A fortnight ago HSJ revealed the Treasury was eyeing up NHS surpluses. This week we tell you how much will be clawed back.

Of the£1.7bn predicted surplus, primary care trusts will be allowed to spend just£400m in 2009-10.

Strategic health authorities will be expected to co-ordinate this and the way they do so will be crucial. Simply dividing surpluses up across their regions based on population won't wash - PCTs have been told this money is theirs to manage, and they must be allowed to do so, even as belts become tighter.

It could have been worse: the surplus is not being taken away completely or necessarily permanently. It is there to provide a financial safety net, it just so happens that it is being called upon sooner than PCTs and trusts would have anticipated a year ago.

Tough choices

In return, PCTs will have to show their mettle. A£1.3bn clawback will mean making tough choices over which services to fund - and which to stop funding.

HSJ's finding that two thirds of PCTs did not decommission any services last year will have to change.

Let's hope that as world class commissioning comes into play, this does not require as great a cultural shift as the numbers might suggest.

Of central importance is that managers do not make decisions that are short term and purely financially driven.

PCTs must continue to focus on improving quality, choice and safety in tough times too.

How will it affect your PCT? Email hsj.feedback@emap.com