Transcript Slide 1
Budget 2014/15 West London CCG Contents The purpose of this paper is to present the Governing Body with the updated budget for the CCG for 2014/15. The paper comprises: Section 1 - The medium term financial position - The CCG’s opening position - A summary of the 10 year financial model Page 3 4 5 Section 2 - Summary budgets 2014/15 - Summary Budgets 2014/15 - Contract negotiation update - Risks and uncertainties - Impact of the NW London financial strategy 7 8 12 14 15 Section 3 - Programme budget for 2014/15 - Summary budgets - Detailed budget by programme area - Reserves and investments - QIPP 16 17 18 23 25 Section 4 - Running costs 26 Section 5 - Conclusion and next steps 28 Section 1 – medium term financial position 3 The CCG’s opening position The financial plan for 2013/14 set out a budget that would deliver: A surplus of £20,155k An underlying (recurrent) surplus of £25,424k. At month 9, the forecast year end position for 2013/14 is: A surplus of £29,612k An underlying (recurrent) surplus of £34,338 k. The financial position has improved in year because of a combination of the successful delivery of QIPP schemes, some unutilised budgets following PCT disaggregation, investment slippage and the lack of need to utilise the contingency budget. This very strong position needs to be viewed in the light of the CCG’s funding position. NHS England has published target capitation budgets which tell us how much funding we should be receiving, based on the assessed need of the local population. West London’s funding is £85m higher than the target funding for the CCG. NHSE has indicated through the funding allocations for 2014/15 and 2015/16 and its further planning guidance that CCGs who are over capitation, as we are, should only expect resource increases in line with inflation over the next few years. This has therefore been reflected in our 5 year planning. The allocations are shown below. 2014/15 CCG West 2015/16 2013/14 Total target Programme Closing Total target Programme Closing baseline programme budget 2014/15 Total programme budget 2014/15 allocation allocation allocation DFT* DFT* allocation allocation DFT* Total DFT* (£'000) (£'000) (£'000) % (£'000) (£'000) (£) % (£'000) 328,111 250,348 335,133 33.91% 84,785 255,395 340,830 33.49% 85,435 Summary of the 10 year model A 10 year planning model has been produced for the CCG. The purpose of undertaking longer term financial planning is to demonstrate the impact of decisions taken for 2014/15 on the future finances of the CCG, so that we can give due regard to the longer term financial viability. This includes determining what we can afford to spend recurrently and what we can only afford to spend non recurrently (i.e. one off expenditure). The graphs below illustrate this. The first graph shows the ‘do nothing’ scenario, where we make no savings or investments in new services and allow expenditure to continue in line with existing trends. The second graph shows the financial model on which the 2014/15 budget is based. In this graph, the investment budget is split between investment that we can make recurrently and investment that we can make non recurrently. The third graph uses the same QIPP and investment figures overall, but all investments are now recurrent. Graph 2 – current financial plan 100,000 35,000 10,000 QIPP £000s £000s 2023/24 2022/23 -500,000 -600,000 -800,000 - 2023/24 2022/23 2021/22 2020/21 -900,000 2019/20 2023/24 2022/23 2021/22 2020/21 2019/20 2018/19 2017/18 -400,000 -700,000 5,000 2018/19 QIPP 2014/15 -120,000 Investment Pot Investment Pot 2017/18 -100,000 -300,000 Surplus 15,000 2016/17 -80,000 Surplus 2021/22 -200,000 20,000 2015/16 -60,000 2016/17 -40,000 2015/16 -20,000 2014/15 £000s - 2020/21 25,000 20,000 2019/20 -100,000 40,000 2018/19 60,000 2017/18 - 30,000 2016/17 80,000 2015/16 100,000 Graph 3 – all investments recurrent 2014/15 Graph 1 – do nothing The graphs demonstrate that: 1) Without a savings plan each year, the CCG will move into deficit in the future 2) While we can afford to make significant investments if we understand our recurrent position, we would quickly move into deficit if we spend all the money recurrently. Surplus Investment Pot QIPP Summary of the 10 year model (2) The tables below summarise the first 5 years of the model. The first table shows the