Chapter 17:
2015/16 Programme
Budgeting Guidance for
CCGs
Programme Budgeting Guidance for CCGs
Financial Year 2015-16
Version number: 1.0
Draft shared: 19th July 2016
First published: 1st August 2016
Prepared by: Programme Budgeting Team, NHS England Analytical Services
[email protected]
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Contents Page
Chapter 17: 2015/16 Programme Budgeting Guidance for CCGs ........................................ 4
17.1 2015/16 Programme Budgeting Guidance for CCGs...................................................... 4
17.1.1 Introduction .................................................................................................................. 4
17.1.2 Programme Budgeting Overview ................................................................................. 4
17.2 What’s new for 2015/16? ................................................................................................. 5
17.2.1 The programme budgeting framework ........................................................................ 5
17.2.2 Refined Care settings .................................................................................................. 5
17.2.3 Approach to allocating expenditure ............................................................................. 5
17.2.4 Changes to submission template................................................................................. 6
17.2.5 Validations and checklist ............................................................................................. 7
17.3 2015/16 Data Collection Timetable ................................................................................. 7
17.3.1 Timetable ..................................................................................................................... 7
17.3.1 Submission Document ................................................................................................. 8
17.4 Calculating Programme Budgeting Data ....................................................................... 9
17.5 PB1 Analysis of Gross Expenditure ............................................................................. 10
17.5.1 PC01: Primary Prescribing ........................................................................................ 10
17.5.2 UC01/SC01: Elective and Non-elective admissions .................................................. 10
17.5.3 UC02: Unscheduled Care- A&E ................................................................................ 12
17.5.4 UC03: Unscheduled Care- Emergency Transport ..................................................... 12
17.5.5 SC02/SC03/SC04: Outpatient Attendances, Procedures & Diagnostic Imaging ....... 13
17.5.6 UN02: Critical Care.................................................................................................... 14
17.5.7 UN03: Unbundled/high cost Drugs & devices ............................................................ 14
17.5.8 OT01: Other Health Care Services ............................................................................ 15
17.5.9 RC01: Running Costs ................................................................................................ 17
17.6 PB2: Analysis of Revenue ............................................................................................. 18
17.7 PB3: Adjustments .......................................................................................................... 19
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Chapter 17: 2015/16 Programme Budgeting Guidance for CCGs
17.1 2015/16 Programme Budgeting Guidance for CCGs
17.1.1 Introduction
The following chapter outlines the requirement and responsibilities of NHS staff involved
in producing CCG level programme budgeting data for 2015/16.
Detailed guidance on the processes involved in calculating programme budgeting data
is set out below, which is also supported by a mapping document.
This guidance will be relevant to Clinical Commissioning Groups (CCGs) and
commissioning support organisations involved in producing programme budgeting data.
17.1.2 Programme Budgeting Overview
NHS England is committed to giving CCGs and NHS England in the regions practical
support in gathering data, evidence and tools to help them transform the way care is
delivered for their patients and populations. Programme budgeting now sits within the
RightCare programme of work which provides a suite of materials to support effective
‘commissioning for value’.
The programme budgeting data return is an analysis of commissioning expenditure by
healthcare condition for example, cancer and mental health and care settings across
the care pathway. The data are used in the Spend & Outcomes Tool and will be
included in the Commissioning for Value Tool this year.
These resources provide commissioners with vital information to support evidence
based investment and prioritisation decisions. This allows healthcare commissioners to
look at activity and outcomes that have been generated in healthcare programmes, to
readjust the pattern of spending to get a better fit with needs of their local populations
and to reduce health inequalities. This should lead to improvements in efficiency (value
for money), effectiveness (better outcomes) and equity (fairer shares of resources and
reduction in inequality of health outcomes).
The data also provide a source of financial information which is relatable to the wider
public and have been successfully used to engage patients in PBMA (programme
budgeting and marginal analysis) reviews of investment in services.
Programme budgeting data are also used to report to Parliament and Health Select
Committees, and continue to be of interest to a wide range of stakeholders, including
academics, public health observatories, and national clinical directors.
There are currently 23 programme budgeting categories, which are based on the World
Health Organisation (WHO) International Classification of Disease (ICD10). Many of
the programmes include additional sub-categories.
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17.2 What’s new for 2015/16?
