In a message dated 05/04/98 18:16:16 GMT, Ahmed wrote:
<< 1. If there are 'overspenders', that means the overall budget is in
the red.>>
Overall the "overspend" is likely to be small in relation to the PCG's budget.
You may have a small problem in the first year if the overspend of the Group
as a whole is large. This either means the group as a whole is profligate or
that the budgets are inadequate. You need to collect and examine the data to
determine which. This is a big task and ill prepared PCGs will find it hard
to do.
<<2. If you do nothing, you are a) in trouble, and, b) can't reward
anybody>>
"Doing nothing" hasn't been an option for any of us for a while. No change
there.
<< 3. if the pverspenders reduce their costs, that makes the overall
budget *less* in the red, nevertheless, still in the red; and item 2
still applies>>
I see you don't have a spell check on your email either.
You may have to be tough about this. It really depends on the answer to 1
above.
<<4. If the overspenders cut their spending so that they are 'budget-
neutral',
you are in the black by the amount the underspenders 'saved'>>
That's OK. The gains can be shared by the earners in the first round. You
need to apply 1 again and decide if the "overspenders" have been underfunded
of simply haven't bothered to rationilse up to now. You can decide how to
handle the incentives when you worjk this out. I never said it would be easy
but it can be made tro work if the incentives are allowed to be generated form
savings and the overall budgets are preserved or allowed to grow in line with
NHS growth overall. Big ifs you may say but life's like that. We need to be
able to argue form strength about resources and that means good data, good
management (and evidence of it) anmd the ability to iddnetify unmet need that
can be addresssed by evidence based medical intervention. We have medicalised
non medically determinable issues for too long. Now its "no more Mr. Nice
Guy" time and e need to stick to what we do (ie treat serious treatable
disease as effectively as we can as the first priority and if we have time and
resources then fool around with the rest if we want - but first things first.
<< 6. But that amount would be small....>>
Not necessarily.
<< 7. And, if I were an underspender, I would want to reward my fellow
savers and certainly not subsidise rewards for those who just managed to
be neutral (at best) or cut their deficit but still in the red (at
worst)!>>
See top.
At least I've got you thinking constructively about it !
<< Equally, if you don't bring in the right amount or the right kind of
flour, you can't expect the same size piece of cake, yes?>>
Yes
Mike
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