHBOARD – MONTH 8

5

Commentary

• The table shows the allocation split

between the in year allocation and draw

down of historical surplus to show the in

year forecast surplus.

• The variance reported on the in year

performance is caused by return of the

non recurrent legacy continuing

healthcare provision (£0.5m) partially

offset by the slightly higher surplus this

year (£0.2m).

In-year allocation: YTD

15/16 Core Allocation 235.23 157.26

Allocation of prior years surplus for drawdown 0.30 0.20

Total share of NHSE mandate for 2015/16 235.53 157.46

Expenditure:

Forecast Expenditure 235.53 157.47

Forecast under/(over)-spend against in year allocation (0.00) (0.00)

In-year performance:

Performance against 15/16 core allocation (0.30)

Made up of:

Planned use of prior year surpluses (agreed drawdown) (0.30)

Other in year under/(over)-spend against resource limit (0.00)

Memorandum: cumulative (historic) surplus/(deficit)

Total share of NHSE mandate for 2015/16 235.53

Return of remaining prior year surplus/(deficit) 2.37

Total allocation plus historic surplus/deficit 237.89

Forecast Surplus / (deficit) against total allocation 2.37

Target additional surplus required to meet business rules 0.00

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UNDERLYING POSITION – NHS ENGLAND DASHBOARD – MONTH 8

6

Commentary

• The table above starts with the reported full year plan and forecast outturn figures for the month to give the reported surplus position. It then adjusts for

non recurrent allocations and non recurrent spend to establish the underlying recurrent position. As at Month 8, Merton CCG’s underlying recurrent

surplus position is 0.94% of the total recurrent resource.

£'000s

CCG

2015/16

Submitted

Plan

Actioned In-

year

changes

CCG 2015/16

Annual

Budget at

M08

B

L

a

n

k

1

In-year over

and under

performanc

e

(B) Other Please explain '(B) Other'

2015/16

Forecast

at M08

(agrees to

ISFE)

B

l

a

n

k

2

Remove

non rec

allocation

s - note 1

Remove

non rec

spend -

note 2

Add back

non rec

QIPP

schemes /

benefits

Remove

FYE of

QIPP

Add FYE of

investments(C) Other Please explain '(C) Other'

2015/16

outturn

exit rate

(underlying

recurrent

position)

(+/-) (+/-) (+/-) (+/-) (-) (+) (-) (+) (+/-)

Resource

Programme allocation 232,047 1,303 233,350 233,350 (3,515) 229,835

Running cost allocation 4,544 4,544 4,544 4,544

Total resource 236,591 1,303 237,894 0 0 237,894 (3,515) 0 0 0 0 0 234,379

Spend

Programme (exc. Headroom) 225,886 1,303 227,189 1,183 228,372 (740) 0 227,632

1.0% headroom 2,612 2,612 2,612 (2,612) 0

Contingency 1,183 1,183 (1,183) Used to support position 0 0

Admin 4,544 4,544 4,544 4,544

Total spend 234,225 1,303 235,528 1,183 (1,183) 235,528 (740) (2,612) 0 0 0 0 232,176

Surplus / (deficit) 2,366 0 2,366 (1,183) 1,183 2,366 (2,775) 2,612 0 0 0 0 2,203

% 1.00% 0.99% 0.99% 0.94%

QIPP

7

Commentary

• YTD QIPP over performance of £0.3m is owing to over

achievement on the mental health placements scheme,

musculoskeletal transactional savings and better care fund

savings. The savings on the mental health placements will taper

off towards the end of the year.

• The FY forecast is break-even. Under achievement of £0.4m is

forecast on the prescribing work stream owing to staff being on

leave and delays in recruitment. Under achievement of £0.4m is

forecast on the outpatient navigation scheme owing to a number

of risks identified with the delivery of the planned care

programme. The under achievement has been offset to some

extent by the Musculoskeletal scheme with forecast savings of

£0.1m and higher than target savings of £0.1m on the mental

health placements scheme. Currently, a gap of £0.6m has been

identified in achieving the QIPP target. An in year scheme on

outpatient QIPP is being worked on and will be reflected on the

dashboard once the project documents are approved at the

Operations Delivery Group.

Nov-15


Schemes

1 1,399 1,854 (455) Transactional 2,294 2,543 (249)

2 1,275 1,124 151 Transformational 2,577 2,328 249

3 2,674 2,978 (304) Total QIPP 4,871 4,871 -

4 2,674 2,978 (304) QIPP Target 4,871 4,871 -

5 100% 111.4% -11% % of Target 100% 100.0% 0%

Year to date (net) Forecast (net)

STATEMENT OF CONTRACT POSITION – At Month 7 not Month 8

8

Commentary

The three highest value

contracts will be discussed in

further detail on slides 10 - 15.

• Croydon Health Services –

YTD under spend of £84k is

driven by emergency (£101k)

and critical care (£54k).

• Royal Marsden – YTD over

performance of £0.2m is

mostly owing to critical care

(£144k) and elective (£109k).

In electives, over

performance is being seen in

breast procedures and

digestive system procedures.

• Queen Mary’s – YTD under

spend of £153k is owing to

mainly to rehab services.

• Chelsea & Westminster –

YTD under spend of £144k is

seen in elective activity

(£101k) mainly T&O.

• Royal National Orthopaedic –

YTD over spend of £67k is

driven by emergency

(reconstruction procedures)

and elective activity (T&O).