overall income and expenditure position. The second table shows how much of the surplus is recurrent and how much is non recurrent. NHS West London CCG Current Yr Year 1 Year 2 Year 3 Year 4 Year 5 I&E Summary 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 £m £m £m £m £m £m Income - Recurrent Allocation 328.1 335.1 328.6 334.2 339.9 345.6 Income - Other Allocations (5.7) 0.0 0.0 0.0 0.0 0.0 Income - Return of prior year surplus 14.8 29.6 30.2 29.6 26.7 27.2 Total Resource Income 337.2 364.7 358.7 363.7 366.6 372.8 Total Net Expenditure 307.6 334.6 329.2 337.0 339.4 348.6 Surplus / (deficit) 29.6 30.2 29.6 26.7 27.2 24.2 Surplus as % of Recurrent Allocation 9.0% 9.0% 9.0% 8.0% 8.0% 7.0% 2014/15 2015/16 2016/17 2017/18 2018/19 Recurrent Non-Recurrent Total £000 £000 £000 29,145 1,017 30,162 25,699 3,874 29,573 22,467 4,267 26,734 18,998 8,190 27,188 17,160 7,034 24,194 The recurrent surplus is the underlying position of the CCG. The underlying position gradually reduces over time to approximately 2% of the CCG’s recurrent resource allocation, and then stabilises at this level. The reduction in the recurrent position allows the CCG to manage the movement towards the capitation funding level while still being able to invest in out of hospital services. It should be noted that these figures assume a very large increase in expenditure in 2014/15 and that this higher level of expenditure is maintained. In practice this would be very hard to achieve while still ensuring value for money in the use of public funds. Section 2 – Summary budget 2014/15 7 Summary budget 2014/15 The summary budget is shown in the table below. This is reconciled to the forecast outturn for 2013/14 so that planned movements in expenditure can be seen. Budget area 2013/14 FOT Revenue resource limit £000s 344,841 Remove non recurrent items £000s (11,178) 2013/14 2014/15 Budget recurrent FOT (inc CQUINS) £000s £000s 333,663 370,307 Variance Expenditure: Acute MH Community Other programme budgets Total programme expenditure Running costs Total expenditure 143,633 61,182 42,682 62,182 309,678 5,550 315,228 (3,305) (45) (2,348) (11,446) (17,143) 0 (17,143) 140,328 61,137 40,333 50,737 292,535 5,550 298,085 141,587 63,075 44,240 88,787 337,688 5,738 343,426 1,259 1,938 3,906 38,051 45,153 188 45,341 Surplus / (deficit) 29,613 5,965 35,578 26,881 (8,697) £000s 36,644 The planned surplus for 2014/15 remains consistent with the surplus delivered in 2013/14. The detailed sections on programme and running costs explain the key movements year on year. Update on budget changes The changes in the summary budget from the budget presented to the March governing body are shown in the table below. Budget area 2014/15 Budget presented to March Board 2014/15 Budget presented to May Board £000s Revenue resource limit Variance £000s 370,307 370,307 0 Total expenditure 138,189 62,597 43,207 90,413 334,407 5,738 340,145 141,587 63,075 44,240 88,787 337,688 5,738 343,426 (3,398) (478) (1,033) 1,626 (3,281) 0 (3,281) Surplus / (deficit) 30,162 26,881 3,281 Expenditure: Acute MH Community Other programme budgets Total programme expenditure Running costs The changes since March reflect the contract agreements that have been reached to date, and the North West London financial strategy, as agreed by governing body in March Underlying position The summary budget includes both recurrent and non recurrent (one off) expenditure. In some areas we are able to make decisions about whether to commit recurrent income to recurrent or non recurrent expenditure. Spending some of our recurrent income for non recurrent purposes allows us to maintain a strong underlying surplus. The table below sets out the how we have committed our funds within the overall budget. Budget area Recurrent income committed recurrently Revenue resource limit £000s 340,694 Recurrent income committed non recurrently £000s 0 Non recurrent income committed non recurrently £000s 29,613 Expenditure: Acute MH Community Other programme budgets Total programme expenditure Running costs Total expenditure 135,960 62,710 43,390 65,005 307,064 5,131 312,196 0 0 0 8,374 8,374 0 8,374 5,626 365 850 15,409 22,250 607 22,856 Surplus / (deficit) 28,498 (8,374) 6,757 The underlying (recurrent) position of the CCG is planned to be a surplus of £28,498k at the end of 2014/15 Bridge analysis The graph and table below shows how we have committed our new resources during 2014/15. 