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These trusts (with no doubt some expensive advice from PWC) are having a laugh, which hopefully the DH (assisted by KPMG or McKinsey) will rebut:
- The tariff already has complexity adjustments
- These trusts are generally in London or cities with high MFF
- These trusts get bunce for teaching, especially dental teaching
- They also get huge amounts of research money
- many also have big charities and commercial income for eg clinical trials and IP

Most have appauling processes and are just downright inefficient. rather than fixing this, they are trying to justify the begging bowl approach