17.2.1 The programme budgeting framework
The main purpose of programme budgeting data is to provide benchmarking information
to NHS organisations, enabling evidence based investment & prioritisation decisions.
The guidance that follows aims to provide a framework for commissioners to analyse
their expenditure. Encouraging a consistent application of this framework means that
any variation, demonstrated through benchmarking, is due to actual differences in
spending patterns rather than a slightly different approach to completing the return.
With this in mind, for 2015/16 there have been some changes to the programme
budgeting methodology and collection templates. These changes are outlined below:
17.2.2 Refined Care settings
For 2015/16, the list of care settings has been refined. The changes include providing a
further breakdown of outpatient activity. Previously, there was one care setting which
covered Scheduled Care Outpatient (PBR) activity. In order to provide greater
transparency, Outpatient PBR expenditure will now be analysed across 3 settings:
 SC02 Scheduled Care Outpatient Attendances
 SC03 Scheduled Care Outpatient Procedures
 SC04 Scheduled Care Outpatient Diagnostic Imaging
There will also be a new care setting, ‘OT01 Other Health care Services’. This setting
will incorporate the following care settings from 2014/15:
 UC04 Unscheduled Care: Other Urgent Care
 UN04 Secondary Care: Other
 DA01 Direct Access Diagnostic Imaging
 CI01 Community and integrated care
 PL01 End of Life Care
17.2.3 Approach to allocating expenditure
In 2014/15, the programme budgeting team provided centrally derived apportionment
data for inpatient, outpatient, A&E and emergency transport activity.
For 2015/16, the programme budgeting team will provide apportionment data for the
following care settings:
 PC01:Primary Care Prescribing
 UC01:Inpatient: Non-elective admissions
 SC01:Inpatient: Elective
 SC02:Outpatient Attendances
 SC03:Outpatient Procedures
 SC04:Outpatient Diagnostic Imaging
 UN02:Critical Care
There will be a separate apportionment workbook for each of these settings. The
workbooks will be in a different format to those used in 2014/15, and will include steps
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for calculating figures and reconciling to accounts values. These workbooks will guide
CCGs through the calculation process and will provide a complete audit trail from
apportionment data through to submission values, highlighting errors at the stage in
which they occur, rather than at pre-submission sense-check stage.
Each workbook will include detailed guidance on how to use them. The source and
extract specification will be included within the apportionment report files to help CCGs
reconcile to their own locally held data.
A key change for 2015/16 is that we will not be providing apportionment data for the
A&E and Emergency Transport care settings, this will need to be calculated using local
information.
Please contact the programme budgeting team if you have concerns over using any of
the centrally derived apportionment data and you feel that using locally derived
apportionment data would be more appropriate.
17.2.4 Changes to submission template
The submission template now incorporates the main submission template and service
level analysis (SLA) into one workbook.
The structure of the workbook has being simplified, removing the requirement to
analyse revenue and adjustments by programme category & care setting.
The structure of the template and key changes are outlined below:
Form
PB1 Gross Exp :
Summary of changes since 2014/15
Main Submission Template: Analysis of Gross Expenditure
Previously referred to as PFR4A, this template follows a similar format to
previous years, requiring the analysis of gross expenditure by programme
category & care setting.
E1 - Other HC
Services
E2 Other HC
Services by PBC
MH1_SL &
location
MH2_SL & Age
MH3_SL &
Condition
For the care setting, ‘OT01 Other health care services’, this column will be
populated automatically based on data entered in forms E1, E2 & MH3.
Supplementary SLA Form : Other Health Care Services
This form builds on the format of SLA E1, from 2014/15. Requiring the
analysis of gross expenditure on ‘Other Health Care service’ by service
type. The majority of expenditure entered within this form will be mapped
automatically to a programme category and will feed directly into the PB1
form.
There are some services which do not map directly to a programme
budgeting category, but for which we expect CCGs to have local
information to support allocation or apportionment. For these services we
are asking for an additional breakdown in form E2 as in financial year
14/15.
Requires a breakdown of some of the services from form E1 by
programme budgeting categories. This will feed through into care setting
OT01 (other health care expenditure) in the main PB1 form.
Supplementary SLA Forms : Mental Health
Analysis of mental health gross expenditure by service line, with a further
breakdown by setting type, age-grouping and condition type. These forms
are in the same format as 2014/15.
