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Appendix 5 Risk Analysis - Liverpool Primary Care Trust Homepage

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					                                                                                                                                                                                           Appendix 5


LIVERPOOL PRIMARY CARE TRUST FINANCIAL PLANS 2007/08 : RISK MONITORING SEPTEMBER 2007


                                                                                                                                                                                                         Risk
POTENTIAL VARIANCES FROM PLAN                                                                                                                             Risk/Variance : (Surplus) / Deficit
                                                                                                                                                                                                        Rating
                                                                                                                                                                             Incorp in
                                                                                                                                                                                       Potential
                                                                                                                  Forecast Outturn - September        Initial     July       Sept 2007            Revised
No.              Budget Area                  Assumption in Plan                          Risk                                                                                          Further
                                                                                                                          2007 Update                 Plans       2007       Forecast            Sept 2007
                                                                                                                                                                                       Variance
                                                                                                                                                                              Outturn
                                                                                                                                                      £'000       £'000        £'000       £'000

                                                                                                                 Commissioners to work with NHS
                                                                                                                 provider (RLBUHT) to monitor
      WET Age Related Macular          Additional funding of £1m included Risk of significant additional
1                                                                                                                closely uptake of treatment. Risk       1,000       1,000             0    (1,000)       G
      Degeneration                     in 2007/08 plan.                   demand.
                                                                                                                 down rated to reflect budget
                                                                                                                 performance to date.


                                       Additional non-rec funding of       Failure to apply access criteria      Continuing / Palliative Care
                                       £2.5m applied to balance 2006/07    appropriately and / or procure        expenditure continues to increase.
2     Continuing / Palliative Care                                                                                                                       1,000       1,000       1,533          1,500     R
                                       budget over-run. £1.5m only to be   effectively leading to budget over-   New criteria likely to add further
                                       consolidated in 2007/08.            run                                   financial pressure.


                                                                                                               Final Central Budgets Allocations
      Shortfall on Central Budget                                          PCT will receive a reduced level of
                                       A range of assumptions based on                                         from the Department of Health
3     allocation from Department of                                        funding from the Department of                                                  500         500      (1,900)            0      G
                                       latest information.                                                     have now been confirmed and are
      Health                                                               Health
                                                                                                               greater than previously notified.


                                       Cost of Activity capped at 2006/07 Continuation of upward trend in
4     Cost per case expenditure                                                                                                                            500         500             0           0      G
                                       level in real terms.               cost per case expenditure.


                                       Assumes new investment to         Initial financial plans for 2007/08
                                                                                                                 Contract agreement has been
5     Sexual Health / GUM              expand service and reduce waiting make no provision for continued                                                   250         250             0           0      G
                                                                                                                 reached with Providers at less
                                       times.                            increases in costs in these areas.
                                                                                                                 additional cost than was
                                                                                                                 envisaged. Services excluded
                                       Cost of Activity capped at 2006/07 Continuation of trend in AIDS/HIV      from PBR are being effectively
6     AIDS/HIV                                                                                                   managed and controlled.                   300         300             0           0      G
                                       level in real terms.               spend.

                                                                           Continuation of upward trend in
                                       Cost of Activity capped at
7     High Cost Drugs/PbR exclusions                                       HCDs/PbR exclusions                                                             500         500             0           0      G
                                       2006/2007 level in real terms.
                                                                           expenditure.

                                       Less than 100% uptake of out-of-    ISTC demand Model leading to          Non Recurrent slippage on ISTC
      Activity (ISTC investment) /     area ISTC capacity assumed.         higher or lower utilisation.          pickup achieved. Further slippage
8     Specialist Commissioning         Changes to investment figures       Financial pressures emerge from       achieved in respect of Wave 2           2,000       2,000      (1,738)            0      G
      Stocktake                        assumed for Specialist              move to usage on Specialist           Diagnostics and Multi-Specialty
                                       Commissioning                       Services.                             programmes.