Plan YTD YTD YTD

Provider Annual Plan Actual Variance YTD YTD YTD Variance Movement from

Plan Other Plan Actual Variance Previous YTD Previous

Adj Challenges extrapolated Month

£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

St George's 56,617 33,176 35,730 (2,554) 0 (284) (621) 33,176 34,825 (1,649) (1,198) (451)

Epsom & St Helier (Acute & Renal) 31,177 19,381 18,919 462 (397) (401) (50) 18,984 18,468 517 215 302

Epsom & St Helier (SWLEOC) 4,310 2,514 2,304 210 0 0 0 2,514 2,304 210 114 97

Kingston Hospital 9,599 5,861 6,043 (183) 0 (76) (18) 5,861 5,950 (89) (211) 122

London Ambulance Service 6,176 3,603 3,603 0 0 0 0 3,603 3,603 0 0 0

Moorfields' Eye 3,859 2,251 2,279 (27) 0 0 0 2,251 2,279 (27) (23) (5)

Croydon Health Services 1,960 1,192 1,114 77 4 (2) (0) 1,196 1,112 84 81 3

Guy's & St Thomas' 1,856 1,083 1,252 (170) 0 (170) 0 1,083 1,083 (0) (0) 0

Royal Marsden 1,387 809 1,043 (234) 0 4 0 809 1,047 (238) (258) 20

Queen Mary's (Roehampton) 1,908 1,120 915 204 0 53 (2) 1,120 966 153 80 73

Chelsea & Westminster 1,395 821 677 144 0 0 0 821 677 144 74 70

Imperial College 870 518 500 18 (3) (10) 0 515 489 26 7 19

University College London 567 0 368 (368) 330 0 0 330 368 (38) (24) (14)

King's College 1,208 705 505 200 (0) 203 (3) 705 705 0 0 0

Royal Brompton & Harefield 380 222 238 (16) 0 0 0 222 238 (16) (1) (15)

Bart's & the London 267 150 155 (5) 0 0 0 150 155 (5) (9) 3

Royal Surrey County 120 70 68 2 0 0 0 70 68 2 1 1

Royal National Orthopaedic 132 55 93 (38) 0 30 0 55 122 (67) (49) (18)

Ashford & St Peter's 0 0 0 0 0 0 0 0 0 0 0 0

Royal Free 127 76 67 10 0 (0) 0 76 66 10 11 (0)

Lewisham Hosptial Trust 118 67 38 30 1 1 0 69 39 30 0 30

North West London 122 72 74 (2) 0 (0) 0 72 73 (2) 3 (5)

West Middlesex 48 29 39 (11) 0 (2) (0) 29 37 (8) (1) (7)

Great Ormond Street 113 66 58 8 0 0 0 66 58 8 12 (4)

Total 124,316 73,839 76,081 (2,243) (64) (655) (696) 73,775 74,731 (956) (1,177) 221

ADJUSTMENTS/CHALLENGES REVISED POSITION SLAM MONTH COMPARISON TO LAST SLAM MONTH

KPIs

CCG Acute Activity Overview – At Month 7 not Month 8

9

St George’s University Hospitals NHS Foundation Trust - Month 7 extrapolated to Month 8

10

Commentary

• A block arrangement has been agreed for A&E and Emergency with the trust.

• A YTD over spend of £1.9m is reported primarily seen in critical care (£0.7m) in specialities like ITU and CIT and outpatients (£0.9m) in the majority of

specialities in particular trauma and orthopaedics, cardiology, gastroenterology, urology and clinical haematology. The discharged critical care activity

in Month 7 was up by 20% compared to Month 1 to 6. The over spend is slightly offset by an under spend on electives (£0.4m) driven by breast

surgery, trauma and orthopaedics, clinical haematology and gynaecology. It is anticipated that further under performance will be seen in outpatient

activity as more activity is shifted to the Nelson Health Centre in the latter part of the year. The FY forecast is an over spend of £2.9m.

POD

Annual Plan

Activity 000s

YTD Plan

Activity

000s

YTD Actual

Activity

000s

YTD

Variance

Activity

000s

FYO Actual

Activity 000s

FYO Variance

Activity 000s

Annual Plan

£000

YTD Plan

£000s

YTD Actual

£000s

YTD Variance

£000

FYO Actual

£000s

FYO

Variance

Post QIPP

£000

FYO Variance

previous

month

£000

Improved/(Det

eriorated)

£000

Elective 10 6 7 1 12 1 11,317 7,501 7,136 365 10,755 562 450 112

Emergency 10 6 5 (0) 9 (0) 18,004 11,974 11,994 (20) 18,004 (0) 0 (0)

Non-Elective 0 0 0 (0) 0 (0) 82 54 286 (232) 429 (348) (342) (6)

Maternity Pathway 4 2 2 (0) 3 (0) 6,792 4,534 4,394 141 6,590 201 260 (58)

A&E 34 20 20 (0) 34 0 4,193 2,788 2,802 (13) 4,192 0 0 0

Out Patient 1st 20 12 14 2 23 3 3,705 2,508 2,902 (394) 4,353 (648) (625) (24)

Out Patient Follow Up 40 24 26 2 45 4 3,856 2,622 2,767 (146) 4,162 (306) (435) 129

Out Patient Procedure 15 9 10 1 17 2 1,944 1,320 1,691 (371) 2,536 (592) (507) (85)

Unbundled Diagnostics 8 5 6 1 10 2 1,028 685 797 (112) 1,197 (170) (176) 6

Critical Care 3 2 2 1 4 1 2,312 1,519 2,243 (724) 3,119 (807) (692) (115)

Direct Access 32 19 16 (3) 27 (4) 2,216 1,499 1,803 (304) 2,708 (491) (490) (2)

Drugs & Devices 0 0 0 0 0 0 707 463 645 (182) 967 (259) (280) 20

Other 0 0 0 0 0 0 (45) 109 0 109 0 (45) 0 (45)

PTS 0 0 0 0 0 0 507 338 340 (2) 511 (4) (2) (2)

CQUIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 175 103 107 4 184 9 56,617 37,914 39,800 (1,885) 59,524 (2,907) (2,839) (68)

11

St George’s University Hospitals NHS Foundation Trust - Month 7 Activity graphs

Epsom and St Helier University Hospitals NHS Trust - Month 7 extrapolated to Month 8

12

Commentary

• The signed contract value is £1.2m higher than the annual plan above as agreement could not be reached with the trust to reduce the plan at the start

of the contract for activity shift to the Nelson Health Centre.

