Back to black

28 Feb 08
JUDY HIRST | It’s that time of year again, when finance managers – faced with embarrassing underspends – suddenly discover an urgent need for new laptops, ergonomic chairs and away days. March is a month for some seriously creative number-crunching.

It’s that time of year again, when finance managers – faced with embarrassing underspends – suddenly discover an urgent need for new laptops, ergonomic chairs and away days. March is a month for some seriously creative number-crunching.

For many NHS trusts, it’s a welcome problem to have. After a protracted period of black holes and gaping deficits, the health service is now finding itself back in the black. The Department of Health is forecasting a £1.8bn surplus this year – twice the level it required (see Waiting for Mr Darzi).

Instead of struggling to keep the hit squads at bay, trusts are casting around for ideas on how to spend the surplus. The NHS chief executive is talking of ‘fantastic opportunities’ ahead.

But, sensibly, the NHS Confederation urges caution. With leaner funding times and new prescribing pressures on services, it makes sense to put plenty away for a rainy day.

And judging from this week’s critical National Audit Office report on GP contracts, it will also make sense to exercise a lot more control over how the money is spent in future.

Despite the £7.7bn ploughed into GP services last year, and an almost 60% increase in GP partner earnings (to £110,000-plus levels), practice productivity has fallen, and money has not flowed to the most deprived areas as intended.

There have been some advances, but the department has overspent on the new contract (by almost 10%), while GPs have been paid more for working fewer hours, the NAO concludes.

In the run-up to the NHS’s sixtieth anniversary and Lord Darzi’s far-reaching review, it will be tempting to put yet more funding GPs’ way, to head off opposition to the health minister’s proposals on polyclinics and surgery hours.

It will be tempting, but it would be a mistake. The ‘long conversations’ that Richmond House officials are reputedly holding on what to do with the surplus need to focus on more deserving causes. Not least, on the practice nurses who are carrying out ever more patient consultations for little financial reward.

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