How PCTs are struggling to hit £20bn savings target

PCTs across England will fail to hit the government's efficiency savings targets this year, which GP leaders have warned could harm GP commissioning.

An investigation by GP has found that trusts across the country have encountered huge difficulties hitting their savings goals as part of the national Quality, Innovation, Productivity and Prevention (QIPP) programme.

Referred to as the 'Nicholson Challenge', this aims to make £20bn of efficiency savings from within NHS budgets by 2014/15.

GP leaders worry that the failure to hit planned savings by the end of 2012/13, when clinical commissioning groups (CCGs) take charge, will force them to play 'catch-up' by cutting harder and faster.

Here, we look at examples of PCTs that are struggling to make these savings.

NHS Buckinghamshire and Oxfordshire Cluster
Difficulties in meeting planned hospital savings in Buckinghamshire and Oxfordshire mean the cluster is set to miss its target by almost a quarter this year.

A recent board report explains how the cluster must save £335m over four years: £129m for Buckinghamshire and £206m for Oxfordshire.

In Oxfordshire, this plan will fall short by £5.4m in 2011/12, or 26% of the target savings. It's a similar picture in Buckinghamshire, with a £6.3m deficit or 24%.

Urgent care makes up a large portion of this shortfall. In Oxfordshire, this includes £576,000 behind target on admissions and £25,000 on excess bed days.

Predictions for the second half of 2011/12 are gloomier still. The board paper explains: 'The forecast for A&E reflects that it is unlikely that any significant improvement will be realised at this stage of the year from existing workstreams.'

NHS Sussex Cluster
Across Sussex, there is real concern that PCTs will fail to hit QIPP targets for the coming year.

The cluster forecasts that it will only hit £72.82m savings against its plan of £111.78m, a shortfall of 35%.

Board papers from 24 January declare that the 'financial position demonstrates there is still a significant risk to the delivery of the QIPP plans and the savings for 2011/12'.

Risks to delivery of the plans identified by the cluster include engagement with the local CCGs, capacity of staff to deliver the savings, and the funding required to support necessary changes.

A spokeswoman for NHS Sussex told GP: 'We are committed to delivering our QIPP targets and work continues to ensure we achieve this and we have seen significant progress in a number of areas including medicines management, prescribing, maternity and estates.'

She added: 'We are working closely with the local CCGs across Sussex and our plans for next year have been developed by our CCGs, ensuring that GPs and other clinicians are right at the heart of deciding how best to improve services for local people.'    

NHS Kingston
In some areas, GPs are feeling the full force of this failure to hit targets.

In NHS Kingston, board papers outline plans to significantly increase management of GP referrals, aiming for a 10% cut across all practices.

This, it argues, will save the PCT £975,000 in 2011/12.

NHS Redcar and Cleveland

In a board report, NHS Redcare and Cleveland admits it will miss its QIPP savings target by £5m.

However, it made assurances that 'work is on-going with South Tees Hospitals NHS Foundation Trust to deliver QIPP efficiencies'.

NHS Staffordshire Cluster
In Staffordshire, local CCGs have taken ownership of the QIPP delivery, but are still struggling with the targets inherited from the area's PCTs.

A board paper from December 2011 says the CCGs are 'confident that it will deliver at least 80% (circa £9m) of the QIPP saving targets for 2011/12'.

However, they are hopeful that the targets for 2012/13 will be achieved in full.

NHS Bath and North East Somerset
Despite predicting a surplus for 2011/12, the PCT is yet to identify £879,000 worth of QIPP savings for 2012/13, the year before CCGs take charge of commissioning.

Key areas of risk identified by the PCT include the high cost if drugs and devices that are outside of a tariff, the increased demand for non-elective care, and the increasing demand or cost of placements for expensive non-acute care.

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