• A YTD over spend of £0.3m and a FY forecast over spend of £0.5m is reported on the main Epsom and St Helier (ESH) contract. The YTD over spend

is mainly reported on outpatients (£1m), critical care (£0.2m) and electives (£0.2m). The over performance is partially offset by under performance in

direct access (£0.5m) and emergency (£0.5m). It is anticipated that further under performance will be seen in outpatient activity to offset the difference

between the signed contract value and plan. The adjustment on the other line relates to the Nelson Health Centre outpatient activity shift.

POD

Annual Plan

Activity 000s

YTD Plan

Activity

000s

YTD Actual

Activity

000s

YTD

Variance

Activity

000s

FYO Actual

Activity 000s

FYO Variance

Activity 000s

Annual Plan

£000

YTD Plan

£000s

YTD Actual

£000s

YTD Variance

£000

FYO Actual

£000s

FYO

Variance

Post QIPP

£000

FYO Variance

previous

month

£000

Improved/(Det

eriorated)

£000

Elective 6 3 4 0 6 0 4,753 3,169 3,352 (183) 5,028 (274) (253) (21)

Emergency 4 3 2 (0) 4 (0) 7,258 4,839 4,382 456 6,574 684 859 (175)

Non-Elective 0 0 0 0 0 0 466 310 470 (160) 706 (240) (227) (13)

Maternity Pathway 3 2 2 0 3 0 3,275 2,183 2,091 93 3,136 139 38 101

A&E 18 11 11 0 18 0 1,976 1,318 1,203 114 1,805 172 161 11

Out Patient 1st 16 10 10 1 17 1 2,535 1,690 1,644 46 2,467 69 80 (11)

Out Patient Follow Up 41 24 29 5 49 8 3,556 2,371 2,452 (82) 3,678 (122) (105) (17)

Out Patient Procedure 10 6 6 1 11 1 1,698 1,132 1,227 (95) 1,840 (143) (99) (44)

Unbundled Diagnostics 6 3 3 (0) 5 (0) 625 417 387 30 580 45 48 (3)

Critical Care 0 0 0 0 1 0 551 368 588 (220) 882 (330) (226) (105)

Direct Access 834 486 375 (111) 644 (190) 3,938 2,626 2,076 549 3,114 824 825 (1)

Drugs & Devices 0 0 0 0 0 0 564 376 396 (20) 594 (31) (56) 26

Other 0 0 0 (0) 0 (0) (1,111) (741) 109 (849) 163 (1,274) (1,459) 185

PTS 0 0 0 0 0 0 308 205 205 0 308 (0) 0 (0)

CQUIN 0 0 0 0 0 0 785 523 523 0 785 0 0 0

TOTAL 939 547 443 (105) 759 (179) 31,177 20,785 21,106 (321) 31,659 (482) (414) (67)

Epsom and St Helier University Hospitals NHS Trust - Month 7 Activity graphs

13

Kingston Hospital NHS Foundation Trust - Month 7 extrapolated to Month 8

14

Commentary

• The signed contract value is £0.4m higher than the annual plan above as agreement could not be reached with the trust to reduce the plan at the start

of the contract for activity shift to the Nelson Health Centre.

• YTD over performance of £0.4m is mainly reported on outpatients (£0.3m) and maternity (£0.1m). In maternity, antenatal intermediate/intensive cases

account for most of the over spend. This is partially offset by an under spend on critical care of £0.2m. Currently, no shift of activity to the Nelson

Health Centre is being seen in the relevant PODs resulting in the over performance reported on outpatients. A FY forecast over spend of £0.8m is

reported. The adjustment on the other line relates to the Nelson Health Centre outpatient activity shift.

POD

Annual Plan

Activity 000s

YTD Plan

Activity

000s

YTD Actual

Activity

000s

YTD

Variance

Activity

000s

FYO Actual

Activity 000s

FYO Variance

Activity 000s

Annual Plan

£000

YTD Plan

£000s

YTD Actual

£000s

YTD Variance

£000

FYO Actual

£000s

FYO

Variance

Post QIPP

£000

FYO Variance

previous

month

£000

Improved/(Det

eriorated)

£000

Elective 1 1 1 (0) 1 (0) 1,303 882 939 (58) 1,409 (106) (135) 29

Emergency 1 1 1 0 1 0 2,023 1,352 1,430 (79) 2,146 (123) (147) 24

Non-Elective 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Maternity Pathway 2 1 2 0 3 0 2,549 1,703 1,797 (95) 2,696 (147) (168) 21

A&E 6 4 4 (0) 6 (0) 727 482 451 31 676 51 71 (20)

Out Patient 1st 6 4 4 1 7 1 930 629 689 (59) 1,033 (103) (91) (12)

Out Patient Follow Up 9 5 5 0 9 0 793 537 554 (17) 830 (37) (21) (16)

Out Patient Procedure 1 1 1 0 1 (0) 228 154 173 (19) 260 (32) (39) 7

Unbundled Diagnostics 1 1 1 0 1 0 96 65 79 (14) 118 (23) (17) (6)

Critical Care 0 0 0 (0) 0 (0) 369 247 47 200 70 299 301 (2)

Direct Access 93 55 58 3 100 7 324 219 199 20 299 25 16 9

Drugs & Devices 1 0 0 (0) 1 (0) 378 256 232 24 348 30 26 4

Other 0 0 0 0 1 0 (394) (307) 18 (325) 185 (579) (579) (0)

