Sally Gainsbury: peculiar commissioning spend estimates could threaten surpluses

The point of the exercise was to crack the how-much-will-clinical-commissioning-groups-get chestnut. The answer itself was not particularly surprising – about £62bn in last year’s money, leaving the central commissioning board with £20bn, public health with around £4bn, and the remaining £20bn or so going down the back of various DH sofas.

The eccentric bit however was the methodology used to define spending. Collected, sensibly enough, through a series of primary care trust data returns, 2010-11 spending was neatly broken down into areas suitable for CCG control, and areas, such as specialist commissioning, which are more apt for the NHS Commissioning Board.

Details such as how much was spent on maternity or on mental health – the commissioning of which has been contentious in the Health Bill discussions – are missing. All such spending is subsumed in the macro “secondary care” category for future CCGs spend. Oh well.

But the really peculiar move was the instruction issued to PCTs completing the form to do so while imagining “a hypothetical situation that the PCT was in financial balance”. So, PCTs making an in-year surplus in 2010-11 – including those whose topslices were not returned – were asked to add that unspent surplus or topslice back into their, er, “baseline spending” figures.

A total of £274m was added in this way by 94 PCTs, all of it, by the way, supplementing the future CCG pot. On the flipside, 36 PCTs drew down surpluses or topslices (or deficits) in the year and so dutifully removed £56m of money they actually did spend from their baseline spending figure.

What does it all mean? After all, PCTs and strategic health authorities are forecast to have a £1.2bn accumulated surplus by the end of 2011-12. Will that all get spent by April 2013? If so, we can take from this it won’t be counted as local area spending or added to the baseline for legacy organisations.

Conveniently a large one-off expenditure on redundancies and restructuring looms. But PCT boards in surplus areas might be feeling a little conned right now. So might their patients.

Sally Gainsbury is a news reporter for the Financial Times.