An analysis of primary care trust spending on different diseases has revealed a number of stark variations, with some PCTs spending up to seven times as much as others in key areas.

An analysis of primary care trust spending on different diseases has revealed a number of stark variations, with some PCTs spending up to seven times as much as others in key areas.

The variations are revealed in a briefing from the King's Fund, which examined Department of Health data from 2003-04 and 2004-05, when PCTs were first required to report spending in 21 different disease areas under the national programme budget project.

The findings show that spending on the government's priority areas of cancer, mental health and coronary heart disease varies enormously across PCTs, even after differences in local health needs and other factors have been taken into account.

In the most extreme case, north London's Islington PCT spent seven times more per head on mental health than Bracknell Forest PCT in Berkshire. Even when the figures were weighted to take account of needs, Islington spent four times as much.

Even neighbouring PCTs vary hugely, with Derbyshire Dales and South Derbyshire PCT spending more than four times as much on mental health as North Eastern Derbyshire PCT.

King's Fund chief economist Professor John Appleby said the findings revealed 'a much more fundamental postcode issue' than the notorious variation in availability of treatments such as the cancer drug Herceptin.

The findings raised questions over whether PCTs were 'just conduits for money' or really determined spending priorities in their areas, he said.

'I suspect the variation arises from the variation in the decisions doctors take all around the country.

'We know there are different prescribing rates that are not explained by differences in need, differences in the thresholds for admission to hospital and differences in when to take patients off the waiting list.

'All these millions of micro-decisions will add up to explain great chunks of this variation in spending.'