This week’s HSJ revelation of the huge scale of primary care trusts’ overspend on acute care exposes the distance between the desire to move more care into the community and delivering it.

The recent spike in GP referrals, the last minute rush to hit the 18-week referral to treatment target and winter pressures all pushed spending over budget, but unrealistic assumptions by PCTs about their ability to direct demand away from hospitals was also a factor.

This year PCT surpluses will cushion the impact of the overspend, but respite will be brief. More care in the community is no longer just desirable, it will be essential if the NHS is going to meet the demands imposed by a future spending squeeze.

Quality of life for patients and the stringencies of forthcoming budgets mean moving far more care out of hospitals is an urgent priority.

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