PTS 0 0 0 0 0 0 67 45 45 0 67 0 0 0

CQUIN 0 0 0 0 0 0 207 138 147 (9) 221 (14) (17) 2

TOTAL 9,599 6,400 6,799 (399) 10,357 (758) (799) 41

Kingston Hospital NHS Foundation Trust - Month 7 Activity graphs

15

NON ACUTE PERFORMANCE

16

• A YTD under spend of £1.1m and FY

forecast under spend of £1.3m is reported

on non acute services. The FY forecast is an

adverse movement of £0.5m compared to

previous month.


forecast underspend of £0.2m is reported on

mental health services. The FY forecast

spend on mental health placements has

increased in Month 8 by £0.2m owing to 4

new placements in November. The FY

under spend of £0.6m on the SWL St

Georges MHT line is owing to slippage on

investments. The FY over spend of £0.3m

on the other line is owing to extra activity

purchased for IAPT in 2014/15 and higher

than anticipated activity at South London &

Maudsley NHSFT.


forecast under spend of £1m is reported on

community services. This is mainly owing to

slippage on Better Care Fund (BCF)

schemes such as interface geriatricians and

dementia nurses where there has been a

delay in recruitment.

• A YTD over spend of £0.8m and FY over

spend of £1.2m is reported on continuing

care. The FY forecast over spend has

increased by £0.3m compared to previous

month as an upward trajectory is being seen

in the SECSU reports. Work is on-going to

ensure the YTD position is validated and a

robust forecast is reported.

• The YTD under spend of £0.9m and FY

forecast under spend of £1.4m on ‘other’

mostly relates to slippage on BCF schemes

such as intermediate care beds and weight

management services where there has been

a delay in the procurement of the service.

Nov-15


Mental Health:

1 10,972 10,549 423 SWL St Georges MHT 16,457 15,823 634

2 2,378 2,485 (107) Placements 3,567 3,727 (160)

3 1,750 1,932 (182) Other 2,625 2,898 (273)

4 15,100 14,966 134 Total Mental Health 22,649 22,448 201

5 1,169 1,189 (20) Learning Disabilities 1,753 1,784 (31)

Community:

6 11,295 10,645 650 Community Services SLA 16,943 15,968 975

7 5,302 6,094 (792) Continuing Care 7,953 9,142 (1,189)

8 2,000 1,821 179 Nelson Health Centre 3,000 3,020 (20)

9 9,023 8,096 927 Other 13,535 12,139 1,395

10 27,620 26,656 964 Total Community 41,430 40,270 1,161

11 43,889 42,811 1,077 Total Non Acute 65,833 64,503 1,331


Commentary

• The annual plan for the Nelson Health Centre reflects the minimum income guarantee

agreement of £3m. The signed contract value is £4.6m. The YTD under spend as at Month 8

is £0.2m when compared to the minimum income guarantee profiled on a straight line basis.

The YTD under spend is £1.1m when compared to the signed contract value.

PRESCRIBING AND PRIMARY CARE BUDGETS

17

Commentary

• A YTD and FY break-even

position is reported on

prescribing and primary care

services.

• The YTD (£0.3m) and FY

(£0.5m) over spend on

prescribing is owing to an

increase in prescribing rates.

The majority of the growth has

been seen in drugs for the

management of diabetes and

new anticoagulants. Drug price

fluctuation is also being seen

across a number of commonly

used drugs such as Metformin.


(£0.3m) under spend on the

GP Led Health Centre is owing

to recharge to other CCGs for

attendances at the walk in

centre.


(£0.2m) under spend on the

111 service is owing to lower

than anticipated activity to

date.

Nov-15


Prescribing:

1 15,333 15,651 (318) Prescribing 23,000 23,474 (475)

2 15,333 15,651 (318) Total Prescribing 23,000 23,474 (475)

Primary Care:

3 1,145 1,135 10 Local enhanced services 1,717 1,702 16

4 710 518 192 GP led health centre 1,065 777 288

5 521 419 102 111 service 782 629 153

6 949 949 (0) Out of hours service 1,424 1,424 -

7 100 93 7 Other 150 140 10

8 3,425 3,115 311 Total Primary Care 5,138 4,672 466

9 18,759 18,765 (7) Total Prescribing & Primary Care 28,138 28,147 (9)


RISKS AND MITIGATIONS

18

Commentary

• The £2.2m Acute SLAs risk in the most likely scenario comprises of: National penalties of £0.8m which need to be reinvested, the benefit of which is

currently shown in the forecast outturn; the risk that the £0.8m activity shift to the Nelson Health Centre might not happen owing to an overall increase

in activity; impact of winter on non elective activity at Epsom and St Helier NHS Trust and Kingston NHS FT of £0.6m.

• Continuing care risk relates to higher than forecast spend on continuing care as the forecast does not include a provision for further growth in

placements.

• Trend analysis shows that the prescribing over spend could be higher than currently forecast

• A detailed report on the actions taken to date and the mitigations in place for financial recovery is also being presented at Finance Committee this

month.