MH3 will feed through into care setting OT01 (other health care
expenditure) in the main PB1 form.
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PB2_Revenue
CCGs are required to complete a form providing details on revenue . The
programme budgeting team will use this to allocate revenue to appropriate
programme budgeting categories and care settings. The information
required includes; type of revenue, source of revenue and service detail.
The form includes a combination of drop down menus and freetext. Please
review the drop down menus in the workbook and let us have details of
any additional lines that you think should be added to the final workbook, to
enable you to describe your revenue details.
PB3_Adjustments The PB3 Adjustments form replaces form PFR4D and PFR4F. This form
follows a similar format to PFR4F, using a combination of freetext and drop
down menus to describe detail of any adjustments required to get to spend
on own population.
17.2.5 Validations and checklist
The programme budgeting returns will be subject to validations and checklists which will
need to be signed off prior to submission. In previous years, a supporting ‘sense check’
workbook has been provided to CCGs. For completeness, these validations have now
been incorporated into the workbook. This year the workbook includes a validations
worksheet, which highlights where errors might have occurred in completing the form.
This will enable you to verify the data prior to submission.
CCGs will be expected to ensure that data forms have been completed correctly and
that all validations are correct prior to submission. Regional leads will also be expected
to verify that all validations are passed before submitting returns in a single batch to the
programme budgeting team.
The validations should be completed for the first submission deadline. The programme
budgeting team will not accept any submissions that do not pass the validations. The
programme budgeting team will only commence central validations on a region’s
submission’s after all locally validated first submissions have been received for that
region. Any delays in meeting the first deadline will result in a delay in receiving central
validations feedback on submissions. This could mean that CCGs will not have the full
resubmission window to make any amendments or changes for the final submission.
17.3 2015/16 Data Collection Timetable
17.3.1 Timetable
Activity
Responsibility
Date
Draft Returns to be
submitted by:
CCGs & Regional
Leads
29th September
2016
NHS England
Analytical team to
provide feedback by:
PB Team
13th October 2016
Final Returns to be
submitted by:
CCGs & Regional
Leads
27th October 2016
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Notes
Regional Leads may wish to
view submissions prior to this
date.
Regional Leads may wish to
view submissions prior to this
date.
In terms of timetable, the majority of the work must be done in August and September in
order to meet the end September draft submission deadline.
Regional leads, CCGs and CSUs need to factor in the validations and checklist sign-off
into their plans to ensure that this is completed in time for the 29th September deadline.
This will ensure that minimal changes should be required in during the two week resubmission period at the end of October.
17.3.1 Submission Document
Main
Programme
Budgeting
Submission
PB1 Gross Exp
Other health E1 Other HC
Care
Services
Services
E2 Other HC
Services by
programme
category
Mental
MH1 SL & location
Health
MH2 SL & Age
Analysis
MH3 SL &
Condition
Revenue
PB2 Revenue
Adjustments PB3 Adjustments
The main PB1 form follows the same format as the
PFR4A from previous years, requiring the analysis of
gross expenditure across programme categories and
care settings.
CCGs are not required to enter any data in the OT01
care setting; this is populated automatically based on
the data entered in forms E1, E2 and MH3.
This form requires a breakdown of Other healthcare
services by service type.
In form E2, where services cannot be mapped to a
specific programme category, the form seeks a further
breakdown by programme category, based on local
data.
These forms requires the analysis of spend by mental
health service, with additional breakdown by setting
type, age-grouping and condition type.
The form includes a combination of drop down menus
and freetext to describe revenue arrangements. Please
review the drop down menus in the workbook and let
us have details of any additional lines that you think
should be added to the final workbook, to enable you
to describe your revenue details.
The PB3 Adjustments form replaces form PFR4D and
PFR4F. This form follows a similar format to PFR4F,
and uses a combination of freetext and drop down
menus to describe detail of any adjustments required
to get to spend on own population
The total values in PB1_Gross Exp, PB2_Revenue must validate to gross expenditure
and revenue as reported in the final accounts template for your CCG.
The total value in ‘PB1_Gross Exp’ should agree to Gross Employee Benefits plus
Other Costs, for both programme expenditure and administrative costs, in the
Statement of Comprehensive Net Expenditure.
