1

NHS BOLTON CLINICAL COMMISSIONING GROUP AGENDA ITEM NO: ……8………………… Date of Meeting: ……13th September 2019……………………… TITLE OF REPORT:

Report of the Chief Finance Officer (Month 4).

AUTHOR:

Kelly Knowles, Deputy Chief Finance Officer

PRESENTED BY:

Ian Boyle, Chief Finance Officer

PURPOSE OF PAPER: (Linking to Strategic Objectives)

To provide the CCG Board with an update on the 2019/20 Financial Plan and Month 4 Budgets.

LINKS TO CORPORATE OBJECTIVES (tick relevant boxes):

Deliver the outcomes in the Bolton Joint Health and Care Plan.

Ensure compliance with the NHS statutory duties and NHS Constitution.

√

Deliver financial balance. Regulatory Requirement. Standing Item. √

RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting)

NHS Bolton Clinical Commissioning Group Board is asked to:- 1. Note the update to the 2019/20 Financial

Plan and associated budgets as at month 4. 2. Recognise the level of risk identified and

note the process in place by the Executive Team and Finance & QIPP Committee to review scenarios on a monthly basis.

COMMITTEES/GROUPS PREVIOUSLY CONSULTED:

The CCG Executive has discussed and supports the recommendations to the Board. The Finance & QIPP Committee has reviewed and discussed the reports at the meeting prior to the Board. The Board will be kept up to date on financial plans and QIPP delivery.

REVIEW OF CONFLICTS OF INTEREST:

N/A

VIEW OF THE PATIENTS, CARERS OR THE PUBLIC, AND THE EXTENT OF THEIR INVOLVEMENT:

Views of stakeholders will be obtained as part of the CCG commissioning plans.

EQUALITY IMPACT ASSESSMENT (EIA) COMPLETED & OUTCOME OF ASSESSMENT:

An EIA assessment is not required necessary for the report.

Report of the Chief Finance Officer Month 4 - July 2019

Ian Boyle Chief Finance Officer

1

1.1 Headlines 1.2 Financial Duties

1. Executive Summary

2.1 Allocation 2.2 Financial Position as at Month 4 2.3 Acute Commissioning 2.4 Non Acute Commissioning 2.5 Running Costs 2.6 Reserves 2.7 Financial Risk 2.8 Impact on 2020/21 Financial Plan

2. Finance and Contract Management

3.1 QIPP Performance 3.2 QIPP Scheme Overview

3. Efficiencies

4.1 Statement of Financial Position 4.2 Cash Limit Drawdown & Better Payment Code 4.3 Capital

4. Financial Control

5. Social Value

Contents

2

1.1 Headlines

The reported financial position for Month 4 is balanced to the financial plan and in line with the 19/20 control total. Headlines for the Month 4 financial position are as follows: • Month 3 data for the Acute providers indicates a forecast over performance of £238k. SLAM plans have

been validated with Providers and appropriate challenges made for activity queries, £21k of which have been confirmed and transacted in the financial position.

• The Funded Care financial position is reported at £245k over spent YTD. The forecast indicates a £921k pressure by the end of the financial year.

• Prescribing data for Month 2 has been received, however the forecast and YTD position have both been brought into line with the plan until further information is received.

• Spend for the PCN DES is now included in the Primary Co-Commissioning position. • A paper that outlines the options for achieving the remaining unidentified QIPP will be presented to the

CCG Executive in August.

Financial Performance

3

July 2019

Plan £000’s

Actual £000’s

Variance £000’s

Plan £000’s

Actual £000’s

Variance £000’s

Allocation (160,884) (160,884) 0 (492,599) (492,599) 0

Expenditure 160,884 160,884 0 492,599 492,599 0

Surplus/(Deficit) 0 0 0 (0) 0 (0)

YTD Forecast

1.2 Financial Duties

The CCG’s statutory financial duties and performance targets are a requirement of NHS England. More detailed updates on these duties are provided throughout the report.

Statutory Financial Duties and Performance Targets

Description Financial Performance Targets Expected Performance

Explanation of the Expected Performance

Revenue Position Operate within approved revenue resource allocation in each and every year. Hold a contingency of at least 0.5%.

Green The CCG has a financial plan that meets this target. Robust

processes are in place to ensure that this is closely monitored and reported through the appropriate CCG Governance.