Worst Likely Best

£000's £000's £000's

1 Planned Surplus 2,366 2,366 2,366

2 Risks

3 Acute SLAs -2,351 -2,151 -800

4 Continuing Care SLAs -300 -200 0

5 QIPP under delivery -622 0 0

6 Prescribing -200 -100 0

7 Total Risks -3,473 -2,451 -800

8 Mitigations

9 Contingency (0.5%) 0 0 0

10 Delay/Reduce Investment Plans 1,000 2,451 800

11 Non recurrent measures 0 0 0

12 Total Mitigations 1,000 2,451 800

13 Net risk -2,473 0 0

14 Risk adjusted performance -107 2,366 2,366

Financial Risk Analysis: Month 8

19

APPENDICES

Appendix

number

Description Slide number

1 Acute Commissioning 19

2 Mental Health & Learning Difficulties 20

3 Other Non Acute 21

4 Primary Care & Prescribing 22

5 Corporate and Estates 23

6 Reserves 24

7 QIPP dashboard 25

8 Investment dashboard 26

Acute Commissioning – Appendix 1

20

Budget Actual Variance Budget Forecast VarianceLast Month

VarianceMovement

14-15 Full

Year Outturn

£000's £000's £000's £000's £000's £000's £000's £000's £000's

FOUNDATION TRUSTS

1 ST GEORGE'S HEALTHCARE TRUST 37,914 39,800 (1,886) 56,617 59,523 (2,906) (2,839) (67) 56,825

2 KINGSTON NHS TRUST 6,400 6,799 (400) 9,599 10,357 (758) (799) 41 9,692

3 MOORFIELDS EYE HOSPITAL 2,573 2,604 (31) 3,859 3,906 (47) (1) (46) 3,546

4 QUEEN MARYS ROEHAMPTON 1,278 1,104 174 1,908 1,729 179 205 (26) 2,001

5 GUYS & ST THOMAS' HOSPITAL TRUST 1,237 1,237 (0) 1,856 1,856 0 0 0 1,879

6 CHELSEA & WESTMINSTER HEALTHCARE TRUST 930 774 156 1,395 1,161 234 210 25 1,414

7 THE ROYAL MARSDEN HOSPITAL TRUST 925 1,196 (271) 1,387 1,716 (329) (314) (15) 1,350

8 KINGS HEALTHCARE TRUST 805 805 0 1,208 1,208 (0) (0) 0 1,119

9 UNIVERSITY COLLEGE LONDON HOSPITALS TRUST 378 421 (42) 567 631 (64) (42) (22) 549

10 THE ROYAL BROMPTON & HAREFIELD HOSPITALS TRUST 253 272 (19) 380 408 (28) 8 (36) 369

11 ROYAL SURREY COUNTY & ST LUKE'S HOSPITAL TRUST 80 78 2 120 116 4 0 4 134

12 THE ROYAL FREE (HAMPSTEAD) NHS TRUST 85 76 9 127 114 14 31 (17) 120

13 GREAT ORMOND ST HOSPITAL FOR CHILDREN NHS TRUST 75 66 9 113 100 13 22 (9) 80

ACUTE TRUSTS

14 EPSOM & ST. HELIER UNIVERSITY HOSPITALS NHS TRUST - ACUTE 20,785 21,106 (321) 31,177 31,659 (482) (415) (67) 31,674

15 LAS - EMERGENCY SERVICE CONTRACT 4,117 4,117 1 6,176 6,176 0 0 0 5,578

16 EPSOM & ST. HELIER UNIVERSITY HOSPITALS NHS TRUST - SWLEOC 2,873 2,633 240 4,310 4,074 236 145 91 4,310

17 CROYDON UNIVERSITY HOSPITAL NHS TRUST 1,307 1,271 36 1,960 1,906 54 (12) 66 1,836

18 IMPERIAL COLLEGE NHS TRUST 580 559 21 870 812 58 46 12 860

19 BARTS & THE LONDON NHS TRUST 178 177 1 267 265 1 15 (14) 261

20 THE ROYAL NATIONAL ORTHOPAEDIC HOSPITAL TRUST 88 140 (52) 132 210 (78) (69) (9) 187

21 LEWISHAM HOSPITAL NHS TRUST 79 45 34 118 68 50 11 39 99

22 LONDON NORTH WEST HOSPITALS TRUST 81 84 (3) 122 126 (4) 7 (11) 93

23 WEST MIDDLESEX NHS TRUST 32 42 (10) 48 63 (15) (17) 2 30

OTHER

24 ASPEN HEALTHCARE 163 163 (0) 244 244 0 0 0 0

25 GENERAL ACUTE COMMISSIONING 83,217 85,569 (2,353) 124,562 128,427 (3,865) (3,807) (58) 124,006

26 NON CONTRACT ACTIVITY 1,518 1,645 (126) 2,278 2,467 (189) (189) 0 2,418

NON-SLA & OTHER

27 LASERCARE CONTRACT (SK!)/ DEXA (SPIRE) / TECHNOMED 66 60 6 100 85 15 15 0 111

28 ESH - CHRONIC FATIGUE SYNDROME / LIQUID BASED CYTOLOGY 63 62 0 94 94 0 0 0 95

29 SYSTEMS RESILIENCE 473 395 78 709 601 108 116 (8) 1,202

30 AQP IVF 126 126 (0) 189 189 0 0 0 0

31 INDIVIDUAL FUNDING REQUESTS 23 31 (9) 34 47 (13) 0 (13) 43

32 SLOWDOWN IN ACUTE OP & ELEC AT SGH / KHT CHALLENGES (0) (0) (0) 0 (796) 796 796 (0) 0

33 TOTAL NON-SLA & OTHER 750 675 75 1,125 220 906 927 (21) 1,451

34 TOTAL ACUTE COMMISSIONING 85,485 87,889 (2,403) 127,965 131,113 (3,149) (3,069) (79) 127,874

Year To Date Full Year Forecast OutturnFOT Movement from

last month

Merton CCG - ACUTE COMMISSIONING

Mental Health and learning difficulties – Appendix 2

21


VarianceMovement

14-15

Full

Year

Outturn

£000's £000's £000's £000's £000's £000's £000's £000's £000'sMENTAL HEALTH CONTRACTS