The total value in PB2_Revenue should validate to Other Operating Revenue, both
programme and administration.
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17.4 Calculating Programme Budgeting Data
CCGs will need to use a combination of Integrated Single Financial Environment (ISFE)
data, final accounts data, contracting data and business intelligence data to identify
spend and to determine the appropriate programme category and care setting.
The specific methods for identifying spend or revenue and the method of allocation or
apportionment are included within the guidance or the mapping documents. If you are
unsure of the approach to use, or it is not covered within the guidance, please contact
the programme budgeting team.
The following table provides an overview of the methodology to be used for expenditure
in each care setting. More detailed information on how each care setting is defined is
included within this guidance.
Care Setting
Primary Care
PC01:
Primary Care Prescribing
Unscheduled
Care
UC01:
Non-elective admissions
UC02:
UC03:
SC01:
A&E
Emergency Transport
Elective
SC02:
Outpatient Attendances
SC03:
Outpatient Procedures
SC04:
Outpatient Diagnostic
Imaging
UN02:
Critical Care
UN03:
Drugs & devices
OT01:
Other Health Care
Services
Running Costs
Scheduled
Care
Unbundled/
High Cost
services
Other Health
Care Services
Running
Costs
RC01:
Methodology for apportioning
expenditure
Apportion using data provided by NHS
England Analytical Services Function
Apportion using data provided by NHS
England Analytical Services Function
Mappings and local data.
Mappings and local data.
Apportion using data provided by NHS
England Analytical Services Function.
Apportion using data provided by NHS
England Analytical Services Function.
Apportion using data provided by NHS
England Analytical Services Function.
Apportion using data provided by NHS
England Analytical Services Function or
local data.
Apportion using data provided by NHS
England Analytical Services Function or
local data.
Mappings and local data.
Mappings and local data.
Enter all expenditure in 23x
The NHS England programme budgeting team will provide programme budgeting
apportionment data for the settings detailed above. There will be a separate
apportionment workbook for each of these settings. The workbooks will include steps
for calculating figures and reconciling to accounts values.
Each workbook will include detailed guidance on how to use them. The source and
extract specification will be included within the apportionment workbooks to help CCGs
reconcile to their own locally held data. The workbooks will be based on the correct tariff
(ETO or DTR) used for each provider for 2015/16. They will include further details and
examples on the expenditure to be included.
Please contact the programme budgeting team if you have concerns over using any of
the centrally derived apportionment data and you feel that using locally derived
apportionment data would be more appropriate.
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17.5 PB1 Analysis of Gross Expenditure
17.5.1 PC01: Primary Prescribing
The NHS England programme budgeting team will provide a workbook to support
CCGs in allocating their primary care prescribing expenditure to programme categories,
within PC01 Primary Prescribing.
CCGs will enter their prescribing expenditure values into the workbook. The workbook
will be set up to apportion the expenditure to programme budgeting categories using
data provided by the Business Services Authority. The workbook will also summarise
the values ready for direct transfer into ‘PC01 Primary Prescribing’ of form PB1.
Expenditure in the setting should include all primary care prescribing and dispensing
expenditure.
CCGs also need to identify whether they have any specific elements of prescribing
expenditure which should not be apportioned using general CCG based programme
budgeting splits. For example, if as a CCG you have lead commissioning expenditure
relating to primary care prescribing for an element of specialised or public health care,
then you will need to exclude this element of spend from the value to be apportioned
and map this directly to a programme budgeting category using local knowledge.
The primary care prescribing workbook will include steps to support you in separating
out this type of expenditure. If you are unsure of which category to map this to, please
get in touch with the programme budgeting central team.
17.5.2 UC01/SC01: Elective and Non-elective admissions
The following provides guidance for analysing elective & non-elective spend for the
respective care settings SC01 and UC01.
The NHS England programme budgeting team will provide separate workbooks to
support CCGs in calculating their elective and non-elective programme budgeting
expenditure.
CCGs will enter their provider spend values into the workbook, which will be set up to
apportion the expenditure to programme budgeting categories using CCG specific SUS
data. The workbook will also summarise the values ready for direct transfer into form
PB1.
CCGs will need to identify their actual expenditure on the prescribed set of elective or
non-elective activity for each of their providers.
