As the winter nights draw in and the temperature drops, little commissioners up and down the land dream of stockings bulging with giant recurring uplifts.
But after the wrapping paper has been recycled, a fair few are likely to be left with disappointed faces.
The Department of Health and Nuffield Trust have spent years working on a new allocation formula which has already, unofficially, awarded each GP practice - and by aggregation each clinical commissioning group - an implicit target budget for the bulk of its budget which covers acute care. The problem is that at 103 of the planned 212 CCGs, acute spending is at least 5 per cent off their target budget. And in 24 - according to data collated by the NHS Information Centre - it is off by more than 10 per cent.
‘The formula is set to multiply the haves-too-much and not-enoughs’
For some, this will be due to conscious decisions such as moves to treat more patients in the community. For many, however, it will reflect past patterns of under- or overfunding, where spending has grown - or not grown - to fit the available budget.
But the introduction of a new formula, combined with the fractionalisation of primary care trusts into CCGs, is set to multiply the numbers of haves-too-much and haves-not-enough.
In 2011-12, just 23 PCTs were left with gaps between their target and overall allocation of more than 5 per cent. Of those, only three were “underfunded” and so duly received extra, above-average increases which left no PCT more than 7.2 per cent under-funded. The remaining 20 “overfunded” PCTs received below-average increases.
But for CCGs, on the new acute formula at least, the number significantly under- and overspending is greater, so much so that without significant increases in their shadow 2013-14 budgets, 30 CCGs from Reading to Hartlepool, Canterbury to Gateshead will start their commissioning careers knowing they are underfunded by more than any PCT has recently been before them. But for the DH, achieving happy faces all round seems an impossible task: budget boosts to the underfunded can only be found through cuts or restrictions at the dozens of CCGs such as South Manchester, Greenwich, Dorset and Hackney, where acute spending significantly outstrips the formula’s target allocation.
Far better, one suspects, to bring on the magicians and fiddle the formula.
Sally Gainsbury is a news reporter for the Financial Times. email@example.com