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NHS financial planning follows a similar routine: Leaders put in draft plans with eye-wateringly high deficits; these are inevitably whittled down to a number acceptable to NHS England; bailouts are made once the plans fall apart during the year.

In 2023–24, the service began the year with a projected financial gap of £700m. Twelve months on, that had risen past £2bn.

So, there will be serious concern at NHSE that the supposedly final plans for 2024–25 suggest a forecast deficit of close to £3bn, around four times higher than the equivalent point last year.

The centre always holds some money back to balance out local overspends, but a gap on this scale would be very difficult to plug and would likely require deep cuts to areas like waiting list investment and, once again, capital budgets.

Sources said NHSE had rejected the plans as “unaffordable” and was now demanding further improvements, issuing new targets for reductions.

One system boss said they were now trying to accelerate existing savings plans, including cutting non-clinical staff. They said: “These are all very doable but the problem is doing them all in this year. The levels of efficiency in plans will now be huge.”

Pharmacy First or pharmacy who?

There is a seven-fold variation between integrated care systems in the uptake of a flagship government primary care access scheme, data has revealed.

The rate of usage of the “Pharmacy First” scheme in North East and North Cumbria — the ICS with the largest uptake — was seven times that in Cornwall and the Isles of Scilly, the lowest, according to an analysis shared with HSJ.

The programme, backed by up to £645m national funding over two years, allows community pharmacists to supply prescription-only medicines to treat seven common conditions (sinusitis, sore throat, earache, infected insect bite, impetigo, shingles and urinary tract infections), to reduce demand on GP practices. 

However, the dataset shows only three out of 10 GP surgeries have referred to the service since it was launched nationally earlier this year. 

The Company Chemists’ Association, which carried out the analysis, said tackling this “postcode lottery” in referral numbers is “critical” to NHSE achieving its ambition to generate 6 million Pharmacy First consultations a year.

Malcolm Harrison, CCA chief executive, told HSJ: “Do I expect ICSs to suddenly have the money to run big public awareness campaigns? Probably not, but I wonder what they could do to really start getting behind the rest of primary care to refer into pharmacy.”

Also on

Junior doctors have announced a fresh round of strike action, scheduled to take place just days before July’s general election. Meanwhile, North East London Foundation Trust and a band seven ward manager have entered not guilty pleas to charges of manslaughter by gross negligence regarding a death on an inpatient ward. And this fortnight’s London Eye has a look at how some of the plans for the healthcare system in the capital could be affected by politics.