Expenditure to be included within Care Settings SC01 elective and UC01 non-elective is
defined as follows:
 CCG commissioned spend on admissions for the following types of
admissions codes:
o Elective – 11,12 and 13
o Non-Elective - 21, 22, 23, 24, 28, 31, 32 81, 82, 83 2A, 2B, 2C and 2D.
 Expenditure within the scope of mandatory tariff, even if local tariffs have
been used. Where local tariffs have been used, the workbooks will include
functionality to allow for adjustments or direct allocations to programme
categories.
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



Expenditure with all providers of UC01 & SC01 activity, including noncontract and private providers
Expenditure should be amount paid for activity rather than contract values
Expenditure should include contract penalties or contract adjustments only if
it affects this range of activity uniquely. This should be programme specific
where possible. If there are contract penalties or adjustments which affect
more than one care setting, include this in OT01, through form E1.
Within your inpatient apportionment workbook, there may be some activity for
programme category ’05x- Mental Health Disorders’. This is likely to relate to
non-mental health spend within the scope of mandatory tariff, but where the
patient has a secondary diagnosis of Dementia or similar. This expenditure
should be included in the relevant UC01 or SC01 column.
Expenditure in SC01 and UC01 does not include:
 Maternity Pathway (including births) and year-of-care expenditure. This
should be excluded from SC01 and UC01 expenditure values and reported
separately in OT01, through form E1.
 Critical care episodes and high cost drug expenditure which are unbundled
from an elective or non-elective admission. These should be reported
separately under the relevant care setting (i.e UN02 or UN03).
 Expenditure on elective or non-elective admissions which are outside the
scope of mandatory tariff, which should be reported separately in OT01,
through form E1.
 Contract penalties or adjustments which affect a range of activity rather than
just elective or non-elective PBR activity as defined above.
 Planned procedures not carried out should be included in form E1.
 CQUINs. This expenditure should be included in form E1, or the Mental
Health analysis forms.
 Cross Border emergency treatment and charges for overseas visitors, this
should be included in form E1.
Where you have expenditure for referral to treatment penalties (in SC01), or
adjustments relating to NEL threshold (Marginal Rate) or NEL Readmissions (in UC01),
this should be included in either the SCO1 or UC01 setting and analysed using the
workbooks. Where material, these should ideally be apportioned or allocated using the
diagnosis codes relevant to the penalty activity. This can be calculated using the
manual allocation/apportionment column within the workbooks. Where immaterial, these
values can be included in the value to be apportioned.
The apportionment workbook is based on SUS data and will include any system-based
adjustments for best practice tariffs (BPTs). However, any locally managed top-ups or
rebates for BPTs not accounted for within the SUS system will need to be adjusted for
manually, in either the UC01 or SC01 apportionment workbook. The apportionment
workbooks are designed to support this and will include examples of how to do so.
Examples of BPT top-ups and rebates applicable to inpatient activity are outlined below:
Setting to apply to: Programme Category
BPT Description
SC01
13x
Endoscopy procedures
UC01
10b
Acute stroke care
Diabetic ketoacidosis and
UC01
04b
hypoglycaemia
UC01
16x
Fragility hip fracture
UC01
16X
Major trauma
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If your CCG has used any adjustments to nationally agreed prices for specific services
within this elective or non-elective activity, please get in touch with programme
budgeting team to discuss appropriate treatment.
17.5.3 UC02: Unscheduled Care- A&E
Expenditure within the UC02 setting should include expenditure on A&E attendances.
Other A&E costs, for example, placing a GP within A&E on weekends, cross border
emergency treatment or overseas visitors, should not be included within the UC02 care
setting, it should be included within OT01, through form E1.
Total expenditure on A&E attendances should be apportioned to programme categories
based on locally held data. The apportionment method should be based on your A&E
attendance activity, which should include diagnosis codes. The diagnosis codes may be
based on either ICD10 or A&E diagnosis codes. If they are ICD10 based you should
use the inpatients mapping within the mapping file. The mapping also includes an A&E
diagnosis code mapping. If you are unsure of how to approach this please contact the
programme budgeting team.
Spend on activity for which diagnosis code data is not available should be allocated to
programme budgeting category 23f.