Running Costs Not to exceed the Running Cost Allowance of £6,322k. Green

The financial budget has been aligned to the financial plan. The CCG has committed to reducing running costs by 20%

during 19/20. Cash Operate within its approved annual cash draw-down

limit (ACDR) in each and every year. Green The CCG has a cash flow plan that meets this target. Processes are in place to monitor and report performance.

Business Conduct Comply with the Better Payments Practices Code of paying 95% of invoices within 30 days.

Green

The CCG has met the performance target in month for both value and number of invoices paid.

Statement of Financial Position

Net Current Assets matches Taxpayers Equity.

Green

The CCG has negative taxpayers equity which reflects the timing of cash flows compared to expenditure incurred over

time.

Quality, Innovation, Productivity & Prevention (QIPP)

Deliver an efficiency across the CCG’s expenditure baseline in order to meet the QIPP challenge. Amber The CCG has a QIPP target of £9.2m for 19/20. There is

currently £0.76m unidentified.

Financial Risk Financial risks and mitigating actions are identified and reviewed on a monthly basis. Amber Financial Risks have been identified for 19/20 and these are

monitored monthly and reported in section 2.7

4

2.1 Allocation

£301k has been received for the Primary Care 5YFV funding. £131k has been allocated to Primary Care for the full year value of two schemes. The remaining funding has been transferred to reserves as the CCG funded the additional access under the Primary Care Locality Service through the baseline budgets during financial planning. This was done to avoid any timing issues between the allocation being received and the CCG making the required contract payments. The CCG is anticipating additional allocation adjustments for the following areas:

• Primary Care 5YFV funding £0.8m • Mental Health 5YFV funding £0.5m

Allocation adjustments

5

PC 5YFV

Trans-formation

Fund

Mentoring Programme

2019-20 Personalised

CareAcute Contracts 228,899 0 228,899Mental Health 42,502 0 42,502Learning Disabilities 5,216 0 5,216Prescribing 46,197 0 46,197Community Services 46,520 0 46,520Continuing Care 16,729 0 16,729Primary Care 55,558 131 131 55,689Other Programme 41,575 170 2,775 5 2,950 44,525

Total Commissioning 483,196 301 2,775 5 3,081 486,277Running Cost 6,322 0 6,322

Total Allocation 2019-20 489,518 301 2,775 5 3,081 492,599

Total Adjustments

Month 4£000

Revised Allocation at

Month 4£000

Allocation Changes 2019-2020 Baseline Allocation at

Month 3£000

Adjustments Month 4

2.2 Financial Position at Month 4

1. £245k over spend YTD within Continuing Care continues to be assessed for validity – further information will be discussed in section 2.4.

2. Provider activity and performance submissions are validated monthly and successful challenges are monitored closely through QIPP reporting.

3. Spend for IT Projects has been reviewed with Bolton FT as the lead provider. The delay in the transition project is causing some of the over spend. The expenditure review highlighted some areas that have been charged that will require credits and once these have been calculated, the appropriate budget transfers will be made.

Headlines & Actions

6

July 2019 Section

Plan £000’s

Actual £000’s

Variance £000’s

Plan £000’s

Actual £000’s

Variance £000’s

Allocation (160,884) (160,884) 0 (492,599) (492,599) 0

Acute Services 78,601 78,686 (85) 236,383 236,616 (233) 2.3

Mental Health 15,973 15,961 12 48,154 48,154 (0) 2.4

Community 14,885 14,887 (2) 44,685 44,689 (4) 2.4

Other Commissioning 9,686 9,828 (142) 29,286 29,218 68 2.4

Primary Care 33,662 33,720 (58) 101,909 101,916 (7) 2.4

Continuing Care 5,520 5,764 (245) 16,511 17,432 (921) 2.4

Running Costs 2,125 2,037 88 6,322 5,922 400 2.5

Reserves 432 0 432 9,349 8,653 696 2.6

Expenditure 160,884 160,884 0 492,599 492,599 0

Surplus/(Deficit) 0 0 0 0 0 (0)

Year to Date Forecast

2.3 Acute Commissioning – Provider View

• The Acute position at Month 4 is based on the Service Level Activity Monitoring (SLAM) provided by Acute and Community Trusts for May (Month 3). This means the July element of this year to date position is an estimate.