                                                                                                  Page 1 of 4
                                                                                                                                                                                            Appendix 5

                                                                                                                                                                                                         Risk
POTENTIAL VARIANCES FROM PLAN                                                                                                                             Risk/Variance : (Surplus) / Deficit
                                                                                                                                                                                                        Rating
                                                                                                                                                                              Incorp in
                                                                                                                                                                                        Potential
                                                                                                                  Forecast Outturn - September        Initial     July        Sept 2007            Revised
No.             Budget Area                    Assumption in Plan                          Risk                                                                                          Further
                                                                                                                          2007 Update                 Plans       2007        Forecast            Sept 2007
                                                                                                                                                                                        Variance
                                                                                                                                                                               Outturn
                                                                                                                                                      £'000       £'000         £'000       £'000

                                                                                                                Commissioning Team to work
                                                                                                                closely with Practice Based
                                        Plan assumes nominal £1m            The level of savings assumed
      Savings Generated by Practice                                                                             Commissioning Groups to manage
9                                       savings in 2007/08 with 70%         within the 2007/08 plan will not be                                            300         300              0           0     G
      Based Commissioning                                                                                       demand and divert high system
                                        reinvested in services.             achieved in-year.
                                                                                                                users into more appropriate
                                                                                                                services.

                                                                            Finance Team to work with Budget
                                                                            Holder to optimise use of
                                                                            resources. Action Plan arising out
                                        Uplift set at 2006/07 out-turn +
                                                                            of Audit Commission review to be In light of the latest information,
10 Primary Care Prescribing             7.2% - ie reduction of 1.8% from                                                                                 1,500       1,500              0           0     G
                                                                            implemented where appropriate.     this risk has been downrated.
                                        SHA guidance.
                                                                            Scriptswitch decision support
                                                                            software to be rolled out
                                                                            imminently.


                                                                            Risk that final 2006/07 out-turn
      Impact of commissioning 2006/07   Range of activity and costs based                                        2006/07 outturn fully covered
11                                                                          activity will exceed the level                                                 500         500              0           0     G
      outturn activity levels           on detailed modeling work.                                               within LDP provisions
                                                                            estimated in the LDP.

                                                                       Full repayment required in 2007
                                        Continued availability of
12 NPC                                                                 with no brokerage back to the             Accumulated brokerage available           500         500              0           0     G
                                        accumulated brokerage assumed.
                                                                       PCT.

                                        Cost of new CSSD service,
                                                                                                                 Unplanned delays in implementing
                                        required to meet national           Actual Costs will exceed current
13 Decontamination strategy                                                                                      the decontamination joint venture         500         500       (1,100)            0     G
                                        standards, could exceed current     estimates
                                                                                                                 proposal.
                                        estimates.

                                        Provision for increased cost        LDP provisions will not be
                                                                                                                 LDP provisions sufficient to cover
                                        incorporated in plan based on       sufficient to cover the running
14 Primary Care Estate                                                                                           running costs of LIFT                     500         500              0           0     G
                                        assumed programme of new            costs of LIFT developments
                                                                                                                 developments in 2007/08
                                        development                         coming on stream in 2007/08.


                                                                                                                 Funding shortfall of up to £0.5m
                                                                                                                 projected initially in relation to
                                                                                                                 patient charge income in the new
                                                                                                                 Dental contract. 2006/07 outturn
                                        Assumption made as to the likely Risk of additional costs over and
15 Dental Contracts                                                                                              position showed improvement in            500            0             0           0     G
                                        impact of patient charges shortfall above funded levels.
                                                                                                                 recovery rates and lower than
                                                                                                                 expected UDA levels. Funding
                                                                                                                 carried forward into 2007/08
                                                                                                                 should eliminate financial risk.