17.5.4 UC03: Unscheduled Care- Emergency Transport
Expenditure on ambulance, air ambulance and helicopter services should be included in
the UC03 Emergency Transport setting. All other services provided by Ambulance
Trusts should be included within OT01, through form E1.
This expenditure should be mapped to programme categories using local data. The
mapping document provides information on how ambulance activity maps to
programme budgeting category using incident classification codes (MPDS) or NHS
Pathways.
In previous years, activity has been weighted by the severity of activity (e.g.
Red/Green). Activity should be mapped to programme categories, as per the mapping
document; there is no requirement to weight this.
Where local data are not available, the programme budgeting team will provide
apportionment data. This will be based on 2013-14 national activity.
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17.5.5 SC02/SC03/SC04: Outpatient Attendances, Procedures & Diagnostic Imaging
The NHS England programme budgeting team will provide a workbook to support
CCGs in calculating their programme budgeting expenditure for each of the following
settings:
 SC02:Outpatient Attendances
 SC03:Outpatient Procedures
 SC04:Outpatient Diagnostic Imaging
The following guidance applies to all three of these care settings.
CCGs will enter their provider spend values into the workbook, which will be set up to
apportion the expenditure to programme budgeting categories using CCG specific SUS
data. The workbook will also summarise the values ready for direct transfer in form
PB1.
Expenditure to be included within the relevant outpatient settings (i.e. SC02, SC03 or
SC04) is defined as follows:
 CCG commissioned spend on outpatient activity
 For SC02 and SC03, expenditure relating to outpatient attendances and
procedures within the scope of mandatory tariff, even if local tariffs have
been used. Where local tariffs have been used, the workbooks will include
functionality to allow for adjustments or direct allocations to programme
categories.
 SC04 should only include expenditure on diagnostic imaging unbundled from
outpatient attendances and procedures.
 Expenditure with all providers of the relevant type of outpatient activity,
including non-contract and private providers (where this is recorded in SUS).
 Expenditure should be amount paid for activity rather than contract values
 Expenditure should include contract penalties or contract adjustments only if
it affects this range of activity uniquely. This should be programme specific
where possible. If there are contract penalties or adjustments which affect
more than one care setting, include this in OT01, through form E1.
Spend in SC02, SC03 or SC04 does not include:
 Maternity Pathway (including births) and year-of-care expenditure should be
excluded from outpatient expenditure values and reported separately in
OT01, through form E1.
 Outpatient activity which falls outside the scope of mandatory tariff, such as
‘Outpatient - did not attends’ (DNAs), should be reported separately in OT01,
through form E1.
 Contract penalties or adjustments which affect a range of activity rather than
just the specific PBR activity as defined above.
 Planned procedures not carried out should be included in form E1.
 CQUINs. This expenditure should be included in form E1, or the Mental
Health analysis forms.
 Cross Border emergency treatment and charges for overseas visitors, this
should be included in form E1.
The apportionment workbooks are based on SUS data and will include any systembased adjustments for best practice tariffs (BPTs). However, any locally managed topups or rebates for BPTs which are not accounted for within the SUS system will need to
be adjusted for manually, in the SC02 or SC03 apportionment workbook. The
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apportionment workbooks are designed to support this and will include examples of how
to do so.
Examples of BPT top-ups and rebates applicable to outpatient activity are outlined
below.
Setting to apply Programme
BPT Description
to
category
SC02
07X
Paediatric epilepsy
If your CCG has used any adjustments to nationally agreed prices for specific services
within these settings, please get in touch with programme budgeting team to discuss
appropriate treatment.
17.5.6 UN02: Critical Care
The NHS England programme budgeting team will provide a workbook to support
CCGs in calculating their programme budgeting expenditure for UN02 Critical Care.
This setting will include all critical care expenditure on adult and paediatric critical care.
For expenditure on specialist intensive care or high dependency units, please contact
the programme budgeting team to discuss the most appropriate method of
apportionment/allocation.
17.5.7 UN03: Unbundled/high cost Drugs & devices
Expenditure to be included within the UN03 ‘unbundled/high cost drugs & devices’
setting is defined as acute expenditure on drugs and devices that are either unbundled
or outside of the scope of tariff.
Expenditure on this should be allocated according to the mapping document.
If a drug or device is not included within the mapping please contact the programme
budgeting team for clarification on how to allocate.