• SLAM information has been available for all our main NHS Providers. The Bolton FT Plan used in these results is currently a draft work in progress. Subsequently, to receiving this Month 3 data, work has now been completed to finalise and agree a SLAM Plan for Month 4.

• The overall position reported at Month 4 is a year to date overspend of £85k. The main contract that gives rise to the overspend is MFT, but this is off set by underperformances in SRFT and Independent Sector.

Year to Date Reported Acute Financial Position

7

2.3 Acute Commissioning – POD View

• The above table includes all NHS Main Acute contracts and the aforementioned draft Plan for Bolton FT. • Data and EUR Challenges have been raised to all Providers, excluding BFT. • The largest variance noted are with regards Maternity, A&E and Non-elective.

Headlines and Adjustments

8

2.4 Non Acute Commissioning – Funded Care

Continuing Care/FNC and Funded Care Team:

The funded care team forecast has improved this month due to non recurrent pay pressure in the senior position being funded through reserves. The forecast for agency remains until November, when it is expected that the vacancies will be filled. High cost cases are being reviewed by the Funded Care Nurses to ensure that packages provided are still meeting the needs of the patients appropriately. Two such packages have been reviewed with the result being a requirement that the patients needs have improved and that step down is appropriate. This benefit is included in the position. A further three reviews are scheduled to take place in August. The full year value of these five packages is £577k. Actions put into place to mitigate the position and deliver QIPP are below:

Liaison Review of packages

£30k

Liaison Calculator

The CCG has approved the FCT to utilise the Liaison Package Calculator, which is a mechanism for calculating the indicative budgets for packages approved by the CCG. The first meeting to start utilising the calculator will be in September.

£TBC

MIAA Recommend-

ations

QIPP delivery plans to include patient pathway management as cited as High Risk in the MIAA report £177k

QIPP

9

July 2019

Plan£000’s

Actual £000’s

Variance £000’s

Plan£000’s

Actual £000’s

Variance £000’s

Continuing Care 5,194 5,419 (226) 15,581 16,485 (904)

Funded Care Team 326 345 (19) 930 947 (16)

Expenditure 5,520 5,764 (245) 16,511 17,432 (921)

Year to Date Forecast

2.4 Non Acute Commissioning – Mental Health

Mental Health:

Learning Difficulties:

• There are no current concerns for the Learning Difficulties budget. • No additional patients are expected to be transitioned under the Transforming Care agenda in the

foreseeable future.

• The Mental Health budget has been maintained at plan this month. • Acute out of area placements are not exceeding the 19/20 YTD budget and, therefore the associated QIPP is

being fully achieved.

10

July 2019

Plan £000’s

Actual £000’s

Variance £000’s

Plan £000’s

Actual £000’s

Variance £000’s

Mental Health 14,182 14,171 12 42,783 42,783 (0)

Learning Disabilities 1,790 1,790 0 5,371 5,371 0

Expenditure 15,973 15,961 12 48,154 48,154 (0)

Year to Date Forecast

2.4 Non Acute Commissioning – Primary Care

The year to date and forecast positions have been brought into line with the overall plan whilst the CCG awaits further analysis and budget phasing information.

GP Prescribing:

The Primary Care IT budget is £55k over spent YTD. The expenditure review has been undertaken with the main provider (Bolton FT) and actions from this meeting are anticipated to be completed by M5. The year to date position for Medicines Management is a £10k under spend which relates to non recurrent vacancies.

Primary Care:

The queries raised with NHSE last month have been resolved and the values known for the Primary Care Network DES payments are now included in the financial position. There is an ongoing discussion with NHSE as to how these will be funded and transacted through the PCCC budget. The forecast has been reported in line with the plan whilst the analysis for the additional resource is reviewed in line with PCN negotiations.

Primary Care Co-Commissioning:

11

July 2019

Plan£000’s

Actual £000’s

Variance £000’s

Plan£000’s

Actual £000’s

Variance £000’s

GP Prescribing 15,399 15,399 0 46,197 46,197 0

Primary Care 4,427 4,485 (58) 13,467 13,474 (7)

Primary Care Co-Commissioning 13,836 13,836 (0) 42,245 42,245 0

Expenditure 33,662 33,720 (58) 101,909 101,916 (7)

Year to Date Forecast

2.4 Non Acute Commissioning – Other Commissioning

The £4k over spend reported in community relates to expenditure for salary reimbursements made to Bolton Hospice.

