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Letter of the week: An underfunding legacy

I would willingly support the Pulse campaign to prevent new consortia – which, as social enterprises, will be legally prevented from being in debt – inheriting the deficits of their preceding PCTs.

GPs facing debt crisis as PCTs fall 300m in red

But before blaming PCTs for bad management, it would be useful to consider how they were funded in the first place.

A few years ago, figures were published for funding per weighted head of population in PCTs and the differences were stark – some spearhead or other deprived areas had funding per head well over £1,000, while some less deprived areas got well under £750. That’s not necessarily a problem – except the PCTs most generously funded tended to have surpluses, implying the funding for the additional care needed by their patients was not being used to provide that care.

The commissioning budget for GP consortia is going to be decided on new criteria by the NHS Commissioning Board, and I wonder whether PCT deficits will be deducted from the first year’s budget for individual consortia.

If so, should any PCT surplus be added to local consortia budgets? Maybe PCTs are in deficit because they were grossly underfunded initially, and their debts have nothing to do with the ability of the PCT or successor consortia to manage budgets. When – not if – consortia are forced into bankruptcy and private companies take over, how will the deficit be handled then?

From Dr Mary Hawking
Dunstable, Bedfordshire

Dr Mary Hawking