High Cost Drugs may be used for multiple treatments. As the mapping generally maps a
drug to a single programme category, commissioners may use local information to
allocate expenditure to an alternative category where appropriate.
Commissioners may also incur expenditure not paid through PbR tariff on drugs that are
included in tariff. For example, commissioners may use a drug that is included in tariff
to treat a separate condition and fund this through innovation payments. This
expenditure should also be included within this setting.
If commissioners have any expenditure on drugs that are not included in the High Cost
Drugs mapping please email the programme budgeting mailbox.
The mapping document also provides information on how to allocate expenditure on
Devices.
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17.5.8 OT01: Other Health Care Services
This setting is for all other elements of Health Care expenditure.
Within the submission template, CCGs are required to complete the supplementary
service level analysis forms (E1, E2, MH1, MH2 & MH3) which will automatically
populate form PB1, allocating spend to the specified programme categories.
The following outline specific guidance in relation to some service types included within
form E1:
For CCGs that have taken on responsibility for GP budgets through primary care
delegated co-commissioning, this expenditure should be included within form E1,
against the service line ‘Primary Care Delegated Co-commissioning’.
Continuing Care should be allocated to the ‘Continuing Health Care’ line. This should
include the assessment cost as well as the cost of care packages. Mental Health and
Learning Disabilities Continuing Healthcare expenditure should be included in forms
MH1 to MH3, not in form E1.
For expenditure relating to end of life care e.g. hospices or non-hospice based palliative
care, this should be identified and further analysed in form E2. If sufficient information is
not available locally to allocate expenditure to programmes this should be included
within category 23F ‘Other - Condition data not recorded/reported’.
Personal health budget expenditure which relates to Mental Health and Learning
Disabilities, the expenditure should be included in forms MH1 to MH3, not in form E1.
Expenditure on the Maternity Pathway should be included in OT01, through form
E1. The apportionment reports do not include expenditure relating to the maternity
pathway (e.g. expenditure on births). CCGs who are not able to separately identify
expenditure on the maternity pathway should contact the programme budgeting team.
Form E1 includes a section relating to ‘Urgent & Intermediate care’. These service types
should include expenditure relating to urgent care, which falls outside the scope of
settings ‘UC01’ to ‘UC03’.
The allocation of Winter Pressures funding will depend on the way in which the funding
is used. Winter Pressures funding used to invest in schemes to prevent admissions to
urgent care, such as improving care in the home/community, reducing admissions or
length of stays. This expenditure should be allocated to a specific service line in form
E1. Where it is invested directly in A&E services it should be included within the A&E
setting (UC02).
For expenditure relating to inpatient activity that falls outside the scope of settings SC01
& UC01, this will need to be allocated to the relevant service type. A mapping of nonPBR Inpatient activity is available within the mapping file. This is based on the HRG of
the admission and details the appropriate line in form E1.
For expenditure relating to outpatient attendances and procedures that fall outside the
scope of settings SC02, SC03 & SC04, this will need to be allocated to the relevant
service type. A mapping of non-PBR outpatient activity is available within the mapping
file. This is based on the treatment function of the attendance and details the
appropriate line in form E1.
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Where CCGs incur expenditure for planned procedures not carried out or DNAs, this
should be included against this line in form E1.
Expenditure relating to CQUINs should be included against the service type ‘CQUINS’.
A further breakdown of this, by programme category is required in form E2. Any
expenditure relating to CQUINs for Mental Health or Learning Disabilities should be
included in forms MH1 to MH3, not in form E1.
Locally made Best Practice tariff adjustments should be included within the relevant
programme specific line in form E1:
BPT Description
Early inflammatory arthritis
Parkinson's disease
Paediatric diabetes
Relevant Row
Programme Category Specific Line
– Musculoskeletal problems
Programme Category Specific Line
– Neurological Problems
Programme Category Specific Line
– Diabetes, Row 57
Some of the service type listed, require a further breakdown by programme category, in
form E2:
 Primary Care
 Continuing Health Care
 End of life Care
 Other Care
 Urgent Care and intermediate care
 Nursing Care
 Allied Health Professionals
 Other Non-PBR Clinics including Outpatients
 CQUINS
 Winter pressures investment in secondary staffing
 Other expenditure relating to acute/secondary care
 Contract Adjustments
 Rehabilitation
If condition based data are not available for a particular service or element of a service,
please record the expenditure value in the appropriate '23' category.
