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Concerns grow over legacy debt

GP commissioning groups face inheriting tens of millions of pounds worth of ‘hidden' debt while being stringently monitored on their ability to deliver NHS efficiency savings, it emerged this week.


An Audit Commission report published yesterday reveals that over £50million of PCT ‘legacy' debt is still hanging over GP commissioning groups and a draft government document shows that GPs will be judged on their ‘track record to date' in delivering NHS efficiency savings before they are handed full commissioning responsibility by the NHS Commissioning Board.


The Audit Commission report - an auditor´s review of NHS financial performance in 2010/11 - showed that while NHS London intervened to bail out eight PCTs in the capital in April to the tune of £150million, a further five PCTs across the country began the 2011/12 financial year with a total of £54million legacy debts.


Today´s draft document, ‘Developing clinical commissioning groups: Towards Authorisation' discloses that CCGs will need to undergo initial risk assessment of their configuration from October 2011 - and ideally no later than December 2011 - and says the NHS Commissioning Board will take applications for authorisation from summer 2012.


Clinical commissioning groups will also have their size and shape assessed to judge whether they are fit to take on PCT functions, the document says.


Our sister paper Pulse has established that the five PCTs which carried over legacy debts into this financial year are NHS Cambridgeshire (£17m), NHS Surrey (£16.7m), NHS Peterborough (£12.8m), NHS Buckinghamshire (£5.3m) and Bexley NHS Care Trust (£1.8m).


But Dr Nigel Watson, chief executive of Wessex LMCs and a GPC member told Practical Commissioning the GPC was concerned that the Department of Health would be able to hide PCTs´ underlying financial problems by bailing them out.


‘Legacy debt needs to be sorted out. Our concern is that they won´t do it. There´s declared deficit and underlying deficit. SHAs can top slice budgets and apparently pay off the deficit without tackling the underlying issues. The problem is that even if your SHA gives you £17million, you start with £17million cost pressure.


‘And the pressure can come from all sorts of areas. In some places you´ve got a foundation trust sitting on tens of thousands of surplus while the PTs are in deficit. We´d like to see much more openness, honesty and transparency over these issues.


‘If you go and buy a car, you know how much it costs, how much you´ve got to spend. With health care at the moment, you don´t really know these things and it´s much more complicated. PCTs and CCGs need to sit down with each other and be completely above board,' he said.


The five PCTs said they would repay legacy debts prior to handing over commissioning responsibility to GPs, with some anticipating making up the shortfall in the coming year.


In response to Pulse´s A Clean Slate campaign last year, ministers promised that GPs would not be saddled with longstanding PCT debts when they take over commissioning responsibilities from April 2013, and would only take on any deficits run up since April this year.