                                                                                                   Page 2 of 4
                                                                                                                                                                                    Appendix 5

                                                                                                                                                                                                 Risk
POTENTIAL VARIANCES FROM PLAN                                                                                                                   Risk/Variance : (Surplus) / Deficit
                                                                                                                                                                                                Rating
                                                                                                                                                                      Incorp in
                                                                                                                                                                                Potential
                                                                                                        Forecast Outturn - September        Initial       July        Sept 2007            Revised
No.             Budget Area              Assumption in Plan                       Risk                                                                                           Further
                                                                                                                2007 Update                 Plans         2007        Forecast            Sept 2007
                                                                                                                                                                                Variance
                                                                                                                                                                       Outturn
                                                                                                                                            £'000         £'000         £'000       £'000

                                                                                                       Preliminary assessment of
                                                                                                       additional resources required to
16 Proposed Provider Arm Separation                 No Variance assumed in Plan                                                                       0           0             0        200      R
                                                                                                       progress the development of an
                                                                                                       Arms Length Provider Unit.

                                                                                                       Plans being considered include
                                                                                                       Prevention/Rehabilitation,
   Consideration of Future
                                                                                                       Treatment Rooms, Community OT,
17 Development Plans to be delivered                No Variance assumed in Plan                                                                       0           0       1,131             0     R
                                                                                                       Children's Vaccination and
   in 2007/08
                                                                                                       Immunisation and District Nurse
                                                                                                       Capacity

                                                                                                       Assessment to accelerate
      Additional Investment to support
18                                                  No Variance assumed in Plan                        achievement of 18 week target in               0           0       1,440             0     R
      18 week target acceleration
                                                                                                       Audiology and Gynaecology


                                                                                                       Overspend due to price changes
                                                                                                       on the National Contract and has
19 Oxygen Contract                                  No variance assumed in Plan                                                                       0           0         440      0            G
                                                                                                       been based on actual activity data
                                                                                                       up to 31st May


                                                                                                       Technical adjustment in respect of
20 Other emerging pressures                         No variance assumed in Plan                        third-party grants that has now                0           0         597      0            G
                                                                                                       been confirmed as a pressure.

                                                                                                       Assessment of commitments
      2007/08 Investment Plan
21                                                  No variance assumed in Plan                        against 2007/08 £50m Investment                0           0       (106)      (6,307)      G
      Proposals
                                                                                                       Proposals

                                                                                                       Need to be reviewed once
22 Restructuring Costs                              No variance assumed in Plan                        implementation of the PCT's new                0           0      (1,500)     (1,500)      G
                                                                                                       structure is finalised.

                                                                                                       Favourable variances on final
23 2006/07 Outturn Position                         No variance assumed in Plan                                                                       0           0      (3,811)     0            G
                                                                                                       2006/07 outturn position


                                                                                                       The underspend on development
                                                                                                       allocations from 2006/07 is
      Dental Contract and Development
24                                                  No variance assumed in Plan                        continuing into 2007/08. A                     0           0     (3,000 )     0            G
      Schemes
                                                                                                       detailed review with the Service
                                                                                                       Directorate is ongoing.




                                                                                         Page 3 of 4
                                                                                                                                                                           Appendix 5

                                                                                                                                                                                       Risk
POTENTIAL VARIANCES FROM PLAN                                                                                                           Risk/Variance : (Surplus) / Deficit
                                                                                                                                                                                      Rating
                                                                                                                                                              Incorp in
                                                                                                                                                                        Potential
                                                                                                Forecast Outturn - September        Initial       July        Sept 2007            Revised
No.          Budget Area        Assumption in Plan                        Risk                                                                                           Further
                                                                                                        2007 Update                 Plans         2007        Forecast            Sept 2007
                                                                                                                                                                        Variance
                                                                                                                                                               Outturn
                                                                                                                                    £'000         £'000         £'000      £'000

                                                                                               Slippage due to mismatch
25 GMS                                      No variance assumed in Plan                        between receipt of allocations and             0           0     (3,000 )    0           G
                                                                                               timing of planned developments.


                                                           Risk of non achievement due to
26 Planned Surplus           As per planning guidance                                          Planned surplus achieved                       0           0     (1,674 )    0           G
                                                                 increased pressures




 RISK SUMMARY (SURPLUS) / DEFICIT                                                                                                    10,350         9,850       (12,688)    (7,107)




                                                                                 Page 4 of 4