Spend should not be recorded for ‘05x Mental Health Disorders’ or ‘06x Problem of
Learning Disability’ programmes within form E2. Mental Health & learning disability
spend is to be analysed in more detail in the separate forms – MH1 to MH3.
Expenditure on services which include elements of spend on both physical and mental
health conditions should be separated out where possible.
Continuing healthcare expenditure related to mental health & learning disabilities should
be included in row S28 in MH1 to MH3. MH3 should be used to provide further details
of this expenditure. For example, Learning Disabilities Continuing Healthcare
expenditure should be included in row S28 in MH1 to MH3 (not row S17) and included
in row S28 column C12 in MH3.
The three mental health analysis forms, MH1, MH2 & MH3 require a breakdown of
expenditure on mental health and learning disabilities. The forms require a service level
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breakdown, and a subsequent breakdown within service types by location (MH1), age
(MH2), and condition (MH3).
There are a number of existing service classifications for mental health services, such
as NHS Benchmarking Network classifications and MHLDMDS teams. Providers and
CCGs may have existing spend information based on these classifications. We have
therefore provided mapping documents which contain information on how to map from
these classifications over to the service classifications. Please refer to these and the
mental health TFC and condition based mapping documents when analysing mental
health and learning disabilities expenditure.
If you need help in determining the method of allocation or apportionment for any of
these activities please contact the programme budgeting team at
[email protected].
17.5.9 RC01: Running Costs
All running cost expenditure should be included in programme category 23x within the
RC01 Running cost setting. This should equal CCG admin expenditure reported in the
final accounts template.
CCGs should contact the NHS England programme budgeting team at
[email protected] to discuss how to allocate any expenditure that
does not fit within the CCG running costs envelope but does not appear to fit within any
other settings.
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17.6 PB2: Analysis of Revenue
PB2 requires the analysis of revenue. The total revenue included here should equal the
total revenue as recorded in the CCG end of year financial return template.
There is significant variation in revenue per head across CCGs, therefore to ensure that
expenditure data are suitable for benchmarking, revenue needs to be analysed
correctly. The information included in this form will be used by the NHS England
programme budgeting team to allocate revenue to the appropriate programme
budgeting category and care setting.
The forms require detail of revenue, by type. The form currently include 5 categories:
 Prescribing
 Acute
 Mental Health & Learning Disability
 Other Health Care services
 Running Costs
When analysing revenue, the key rule of thumb is that the allocation of revenue to
programme category should match the allocation of expenditure which the revenue was
used to fund.
For each of these revenue types, the forms requires:
 Details relating to the 'Revenue source' and 'Reason for revenue '. Select form
the drop-downs provided.
 Please also include the type of service that this relates to.
 Use the 'Description ' freetext box to provide any additional information,
 Then select the programme budgeting category for the revenue line, Please
note, the programme category only needs to be selected where this is known.
There is no requirement for revenue to be apportioned across programme
categories within this form. Therefore, where it is not possible to select a
programme category, please leave this option blank.
 And include the value. Income should be entered as negative values.
If there are any elements of revenue that you are not clear on how to allocate, please
contact the programme budgeting team.
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17.7 PB3: Adjustments
Programme budgeting data will be published in the form of a benchmarking tool which
will allow CCGs to compare spend across programme categories to spend with similar
CCGs.
Published data will be based on net expenditure, which will be calculated centrally using
the information that you have provided in forms PB1 and PB2. If you have unique
funding or commissioning arrangements which means that your net expenditure will not
be suitable for benchmarking purposes, please provide full details of this arrangement
in form PB3. Examples of things you may want to consider are:
 Where your net expenditure includes spend on another CCGs population; or
 Where your CCG receives funding which the majority of CCGs do not.
You will need to provide full details of the arrangements, the value, and where possible,
information on which care settings and programme budgeting categories are affected.
Adjustments do not need to be made for contributions to the CHC risk pool.
NHS England will review this information and decide whether to make adjustments to
your CCGs net expenditure prior to publication in the benchmarking spreadsheet.
Please complete this form with as much detail as possible to avoid the need to follow up
with following the submission deadline.
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