1 SOUTH WEST LONDON AND ST GEORGES MENTAL HEALTH TRUST 10,972 10,549 423 16,457 15,823 634 639 (5) 14,532

2 SUSSEX FOUNDATION PARTNERSHIP - TIER 4 DETOX SERVICE 214 210 4 321 315 6 6 0 315

3 SOUTH LONDON & MAUDSLEY 188 260 (72) 282 390 (108) (108) 0 240

4 SABP & MH NCAS 54 80 (26) 82 120 (38) (38) 0 221

JOINT AGENCY, VOLUNTARY & INDEPENDENT SECTOR CONTRACTS

5 CAMHS DEVELOPMENT FUND/YOUTH OFFENDING TEAM 173 151 22 260 227 33 10 23 159

6 MERTON VOLUNTARY SECTOR / CARERS SUPPORT 55 55 (0) 83 83 (0) (0) 0 91

7 ADVOCACY SERVICES 35 35 (0) 53 53 0 0 0 10

8 DEMENTIA SERVICES (Alzheimer's) 55 45 9 82 68 14 0 14 73

NAMED PATIENTS & PLACEMENTS

9 MENTAL HEALTH PLACEMENTS AND UNCONTRACTED ACTIVITY 2,378 2,485 (107) 3,567 3,727 (160) (15) (145) 3,541

OTHER MENTAL HEALTH SERVICES

10 IAPT 941 1,061 (120) 1,412 1,592 (180) (180) 0 1,393

11 MENTAL HEALTH RESILIENCE 0 0 0 0 0 0 0 0 120

12 MH ENQUIRIES/NSF IMPLEMENTATION COSTS 33 33 0 50 50 0 0 0 0

13 TOTAL MENTAL HEALTH 15,100 14,966 134 22,649 22,448 201 314 (113) 20,696

14 LEARNING DISABILITIES 191 145 46 287 318 (31) 44 (75) 287

15 LEARNING DISABILITIES CONTINUING CARE 978 1,044 (66) 1,466 1,466 0 0 0 1,435

16 TOTAL LEARNING DIFFICULTIES 1,169 1,189 (20) 1,753 1,784 (31) 44 (75) 1,721

Year To Date Full Year Forecast OutturnFOT Movement from last

month

Merton CCG - NON ACUTE COMMISSIONING

Other Non Acute – Appendix 2a

22


VarianceMovement

14-15

Full

Year

Outturn

£000's £000's £000's £000's £000's £000's £000's £000's £000's

17 END OF LIFE - LOCAL ENHANCED SERVICE 13 19 (6) 19 28 (9) (9) 0 22

18 NURSING - MARIE CURIE - CANCER 67 67 (0) 100 100 0 0 0 104

19 BEREAVEMENT SERVICES 67 47 21 101 65 36 36 0 2

20 HOSPICES 355 351 3 532 527 5 0 5 652

21 SWL CANCER NETWORK AND ESH CANCER NURSE 121 111 10 181 167 14 0 14 199

22 TOTAL END OF LIFE CARE AND HOSPICES 622 594 28 933 887 46 27 19 979

23 HOME OXYGEN SERVICE 143 143 (0) 214 214 0 0 0 212

24 TB PROJECT 88 88 0 132 132 0 0 0 0

25 CARDIOLOGY 42 42 (0) 63 63 0 0 0 2

26 TOTAL LONG TERM CONDITIONS 272 272 (0) 409 409 0 0 0 214

27 URGENT CARE 20 20 0 30 30 0 0 0 22

28 GPSI'S COMMISSIONING - MINOR SURGERY 53 57 (3) 80 85 (5) (5) 0 70

29 OPHTHALMOLOGY (LOW VISION SERVICE) 8 8 0 12 12 0 0 0 8

30 BPAS 113 113 (0) 170 170 0 0 0 151

31 MARIE STOPES INTERNATIONAL 77 77 (0) 116 116 0 0 0 115

32 HEALTH COACHING 77 57 20 116 86 30 30 0 55

33 INTERMEDIATE CARE COMMISSIONING (BEDS) 437 437 (0) 656 656 0 0 0 686

34 DESP SURVEYANCE SERVICE 41 43 (1) 62 64 (2) (2) 0 16

35 BETTER CARE FUND 5,014 4,181 832 7,520 6,271 1,249 1,288 (39) 160

36 TOTAL URGENT AND INTERMEDIATE CARE 5,842 4,994 848 8,762 7,490 1,272 1,311 (39) 1,283

37 COMMUNITY SERVICES 11,295 10,645 650 16,943 15,968 975 966 9 14,354

38 NELSON HEALTH CENTRE 2,000 1,821 179 3,000 3,020 (20) (6) (14) 0

39 PODIATRY 54 87 (33) 81 130 (49) (44) (5) 81

40 MERTON ICES 265 165 100 397 247 150 150 0 247

41 MERTON MUSCULOSKELETAL SERVICE 403 333 70 605 500 105 105 0 67

42 TOTAL COMMUNITY SERVICES 14,017 13,051 967 21,026 19,865 1,161 1,171 (10) 14,748

43 PAEDIATRIC, AUDIOLOGY AND DESIGNATED CHILD DEATH DOCTOR CONTRACT 391 397 (6) 586 596 (10) (10) 0 612

44 MERTON CHILDREN - SCPS 1,105 1,184 (79) 1,657 1,776 (119) (53) (66) 1,633

45 SLAM CAMHS AND AD HOC 46 46 0 69 69 0 0 0 63

46 SAFEGUARDING CHILDREN BOARD 23 23 (0) 35 35 0 0 0 32

47 TOTAL CHILDREN SERVICES 1,565 1,651 (86) 2,348 2,476 (129) (63) (66) 2,340

48 FUNDED NURSING CARE 804 927 (124) 1,205 1,391 (186) (53) (133) 1,238

49 PERSONAL HEALTH BUDGETS 0 161 (161) 0 241 (241) 0 (241) 0

50 JOINT FUNDED 293 382 (89) 440 573 (134) 0 (134) 395

51 CONTINUING CARE PLACEMENTS - MERTON 4,205 4,624 (419) 6,308 6,937 (629) (883) 253 5,879

52 TOTAL ADULT CONTINUING CARE 5,302 6,094 (792) 7,953 9,142 (1,189) (935) (255) 7,513

53 TOTAL NON ACUTE COMMISSIONING 43,889 42,811 1,077 65,833 64,503 1,331 1,869 (539) 49,495


month

Merton CCG - NON ACUTE COMMISSIONING

Primary Care & Prescribing – Appendix 4

23


VarianceMovement

