Financial issues

Difficulties have already emerged with CCG finances.  A recent HSJ article pointed out that whilst Andrew Lansley had last year insisted that CCGs would not inherit any legacy debt from PCTs and that they would operate with a clean balance sheet, just a few months into the new system NHS England finance director Paul Baumann has warned “a quarter of CCGs are having real difficulty making ends meet, with little or no reserves to fall back on”, and that some CCGs also have “a significant underlying deficit to deal with”.  CCGs have also complained about being informed at short notice that their 2013-14 budgets were smaller than expected, or that they were responsible for services that they had not anticipated. Mr Baumann said that these issues came about due to the complexity of disaggregating primary care trusts budgets. He added: “It is massively complex and frankly weve all been surprised [at] the difficulty getting that tied down.”

Another HSJ article explains that Department of Health records show that CCGs may have inherited unfunded liabilities for hundreds of millions of pounds worth of continuing healthcare claims made before they came into being. Clinical commissioners had warned last year that PCTs should not be allowed to record significant contingent liabilities in their final year. Whilst contingent liabilities will not necessarily translate into actual costs, any unfunded costs shouldered by CCGs would potentially be controversial as the government has repeatedly insisted the new commissioners will not be responsible for resolving their predecessors legacy debts. Some commissioners have issued warnings about the impact contingent liabilities could have on their finances. 

According to Pulse, CCG leads are facing multi-million shortfalls as specialized commissioning and social care take large amounts out of their budgets, putting in doubt plans to improve patient care. CCG leaders told Pulse that money saved for non-recurrent spending in 2013/14 was being used to plug sudden gaps in funding, and the uncertainty could lead to plans to improve local services being abandoned. Pulse explains that one in ten trusts and CCGs are predicting that they will be deficit by the end of the financial year, according to the Kings Fund latest Quarterly Monitoring Report. Only one in ten NHS finance directors believe their chances of meeting the target is better than 50/50, with 56% identifying a high or very high risk that the target will not be met. Another survey by Primary Care Commissioning and Capsticks, a healthcare law firm, found that more than a third of commissioning groups (36%) who responded to the survey said they were ‘extremely concerned’ or ‘very concerned’ about the challenge facing their organisation in achieving financial balance. This figure rose to more than 80% if those citing ‘moderate concern’ were included.


Troubled CCG says its deficit could reach £40m (6 March 2015: HSJ)

One-third of CCGs concerned about achieving financial balance (22 January 2015: Pulse)

CCG faces deficit of £29m (23 December 2014: Pulse)

CCGs' financial position is 'unsustainable', spending watchdog warns (7 November 2014: Pulse)

CCG restricts treatment for smokers and obese patients (4 December 2014: Pulse)

One third of CCGs fail to allocate £5 per head funding promised for vulnerable patients (29 October 2014: Pulse)

18 CCGs forecasting year-end deficit (28 October 2014: Pulse)

Mid Essex CCG proposes IVF for HIV and cancer patients only (24 July 2014, BBC News)

'Extreme worry' over NHS Kernow £75m procurement plans (25 June 2014, BBC News)

Deafblind charity Sense opposing hearing aid cuts (25 June 2014,  The Sentinel)

North west London CCGs to bring services in house. (Health Service Journal: 14 May 2014)

CCGs prepare to step in to fund GP seven-day opening pilot when Government scheme ends. (Pulse: 16 April 2014)

NHS will struggle to meet £20bn productivity challenge, shows survey (Pulse: 18 September 2013)

Legacy of care claims liabilities threatens CCGs’ finances (HSJ:4 September 2013)

How is the health and social care system performing? (King’s Fund: September 2013)

CCGs face cutting services to plug sudden million-pound gaps in budgets (Pulse: 30 July 2013)

Unpicking the great CCG budget 'swindle' (HSJ: 18 June 2013)

One Quarter of CCGs having Issues Making Ends Meet (Commissioning GP: 12 June 2013)

Money worries and support top CCG concerns ( June 2013)



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