13/14 Surplus Non Recurrent Adjustments Change in Allocation Net Tariff Deflator Activity Growth Other Cost Pressures QIPP savings Investment Contingency 2% headroom £000s 29,613 9,952 7,031 2,399 (8,048) (11,383) 9,794 (10,626) (1,852) (8,374) Contract negotiation position As at 29 April the CWHHE CCGs have reached contract agreements with the following trusts: Chelsea and Westminster NHS Foundation Trust Imperial College Healthcare NHS Trust North West London Hospitals NHS Trust The Hillingdon Hospitals NHS Foundation Trust West Middlesex University Hospital NHS Trust Royal Brompton & Harefield NHS Foundation Trust Moorfields Eye Hospital NHS Foundation Trust King’s College Hospital NHS Foundation Trust London Ambulance Service NHS Trust (including HART) Central London Community Healthcare Trust West London Mental Health NHS Trust Contract agreements remaining outstanding include: Central and North West London Foundation Trust University College London Hospitals NHS Foundation Trust Other out of North West London trusts. Several of the contracts that have been agreed are block contracts with performance incentive payments built in. The purpose of this contracting approach is to provide stability during the time of transition to the future acute hospital configuration set out in Shaping a Healthier Future, while also putting in place the appropriate incentives to deliver the necessary clinical transformation. As these contracts contain limited in year risk for commissioners, they have been agreed at a higher value than would have been the case if a PbR contract had been agreed. We are still seeking to reach agreement with CNWL, one of our key providers. Once these are agreed the level of risk will need to be reviewed. 12 Agreed Contracts The WL CCG agreed contract figures as at 29 April are shown in the table below: ChelWest Imperial NWL Hillingdon West Middlesex Royal Brompton Moorfields Kings LAS inc HART CLCH WLMHT £000s 43,957 66,840 1,046 281 123 1,669 814 333 7,540 33,940 1,171 13 Current risks and uncertainties The risks and uncertainties currently identified are: 1) External System Risks On going 2014/15 contract negotiations Uncertainty of allocations beyond 2015/16 Unresolved PCT disaggregation issue regarding specialised commissioning and the impact on CCG allocation and expenditure. Lack of clarity on property costs - again this is a PCT disaggregation issue that has not been finalised. Integrated single financial environment not fit for purpose – whilst on the face of it this is not a financial risk, the difficulty in providing budget holders with accurate statements could pose a financial risk. Continuing care restitution payments – the planned NHS England approach to top slice CCG allocations to fund these payments, rather than utilising brought forward provisions, could create a material cost pressure. Potential further pressure on the SAHF budget Risk of provider underdelivery against national targets (e.g., 18 weeks RTT) 2) Internal Risks Delivering the full QIPP programme. Implementation of the better care fund. Reduction in levels of running cost allocations in subsequent years. The agreement of block contracts with some providers mitigates much of the in year risk associated with the delivery of the QIPP programme. However, achieving QIPP is critical to improving the underlying position of the CCG and to ensuring that a balanced budget can be set for 2015/16. Internal monitoring will therefore continue based on actual activity and ignoring the block arrangements. 14 Financial Strategy This updated budget reflects the funding agreed as part of the North West London financial strategy agreed by the governing body in March, which resulted in the transfer of a net £6.4m of recurrent funds and £11.8m non recurrent funds from West London into other CCGs, in recognition of the over capitation position of West London and the under capitation position of other CCGs, and the need for them to invest in out of hospital and primary care services to deliver Shaping a Healthier Future. The overall impact of these transfers has been a reduction in the West London surplus for 14/15 of £3.3m, with the remainder being funded from reserves. 