14-15

Full

Year

Outturn

£000's £000's £000's £000's £000's £000's £000's £000's £000's

1 PRESCRIBING 14,849 15,146 (297) 22,274 22,720 (446) (593) 147 22,384

2 SCRIPTSWITCH 68 69 (1) 102 104 (2) (2) 0 96

3 CENTRAL DRUGS 416 435 (19) 624 650 (27) (27) 0 617

4 TOTAL PRESCRIBING 15,333 15,651 (318) 23,000 23,474 (475) (622) 147 23,097

5 LES - NEAR PATIENT TESTING 5 4 1 7 6 2 2 0 7

6 LES - ATRIAL FIBRILATION 3 3 1 5 4 1 1 0 4

7 LES - ANTI COAG 147 133 14 221 200 21 21 0 227

8 LES - PHLEBOTOMY 101 81 20 152 122 30 30 0 151

9 LES - POST OPERATIVE WOUND CARE 16 13 3 24 20 4 4 0 19

10 LES - MENORRAGHIA 57 84 (27) 86 126 (40) (40) 0 122

11 LES - GYNAECOLOGY 49 48 1 73 72 1 1 0 73

12 LES - UROLOGY 26 19 8 39 28 11 11 0 39

13 LES - DIABETES 14 17 (3) 21 26 (5) (5) 0 16

14 LES - CARE OF OLDER PEOPLE 726 726 0 1,089 1,089 0 0 0 765

15 LES - OTHER (0) 7 (7) (0) 10 (10) (10) 0 0

16 LOCAL ENHANCED SERVICES 1,145 1,135 10 1,717 1,702 16 16 0 1,424

17 111 CONTRACT 521 419 102 782 629 153 93 60 441

18 PMS - OUT OF HOURS 949 949 (0) 1,424 1,424 0 0 0 1,416

19 TOTAL OUT OF HOURS 1,471 1,369 102 2,206 2,053 153 93 60 1,857

20 GP - STATUTORY MEDICAL FEES 100 93 7 150 140 10 10 0 140

21 QUALITY PREMIUM PROGRAM 0 0 0 0 0 0 0 0 52

22 WILSON WALK IN CENTRE (UNREGISTERED PATIENTS) 710 518 192 1,065 777 288 288 0 781

23 TOTAL PRIMARY CARE OTHER 810 611 198 1,215 917 298 298 0 973

24 TOTAL PRIMARY CARE & PRESCRIBING 18,759 18,765 (7) 28,138 28,147 (9) (216) 207 27,352


month

Merton CCG - PRIMARY CARE & PRESCRIBING

Corporate and Estates – Appendix 5

24


VarianceMovement

14-15

Full

Year

Outturn

£000's £000's £000's £000's £000's £000's £000's £000's £000's

1 TOTAL RUNNING COSTS 3,029 3,029 (0) 4,544 4,544 0 (0) 0 4,909

2 GP IT (SLCSU) 373 373 (0) 559 559 0 0 0 501

3 CONTINUING CARE TEAM (SLCSU) 242 217 25 363 326 37 37 0 326

4 ISPS (SLCSU) 13 13 (0) 19 19 (0) (0) 0 26

5 RECLASSIFICATION OF RUNNING COSTS TO PROG COSTS 165 152 13 248 228 20 20 0 483

6 INFECTION CONTROL (SLCSU) 16 16 (0) 24 24 0 0 0 30

7 TOTAL CSU CHARGES 808 770 38 1,213 1,156 57 57 0 1,365

8 MEDICINES MANAGEMENT 385 277 109 578 415 163 163 0 335

9 SAFEGUARDING 65 125 (60) 98 188 (90) (90) 0 204

10 INTERPRETING SERVICES 13 13 (0) 20 20 0 0 0 12

11 CLINICAL LEADS 112 243 (132) 335 364 (29) (1) (29) 0

12 TRANSFORMATIONAL SERVICE MANAGERS 808 924 (116) 1,044 1,386 (341) (322) (19) 798

13 DEPRECIATION 107 72 35 160 129 31 31 0 0

14 LEVIES/PPI/CSU COMMS/PRC TRAINING 227 197 30 340 295 45 45 0 135

15 TOTAL OTHER CORPORATE COSTS 1,717 1,851 (134) 2,575 2,796 (221) (174) (48) 1,992

16 PROPERTY COSTS 272 226 46 408 340 69 195 (127) 222

17 TOTAL CORPORATE & ESTATE COSTS 5,826 5,877 (50) 8,740 8,835 (95) 79 (174) 8,488


month

Merton CCG - CORPORATE & ESTATES

Reserves – Appendix 6

25


VarianceMovement

14-15

Full

Year

Outturn

£000's £000's £000's £000's £000's £000's £000's £000's £000's

1 CCG SLA RESERVE 607 577 30 911 866 45 45 0 (565)

2 CONTINGENCY (0.5%) 789 0 789 1,183 0 1,183 1,183 0 195

3 NON RECURRENT FUND (1%) 2,013 1,545 468 2,612 2,064 548 0 548 1,688

4 OTHER NON RECURRENT FUND 97 1 96 146 0 146 109 37 465

5 NETA RESERVE (0) 0 (0) 0 0 0 0 0 507

6 TOTAL RESERVES 3,506 2,123 1,383 4,852 2,930 1,922 1,337 585 2,290


month

Merton CCG - RESERVES &

OTHER

QIPP – Appendix 7

26

FULL YEAR

IDTransformational &

TransactionalPROJECT

Planned

£000's

Actual

£000's

Variance

£000's

Planned

£000's

Actual

£000's

Variance

£000's

Planned

£000's

Actual

£000's

Variance

£000's

Planned

£000's

Actual

£000's

Variance

£000's

Forecast

movement in

month

Planned

£000's

Forecast

£000's

Variance

£000's

1 Transformational Better Care Fund 387 593 -206 0 0 0 387 593 -206 85 34 51 0 729 729 0 G

2 Transformational Inpatient redesign 58 0 58 0 0 0 58 0 58 29 0 29 0 175 175 0 G

3 Transformational Diabetes Eye Screening Program 53 45 9 38 41 -3 15 4 11 2 0 2 0 23 2 21 R

4 Transformational Nelson Health Centre 206 84 122 0 0 0 206 84 122 26 13 13 -38 309 168 141 R