Community:

The queries relating to invoices coded to Commissioning non-acute have been resolved, and the impact removed from the position. The Property Recharge cost centre is over spent by £147k, this is partially due to the categorisation of expenditure which will be corrected in Month 5 and partially due to invoices received for 18/19 that are being queried by the finance team.

Other Commissioning:

The Other Corporate budgets are reporting a year to date underspend due to vacancies within the Safeguarding and Nursing and Quality teams. Recruitment is underway for both areas.

Other Corporate:

12

July 2019

Plan £000’s

Actual £000’s

Variance £000’s

Plan £000’s

Actual £000’s

Variance £000’s

Community 14,885 14,887 (2) 44,685 44,689 (4)

Other Commissioning 9,353 9,520 (167) 28,287 28,271 16

Other Corporate 333 308 25 999 946 53

Expenditure 24,571 24,715 (144) 73,971 73,907 64

Year to Date Forecast

2.5 Running Costs

The year to date underspend of £88k is derived through vacancies throughout the CCG. Although these are non recurrent savings in 2019/20, all vacancies will be reviewed as part of the running cost reduction whereby the CCG has committed to reducing running costs by 20% by 2020/21 in line with NHS England guidance. An update on progress towards this target will be presented to the Executive by the end of August. The CCG has included £400k on the QIPP Programme for 2019/20 to contribute to this requirement, which is reflected in the forecast position.

Running Costs:

13

July 2019

Plan£000’s

Actual £000’s

Variance £000’s

Plan£000’s

Actual £000’s

Variance £000’s

Running Costs 2,125 2,037 88 6,322 5,922 400

Expenditure 2,125 2,037 88 6,322 5,922 400

Year to Date Forecast

2.6 Reserves

Commitments on reserves are investments and pressures whereby funding has been approved by the CCG Executive. The majority of the potential commitments are areas of investment identified within the financial planning process that have not yet been formally approved by the CCG Executive but where funding requests are expected to be made later in the financial year. The commitments on the reserves position have increased significantly this month with additional pressures recognised for the delay in the IT Transition project. The CCG has identified the 0.5% contingency separately within reserves.

Reserves:

14

Potential Spend£'000's

Reserves £'000's

Commissioning Reserve 7,1060.5% Contingency 2,243Total Reserves 9,349Commitment on Reserves (3,910)Remaining Reserves after Commitments 5,439Potential Commitment on Reserves (5,752)Remaining Reserves after potential commitments (313)Potential CCG Mitigations 3,597Remaining Reserves after CCG mitigations 3,284Identified Risks (7,862)Remaining Reserves after identified risk applied (4,578)

2.7 Financial Risk

An evaluation of the financial risks to the delivery of a balanced plan has been undertaken. Ongoing close monitoring and review of these is taking place each month to ensure a balanced financial position is delivered.

Financial Risk:

15

Risk as per Financial Plan

Risk as at M4

£000s £000s

Failure to control demand

Failure to control demand within Acute and Independent Providers

3,000 H 3,000

QIPP programme established for service redesign and contractual efficiencies.Aligned Incentive Contract continues with BFT.Close contract monitoring of all other contracts with a refreshed challenge process established.

Increased costs of Continuing Health Care

Increase in high cost placements 1,000 H 600

Funded Care Team have updated the action plan to continue to review all placements and contracts with all providers. The risk has reduced to £600k from £1.5m as £900k is reflected in the position.

MH/LD high cost placements.

Failue to control Out of Area Placements and the increase in high cost placements

2,000 M 1,000Service redesign continued from 18/19, with local beds available.Continued joint working with GMMH to reduce high cost OOA placements.

Failure to control prescribing spend and deliver efficiency

Failure to control NCSO pressures.Failure to control demand.

600 H 600Bolton Quality Contract continues and medicine s management QIPP programme Full suite of monitoring in place.

Failure to control primary care spend

Failure to control spend requirements within LES and Primary Care IT

400 H 400 Regular review meetings with the CCG Primary Care team.

IT Risk relating to transition project

Specific risk relating to IT Transition project 500 H 500

Regular updates are made to the CCG Executive and with oversight via IT Transition Board

Failure to control spend within Primary Care Co-Commissioning

Failure to control spend within the Delegated budget.