15 Section 3 – Programme budgets 16 Programme budget 2014/15 The summary programme budget is shown in the table below. This is reconciled to the forecast outturn for 2013/14 so that planned movements in expenditure can be seen. Budget area Expenditure: Acute MH Community Other programme budgets Total programme expenditure 2013/14 FOT £000s Remove non recurrent items £000s 143,633 61,182 42,682 62,182 309,678 (3,305) (45) (2,348) (11,446) (17,143) 2013/14 2014/15 Budget recurrent FOT (inc£000s CQUINS) £000s 140,328 61,137 40,333 50,737 292,535 141,587 63,075 44,240 88,787 337,688 Variance Slide reference £000s 1,259 1,938 3,906 38,051 45,153 18 20 21 22 The key movements between years for each contract are explained in the detailed slides that follow. It should be noted that some contracts have not yet been agreed and that those that have been agreed are not yet reflected in the budgets. The budget figures are therefore indicative and subject to change as contracts are signed. Acute budget The acute budget is shown in the table below. This is reconciled to the forecast outturn for 2013/14 so that planned movements in expenditure can be seen. Budget area Acute contracts: Imperial Chel West Other contracts Contract settlement reserve Total contracts NCAs LAS Other acute Other reserves Total acute expenditure 2013/14 FOT £000s Remove non recurrent items £000s 67,970 43,473 14,580 1,538 127,562 4,540 7,428 4,102 0 143,633 934 0 0 (1,538) (604) 0 87 (2,788) 0 (3,305) The key movements are explained on the next slide. 2013/14 2014/15 Budget recurrent FOT (inc CQUINS) £000s £000s 68,905 43,473 14,580 0 126,958 4,540 7,516 1,314 0 140,328 66,840 43,957 13,047 0 123,845 4,934 7,540 4,862 407 141,587 Variance QIPP included in budget £000s £000s (2,065) 484 (1,533) 0 (3,113) 393 24 3,548 407 1,259 (4,852) (3,425) (145) 0 (8,422) 0 0 0 (453) (8,875) Acute (2) The key movements between years for each contract are explained below. The lmperial College and ChelWest contracts with West London CCG are the agreed block contracts The contract settlement reserve has been removed following the agreement of block contracts with the key providers The other acute budget includes a contribution from reserves of £4m towards the 14/15 contract settlement The other reserves include £860k acute non demographic reserve partially offset by £453k unidentified QIPP It should be noted that some of the smaller out of area contracts have not yet been agreed. The budget figures are therefore indicative and subject to change as contracts are signed. Mental Health budget The MH budget is shown in the table below. This is reconciled to the forecast outturn for 2013/14 so that planned movements in expenditure can be seen. Budget area MH contracts: CNWL West London MH Trust Other MH Total MH expenditure 2013/14 FOT £000s Remove non recurrent items £000s 40,984 1,488 18,710 61,182 (100) (292) 347 (45) 2013/14 2014/15 Budget recurrent FOT (inc CQUINS) £000s £000s 40,884 1,196 19,057 61,137 39,710 1,171 22,194 63,075 Variance QIPP included in budget £000s £000s (1,174) (25) 3,137 1,938 (425) 0 (200) (625) The key movements between years for each contract are explained below. The CNWL contract with West London CCG has not yet been agreed, and the budget figures are expected to increase The other MH contracts increase by £2.8m, driven by cost pressures (including £0.6m increase in spot placements, £0.5m step down of MH secure clients from NHSE, and £0.4m additional S117 clients and transition cases) It should be noted that some contracts have not yet been agreed, including the CNWL contract. The budget figures are therefore indicative and subject to change as contracts are signed. Community budget The community budget is shown in the table below. This is reconciled to the forecast outturn for 2013/14 so that planned movements in expenditure can be seen. Budget area Community contracts: CLCH Other community Total community expenditure 2013/14 FOT £000s Remove non recurrent items £000s 35,567 7,115 42,682 (2,028) (320) (2,348) 2013/14 2014/15 Budget recurrent FOT (inc CQUINS) £000s £000s 33,539 6,794 40,333 33,940 10,299 44,240 Variance QIPP included in budget £000s £000s 401 3,505 3,906 (754) 1,710 956 The key movements between years for each contract are explained below. The CLCH contract with West London CCG increases by £0.4m in 2014/15; this is the agreed