5 Transformational MSK 0 14 -14 0 0 0 0 14 -14 0 0 0 -21 0 71 -71 G

6 Transformational Outpatient Navigation 0 0 0 0 0 0 0 0 0 0 0 0 -100 419 65 354 R

7 Transformational Care homes pharmacy 20 0 20 0 0 0 20 0 20 10 0 10 -10 59 49 10 A

8 Transformational Nutrition 59 94 -35 0 0 0 59 94 -35 3 10 -7 10 68 94 -26 G

9 Transformational Prescribing 460 352 108 0 0 0 460 352 108 58 12 45 -27 690 369 321 R

10 Transformational Medicines waste campaign 133 0 133 64 16 48 70 -16 85 9 0 9 0 105 -16 120 B

11 Unidentified QIPP 0 0 0 0 0 0 0 0 0 0 0 0 118 0 622 -622 G

12 Transactional Acute challenges 705 869 -165 0 0 0 705 869 -165 0 112 -112 0 1,409 1,409 0 G

13 Transactional Mental Health demographic growth 312 312 0 0 0 0 312 312 0 0 0 0 0 312 312 0 G

14 Transactional Mental Health placements 83 268 -185 0 0 0 83 268 -185 10 68 -58 68 125 268 -143 G

15 Transactional MSK 0 105 -105 0 0 0 0 105 -105 0 0 0 0 0 105 -105 G

16 Transactional Running costs 299 299 0 0 0 0 299 299 0 37 38 0 0 448 448 0 G

TOTAL 2,776 3,034 -259 102 56 45 2,674 2,978 -304 269 287 -18 0 4,871 4,871 0 G

FULL YEAR NET QIPP SAVINGSYTD GROSS QIPP SAVINGS YTD PROJECT COSTS YTD NET QIPP SAVINGS NET QIPP IN MONTH

Net Position

Rag Rated

Investments – Appendix 8

27

INVESTMENT

CATEGORY

PROJ. DESCRIPTION Lead Total Investment

(£000s)

Planned

(£000s)

Position

(£000s)

Variance

(£000s)

NET FOT (RAG

RATED) (£000s)

1BCF

4 x new nursing posts

For 3 integrated locality teams A Bunka 230 230 134 96 A-R

2 BCF Interface Geriatricians / Clinical input A Bunka 200 200 52 148 R

3 BCF Dementia nurses A Bunka 300 300 160 140 A-R

4 BCF Expert Patient Programme A Bunka 96 96 80 16 A-G

5 BCF Telehealth A Bunka 96 96 - 96 B

6BCF

New OPARS Older People's Assessment & Rehab

ServiceA Bunka 150 150 156 (6) G

7

BCF

CPAT

Community Prevention of Admission Team 2

- input into Nursing Homes

A Bunka 266 266 159 107 A-R

8 BCF Rapid Response Team at ESH and STAR Team at SGH A Bunka 200 200 - 200 B

9 BCF Prevention of Admission (Step up) beds A Bunka 295 295 200 95 A-R

10 BCF Step Down Beds A Bunka 295 295 200 95 A-R

11 BCFIn reach into St George's – 72hr Intensive

Rehabilitation (with SMCS)A Bunka 150 150 150 - G

12 BCF Increased Night nurses to support carers A Bunka 66 66 49 16 A-R

13BCF Integrated complex older people's pathway (ICOPP) A Bunka 104 104 59 45 A-R

14 BCF7 Day working - Health

Community Rehab Service 4A Bunka 130 130 50 80 R

15 BCF Psycho -geriatrician input A Bunka 73 73 - 73 B

16BCF

Community Rehab Service 1

(Home Based)A Bunka 219 219 105 114 R

17 BCF End of Life Care A Bunka 238 238 193 45 A-G

18 BCF Data sharing A Bunka 15 15 - 15 B

19 BCF Other A Bunka - - - - B

20 BCF Social Care 7 day working A Bunka 260 260 260 - G

21 BCF Data sharing A Bunka 15 15 15 - G

22 BCF Voluntary Organisations A Bunka 80 80 80 - G

23 BCF Social care bill A Bunka 400 400 400 - G

24 BCF Domiciliary Package A Bunka 1,200 1,200 1,200 - G

25 BCF Miles Reablement A Bunka 500 500 500 - G

26 BCF New allocation A Bunka 3,428 3,428 3,428 - G

27 Total 9,005 9,005 7,630 1,375 A-G

28 B

29 QIPP Diabetes Eye Screening Program C Charlton 57 57 57 - G

30 QIPP Medicines Management Waste Campaign S Agama 96 96 16 80 R

31 Total 153 153 73 80 R

32 B

33

Other CAMHS - Single point of access E Gennard 401 401 257 144 A-R

34Other Establish an effectice crisis management service E Gennard 200 200 - 200 B

35Other Improving investment & support for community E Gennard 463 463 218 245 R

36Other Tier 3 Weight management services C Charlton 303 303 - 303 B

37 Other HARI A Bunka 165 165 125 40 A-R

38Other Proactive repeat prescribing review S Agama 147 147 94 53 A-R

39 Total 1,679 1,679 694 892 R

PROGRAMME TOTAL (£000s) 10,836 10,836 8,397 2,346

Full Year (FY)

Documents

REPORT TO MERTON CLINICAL COMMISSIONING ......2016/01/26 · digestive system procedures. • Queen Mary’s – YTD under spend of £153k is owing to mainly to rehab services. •