500 H 500 Regular review meetings with the NHSE finance team.

Estates Failure to control Estates spend including Avondale 500 H 500

Establish CCG Estates group with GP membership to report into CCG Executive and SEG

Unidentified QIPPValue of the QIPP programme that remains unidentified 2,551 M 762

Additional QIPP for non Bolton FT challenges recognised in Month 4. Service transfer will result in a part year QIPP which is reflected in this position.

Total 11,051 7,862

Risk Risk Description H/M/L Mitigating Actions

2.8 Impact on the 2020/21 Financial Plan

The financial plan for 2020/21 is based on the allocations that have been shared by NHSE through the 19/20 planning round. This has been refreshed to include the historic drawdown that the CCG will be utilising following further support to the National position in 19/20. The CCG has reviewed the proposed investments, growth assumptions and cost pressures for 2020/21 and this has provided an anticipated QIPP figure of £10.5m. The Long Term Plan is due to be submitted to NHSE at the end of September, the GM deadline is 16th September.

Financial Plan 2020/21:

16

£,000's2020/21 Allocation - Programme 456,193 2020/21 Allocation - Primary Care 43,921 2020/21 Allocation - Running Cost 5,578 Total 2020/21 Allocation 505,692 Expenditure 513,906 QIPP (10,500)0.5% Contingency 2,286 Total 505,692

3.1 QIPP Performance

The CCG is forecasting to meet the QIPP target of £9.2m in 2019/20. However, delays to the schemes in Continuing Healthcare and Prescribing are causing a YTD under delivery of £500k. The remaining YTD under delivery is due to the remaining unidentified QIPP of £0.3m. £21k of non Bolton FT contract challenges have been recognised in the Month 4 YTD and forecast position. This confirmed value and the transfer of EBUS activity to Bolton FT has reduced the unidentified QIPP from £848k to £762k.

Headlines:

A Joint Savings Board is being established with membership from both the CCG and Bolton FT agreed. As such a new Joint Savings Report will be created to meet the requirements of this Board.

Shared Savings:

17

Jul 2019

Plan£000’s

Actual £000’s

Variance £000’s

Plan£000’s

Actual £000’s

Variance £000’s

Plan£000’s

Actual £000’s

Variance £000’s

Prescribing 175 133 (42) 700 533 (167) 2,100 2,100 0Running Costs 33 33 0 133 133 0 400 400 0Continuing Healthcare 83 0 (83) 333 0 (333) 1,000 1,000 (0)Estates 0 0 0 0 0 0 286 286 0Acute 42 42 0 167 167 0 500 500 0Other Acute 125 125 0 500 521 21 1,565 1,586 21Mental Health 58 58 0 230 230 0 690 690 0Partnership Prioritisation 142 142 0 568 568 0 1,703 1,703 0Contract savings 17 17 0 67 67 0 200 200 0Unidentified 64 0 (64) 254 0 (254) 783 762 (21)QIPP Total 738 549 (189) 2,952 2,218 (733) 9,227 9,227 0

In Month Year to Date Forecast

3.2 QIPP Scheme Overview In Development In Delivery

Stage 1 Ideas generation

Stage 2 Design and Planning

Stage 3 Delivery

Stage 4 Monitoring

CCG

QIP

P Sc

hem

es 1

9/20

• Repatriation • NWAS Contract

opportunities • Reduction in ambulance

conveyances • Community block

baselining • AQP • NEL growth • Cataract Pathway • New ways of working • TF/investment mitigation • Community Glaucoma • Bridgewater contract

19/20 • Impact of new OP

commissioning principles • Mobile Asset Review

• CHC Night sits • CHC wider savings • Medicines Specialist areas • A&E growth reduction • NWAS Type 3 & 4 callouts • Transfer of EBUS Activity • Children's’ continence

products – eligibility element

• CHC High Cost Cases

• Meds Optimisation work plan 2019/20

• MH Acute OAP’s • Contractual Efficiencies

2019/20 • Partnership Prioritisation • Running costs 2019/20 • Non BFT Contract challenges

Join

t Ser

vice

re

desig

n sc

hem

es

(nil

finan

cial

val

ue)

• Joint commissioning • QIPP menu of

opportunities • Sharing back office

functions • Right Care

• Estates rationalisation • System wide prescribing –

Biosimilar Drug Switches

Miti

gatin

g op

port

uniti

es

19/2

0

• Prescribing outturn benefit

18

4.1 Statement of Financial Position

• The YTD Statement of Financial Position (SoFP) is summarised in the table above and compared to the position at the end of March 2019.