contract amount The other Community budget increases by £3.5m, driven by QIPP investments (£1.7m), the rollout of the Community Cardiology service from QPP to K&C (£1m), and the rollout of the MSK service to QPP (£0.6m) It should be noted that some contracts have not yet been agreed. The budget figures are therefore indicative and subject to change as contracts are signed. Other programme budgets The other programme budgets are shown in the table below. This is reconciled to the forecast outturn for 2013/14 so that planned movements in expenditure can be seen. Budget area Other programme budgets: Continuing care Primary care Contingency 2% Headroom Other Total other programme budgets 2013/14 FOT £000s Remove non recurrent items £000s 13,048 30,224 0 0 18,911 62,182 (8) (663) 0 0 (10,775) (11,446) 2013/14 2014/15 Budget recurrent FOT (inc CQUINS) £000s £000s 13,040 29,561 0 0 8,136 50,737 14,068 32,203 1,852 8,374 32,291 88,787 Variance QIPP included in budget £000s £000s 1,028 2,643 1,852 8,374 24,154 38,051 (300) (950) 0 0 0 (1,250) The key movements between years for each contract are explained below. The Continuing Care budget increases by £1.0m in 2014/15, driven by increased activity (including £0.6m physical disabilities) and the Primary Care budget increases by £2.6m, driven by £2m investments in primary care There is a Contingency of 0.5% for 2014/15 and Headroom of 2.5% £34.0m increase in Other budgets including WL CCG investments and reserves for the North West London Financial Strategy. Investments are discussed further on the following slides. Reserves and investments The budget includes the following reserves and investments: Nature of budget Reserves: Contract settlement reserve Overperformance reserve Contingency Total reserves Investments: Investment 14/15 - Primary Care Investment 14/15 - Other Investment 14/15 - QIPP Total investments NWL Financial Strategy 2% Headroom Reserve for financial strategy Total NWL Financial Strategy Programme area Recurrent value £000s Non recurrent value £000s Acute Acute Other 0 860 1,852 2,712 0 0 0 0 Primary care Reserves 2,000 2,190 1,810 6,000 0 8,822 0 8,822 6,436 6,436 8,374 11,845 20,219 2% Headroom Reserves The investment reserves set out above include the impact of the NWL financial strategy. Further detail on the planned investments is set out on the next slide. Investments Investment plans identified to date for 14/15 total a maximum of £15.1m. These are summarised in the table below. Work is continuing to refine the investment plans, to identify any overlaps between schemes, and to risk assess the schemes for slippage. The CCG is in the process of reviewing and approving each proposal using prioritisation criteria including the funding arrangements and the investment plan will be monitored throughout the year by the Investment Task Force. Programme Name Recurrent Plan 14/15 £ NonRecurrent Plan 14/15 £ Total Plan 14/15 £ Children 125,000 49,000 174,000 Effective Organisation (incl corporate comms) 155,000 245,000 400,000 Public and Patient Engagement 523,500 430,000 953,500 2,822,353 1,400,000 4,222,353 1,000,050 1,000,050 982,787 162,000 1,144,787 Planned Care 1,324,000 716,000 2,040,000 Primary Care 2,100,000 2,096,000 4,196,000 PPF / Integrated Care IT Mental Health (inc Learning Disabilities) Unplanned Care Other Total - - 130,000 130,000 421,000 450,000 871,000 8,453,640 6,678,050 15,131,690 Aside from the CCG investment pot, there are several other potential funding sources for these investments depending on alignment with our strategic priorities. These include: BCF pump priming funds, PM Challenge Fund, NWL non-recurrent 2.5% headroom fund (Part A of NWL Financial Strategy), and scheme slippage. QIPP plan – 2014/15 Investment (£000) NET Savings (£000) Scheme type GROSS Savings (£000) The QIPP plan for the year is shown below. This has been reflected in budgets. WL001 Acute services £1,160 £0 £1,160 WL012 Mental Health (CNWL) £425 £0 £425 WL021 Community services (CLCH) £344 £0 £344 WL022 Specialist Housing Strategy for Older People: Care Services Procurement (SHSOP CSP) £200 £0 £200 WL020 AQP TOP £140 £0 £140 WL027 St Charles Hospital - financial efficiency through void space reduction £260 £0 £260 WL028 Transforming Nursing and Care Home Contracting £300 £0 £300 WL029 Small Contracts Efficiency Scheme Code