THE GP group leading health commissioning in Croydon has taken the "unprecedented" step of posting a £20 million deficit budget two months after it officially came into existence.
Croydon Clinical Commissioning Group (CCG) has told NHS England it will spend at least £19.9 million more than its £405 million budget in the current financial year.
Its governing body has also admitted that a three year recovery plan to break even by 2015/16 will fall £17 million short.
The CCG finds itself in a "significant financial challenge" even though £38 million has been saved from cutting or redesigning services over the last two years.
Speaking at a public governing body meeting held on Tuesday, Agnelo Fernandes, assistant clinical chairman, said the problem could not be "understated".
He added: "Posting a budget deficit is unprecedented in an NHS organisation but as a governing body it has to be said there isn't the money there.
"We have to be honest with ourselves in ensuring NHS England doesn't intervene in any other way."
Chairman Tony Brzezicki added: "We have had discussions with NHS England. It's a unique position in London and it's being taken into consideration as we speak. There's not much detail to add."
Though the deficit was described as unprecedented, other GP groups in areas such as Oxfordshire and Northamptonshire face financial difficulty, though Croydon's deficit appears the largest of any CCG.
Croydon CCG spent an hour and a half debating a review of healthcare in south west London and a fraction of the time discussing the deficit.
A number of board members said Croydon had been "under-resourced", particularly in light of the population boom revealed by the 2011 Census.
The borough, they said, is 0.5 per cent below capitation (the money paid to healthcare service providers) compared to its neighbours in south west London which are between 3.5 and 15 per cent above.
If the same formula is applied to the 2011 Census, which showed that Croydon's population increased by 33,000 in ten years, then the borough would be six per cent below the funding it requires, the CCG said.
David Hughes, a lay member of the board, added: "Our inherited debt position is an historical annual recurrent deficit.
"In other words, this isn't something that went wrong. It's continuing into the future; we do not get enough money for the services we have to provide."
Dr Brzezicki said the increase in population had not been factored in to Croydon's resource allocation, "adding to the problems of commissioning services in Croydon and providing social care".
The CCG must save £47 million if it is to break even by 2015/16. It has identified £30 million of what the NHS calls QIPP (Quality, Innovation, Productivity and Prevention Plan) savings but Mike Sexton, chief financial officer, admitted: "The identified opportunity to improve efficiency and deliver savings is not sufficient to close the funding gap."
To meet the saving requirements set by the Department of Health, the challenge is greater still, with £60 million of efficiencies needed to be found over the next three years.
The CCG said it was unable to provide anyone to answer detailed questions about the deficit, including the potential impact on patient care, before the Advertiser went to press.
It aims to deliver £14 million of savings over the next year, in part by schemes aimed at reducing the number of A&E attendances and admissions at Croydon University Hospital.
It spent £20 million on delivering acute care in April, with overall costs at £35 million, almost £2 million over budget, suggesting the deficit could be far greater than forecast. The CCG said it would wait until May's report before drawing conclusions.
NHS Croydon, the primary care trust which preceded the CCG, made £21.4 million of savings in 2012/13, in areas such as integrated care and reduced drug spend.
In acute care, it "tackled and reversed" costly follow-up outpatient appointments by introducing a 'patient navigation service' to "ensure patients are only recalled for a face to face follow-up appointment where necessary".
Where appropriate, patients have received either a telephone follow-up or have been discharged "safely back into the care of their GP".
Efforts have also been made to have patients discharged from hospital earlier. A project officer spent two days a week in the anti-coagulation clinic at Croydon University Hospital to "assist the service in identifying patients who were eligible for discharge".
The CCG's three-year action plan will see a redesign of services such as dermatology, sickle cell and haemophilia, and gynaecology.
There will also be a review of the community bed policy and new urgent care, dementia and diabetes systems.
In 2010/11 NHS Croydon posted a £27.8 million understatement of expenditure, which was corrected with a prior year adjustment, leading to decreased spending in 2011/12.
Under current business rules, the £20 million overspend will need to be repaid next year.
The recovery plan is subject to the approval of NHS England, which has not yet responded to the Advertiser's request for a comment.
In a statement issued this afternoon, Croydon CCG said the "significant financial challenge" it faces is the result of increasing hospital based services, population growth and recovery from the overspend in Croydon PCT in 2010/11, directly contradicting NHS London's insistence that the scandal had no ongoing impact on the delivery of healthcare.
