Surely the deficit issue has been well known since they first arose? I
remember pointing it out as a problem in an editorial on our web site four
months ago. The deficits are hardly secret, since they are shown in the HA
annual reports. If you want a version on disk, all you have to do is ring up
your finance department and ask.
Interestingly, I'm not as certain as I was that PCGs will inherit the
deficits to begin with, because if they do, they won't get off the ground at
all. There isn't any guidance on the subject, and I would be surprised if
there wasn't a honeymoon period of two to three years before PCGs inherit
the problem.
The problem with the deficits is that they are nultifactorial, being
composed of:
1. general underfunding after years of CIP
2. specific shortfalls in HCHS caused by higher than expected levels of
activity (mostly generated by higher than expected levels of GP referrals)
3. fixed and semi-variable cost overruns in trusts (caused by building new
records departments, replacement of dying X-ray setups, and appointments of
new consultants)
Dealing with them in a logical fashion will be problematic. The logical view
to take is that NHS finance is monopoly money anyway, because no politician
actually has the balls to cut services. The neat trick is to take up the EBM
and clinical effectiveness agenda big time, and to demonstrate that items 2
and 3 are actually part of 1, then ask for more dosh. We won't get it, of
course, but it will be interesting to see the NHSE hoist upon its own
petard.
Andrew
> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]On Behalf Of Peter Fink
> Sent: 29 April 1998 04:48
> To: Ahmad Risk
> Cc: GP-UK
> Subject: RE: Inheriting the earth? What if?
>
>
> I think it's outrageous that you were censored. I'd complain to
> your LMC who
> should report it to the GMSC and thence HMG, who have requested
> details of
> H.A.s who are being autocratic.
> Two points.
> 1 Why didn't you all know about the deficit already? HAs have kept things
> quiet because their jobs were on the line. GPs can shout about
> both this and
> the rationing decisions, to the world.
> 2 It will be a multi-professional group including Nurses,
> hopefully CHC and
> Social Services, even local Councillors who will take some of the
> weight of
> these decisions.
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