Transactional Productivity Total Transformational (unscheduled) £250 £0 £250 £3,079 £0 £3,079 WL007 Putting Patient First - Whole System Integrated Care £4,129 £967 £3,162 WL003 CIS Early Discharge Service £250 £50 £200 WL008 UCC/A & E £450 £100 £350 Unscheduled total £4,829 £1,117 £3,712 WL009 Referral Standardisation Scheme £1,500 £500 £1,000 WL013 MSK Pathway £250 £0 £250 WL014 Primary Care Children Hub £100 £0 £100 WL015 Primary Care Prescribing £800 £0 £800 £600 £200 £400 £3,250 £700 £2,550 £453 £0 £453 Transformational (planned care) WL018 WL030 Planned Care Total Unidentified QIPP Risk Adjustment Long Term Conditions (Cardiology/Diabetes/ Respiratory) Community Opthalmology Service TBC -£1,416 Grand Total £11,158 £1,817 £8,378 Section 4 – Running Costs 26 Running costs At a national level, the total running cost budget has been frozen for 2014/15, and then reduces by 10% in 2015/16. The link between running costs and population has been maintained – this means that the total national running cost budget has been divided by the total population to derive a new spend per head, reducing from £25 per head in 2013/14 to £24.73 in 2014/15 and £22.07 in 2015/16. Running cost budgets are pooled across the collaboration. At the collaborative level, there is a small increase in the running cost budget for 2014/15 of £400k. For West London, there is a small increase of £188k. Budgets for running costs are currently being finalised but will not exceed the total funding available. A high-level view of the budgets is set out below, with some narrative about the key movements between 2013/14 forecast outturn and 2014/15. The table also shows an estimate of the saving that will be required in 2015/16. Across the Collaborative the saving requirement is c. £250k and the West London share is £59k. 20134/14 2014-15 Movement FOT £'000 £'000 Budget £'000 % CCG Pay 1,581 77 5% CCG Non-Pay CSU charge Collaborative recharge 934 2,817 370 (265) (70) 177 -28% -2.5% 48% Less programme recharges (101) (25) 24% Reserves Savings Total - Running costs 0 0 5,601 244 0 2015-16 Narrative Movement Includes FYE of post recruited late and budget for average 3% 1,658 50 increments. 668 Reduces due to non-recurrent spend taken out (0) 2,746 Agreement to reduce cost by 5% in months 7 - 12 (211) 547 Charged in line with affordability (111) Increases in line with pay costs plus additional programme recharge (125) (4) identified 244 Uncommitted reserve (244) 0 Split based on allocation (59) 5,738 Budget £'000 % 3% 1,708 0% -7.7% -20% 668 2,535 436 3% (129) 0 (59) 5,159 Section 5 – Conclusion and next steps 28 Conclusions The budgets presented in this paper were originally agreed at the March governing body, and have been updated to reflect agreed contracts and the North West London Financial Strategy The CCG has a strong underlying position – by spending a large proportion of its reserves non recurrently it can protect itself against medium term risk as funding levels are reduced The main acute contracts with Imperial and ChelWest have been agreed as block contracts, thus removing much of the inyear risk around contracts. The Governing body is asked to; Approve the budgets Next steps The next steps are to: Finalise contract negotiations with CNWL and the remaining out of area providers Ensure all QIPP and investment plans are robust and move into implementation Appendix 1 - assumptions 2014/15 Publ 2015/16 Publ 2016/17 1.8% 2017/18 1.7% 2018/19 1.7% Contingency -4.0% -4.0% 2.6% 2.6% 1.7% 1.0% 2.2% 2.2% 1.0% 0.0% 0.6% 3.0% 2.0% 3.3% 3.0% 2.0% 1.0% 0.0% 0.5% -4.0% -4.0% 2.9% 2.9% 1.7% 1.0% 2.2% 2.2% 1.0% 0.0% 0.6% 3.0% 2.0% 3.3% 3.0% 2.0% 1.0% 0.0% 1.0% -4.0% -4.0% 4.4% 4.4% 1.7% 1.0% 2.2% 2.2% 1.0% 1.8% 0.6% 3.0% 2.0% 3.3% 3.0% 2.0% 1.0% 0.0% 1.0% -4.0% -4.0% 3.4% 3.4% 1.7% 1.0% 2.2% 2.2% 1.0% 1.7% 0.6% 3.0% 2.0% 3.3% 3.0% 2.0% 1.0% 0.0% 1.0% -4.0% -4.0% 3.3% 3.3% 1.7% 1.0% 2.2% 2.2% 1.0% 1.7% 0.6% 3.0% 2.0% 3.3% 3.0% 2.0% 1.0% 0.0% 1.0% Non-Recurrent Headroom 2.5% 2.0% 2.0% 2.0% 2.0% 2.5% 2.5% 2.5% 2.5% 2.5% Allocation Growth Gross Provider Efficiency Provider Inflation Demographic Growth Non-Demographic Growth CQUIN Allocation Growth Acute Non acute Acute Non acute Prescribing Primary care Mental health Community Corporate Allocation Growth Yes Acute CHC Prescribing Primary care Mental health Community Non acute Yes