Published: 17/02/2005, Volume II5, No. 5943 Page 3

There has been a muted response from primary care trusts to last week's cash allocations for 2006-08 - many fear the rises will not be enough to achieve a step change in tackling health inequalities.

When the headline announcements of funding increases for some of the most challenged PCTs are examined in more detail, their apparent gains evaporate.

As we report this week (news analysis, pages 16-17), when bare population figures are adjusted for important criteria such as age and social need, some PCTs are more than 30 per cent worse off.

Added to this is the concern that government's decision not to ringfence the extra cash for spearhead PCTs will see it being used to meet short-term targets.

That PCTs are not content in this supposed age of plenty is underlined by the latest HSJ Barometer survey of PCT chief executives (Data Briefing, page 26).

This shows that confidence, which had been steadily growing during last year, seems to have slumped dramatically in January. It is particularly notable that optimism has fallen furthest in those areas which depend on good relationships with secondary care.

Confidence in their negotiating power is at a new low.

This is a time of uncertainty for many PCTs. Can they use the 'extra' funds to promote public health and local delivery or will the NHS revert to type with the acute sector dominant?