• The CCG has negative taxpayers equity which reflects the timing of cash flows compared to expenditure incurred over time. There are no significant issues or movements to report.

Headlines:

19

Statement of Financial Position March 2019 July 2019 Commentary£000 £000

Non current assets 328 291 Property Plant and EquipmentTrade & other receivables 1,373 741 Monies owing to CCG by other organisationsPrepayments and accrued income 1,541 7,850 Expenditure paid in advance /income not yet invoicedCash & cash equivalents 27 5 Cash at bank/in handTotal current assets 2,941 8,596 Total monies owed to CCG plus cash /bank

Trade & other payables (6,561) (6,934) Invoices received from providers/suppliers but not yet paidAccruals & deferred income (23,221) (24,393) Expenditure for services received not yet invoiced by provider/supplierProvisions (957) (957) Liabilities relating to past eventTotal current liabilites (30,739) (32,284) Total monies owed by CCG

Net assets/(liabilities) employed (27,470) (23,397) Total monies owed by CCG net of total monies owing to the CCGTaxpayers equityGeneral fund (27,470) (23,397) Total Investment by Taxpayers

4.2 Cash Utilisation & BPPC

• The CCG’s Annual Cash Drawdown Requirement (ACDR) for 2019-20 is set based on the allocation. The CCG has an annual ACDR of £492.6m and has received £165.0m cash to the end of July 2019, representing 33.54% of the ACDR.

• The cleared bank balance target is measured at the end of the year, performance for this is shown above.

Cash:

• The CCG achieved the Better Payment Practice Code (BPPC) target paying over 95% of invoices by volume and value within 30 days. The performance is shown in the table above.

BPPC:

20

Performance of month end cash position Target Actual Trend

Cleared bank balance £506.4m £224.6k

% of monthly draw down <1.25% 0.55%

% of invoices paid within payment terms

Target Actual Trend

By Value 95.00% 96.45%

By Volume 95.00% 98.95%

£0£100£200£300£400£500

April

May

June July

Augu

stSe

ptem

ber

Oct

ober

Nov

embe

rDe

cem

ber

Janu

ary

Febr

uary

Mar

ch

£m

Cash utilisation

Cash Plancumulative

Cash Actualcumulative

YTD Cash flow Statement July 2019£000

YTD Allocation 160,884(Increase)/decrease in trade & other receivables 5,677Incease/(decrease) in trade & other payables (1,609)Increase/decrease in Provisions 0Provisions utilised 0Depreciation and Amortisation (36)Incease/(decrease) in capital payables 64Increase/(decrease) in cash (22)YTD Cash drawn 164,958

4.3 Capital Programme

• Bolton CCG HQ relocation – on track • Little Lever Health Centre development – on track • Primary Care schemes

• BAU – on track • ETTF – on track • GM Digital Fund - 1 application approved – implementation plan progressing

In progress:

• GM Digital Fund

• 1 funding application awaiting formal approval • 2 funding applications submitted in month 4

New initiatives:

21

5.0 Social Value

• Social value describes the social benefits achieved from public services and not limited to financial transactions. The CCG can measure its financial impact on social value as: • Payments to the local economy – 72% of payments made in April to July 2019 were to Bolton based

providers and suppliers and a further 22% to providers and suppliers in other regions within Greater Manchester.

• 55% of the workforce live in Bolton. • 97% of grant payments made in April to July 2019 were to Bolton based Voluntary Community

Social Enterprise (VSCE) sector and 3% to other Greater Manchester VSCE sector.

• The CCG are working closely with CVS to look at appropriate targets and further indicators of social value and use of apprenticeship schemes

Social Value – Financial impact:

22

Payments to local economy Bolton

GreaterManchester

Other regions

Workforce Bolton

GreaterManchester

Other regions

VCSE grants

Bolton

GreaterManchester

6.0 Action Requested

• Note the CCG financial position as at Month 4. • Recognise the level of risk identified and note the process in place for the CCG Executive Team and

Finance & QIPP Committee to review scenarios on a monthly basis.

Action Requested

23