Published: 24/03/2005, Volume II5, No. 5947 Page 13

A certain - some might say rather meaty - Department of Health official is apparently fond of bearing down on chief executives at this time of year with the line: 'Which of the two words 'financial' and 'balance' do not you understand?' Some primary care trust senior executives would like to ask him the same question, considering the DoH's own failure to balance its payment by results policy for full rollout in 2005-06.

NHS commissioners have more reason to be miserable this year, according to some, as an extra layer of targets gets slapped on their already overloaded backs in the shape of the public health delivery paper.

As HSJ reported last week (news 13-15, 17 March) PCTs are scrambling to add extra requirements to their local delivery plans.

As one Midlands public health director points out, 'another fine example of partnership-working at the top' meant that the delay in the publication of the delivery plan resulted in PCTs having almost no time to rewrite their LDPs before submission to strategic health authorities.

And, according to one spearhead PCT chief executive - one of 88 that received extra public health funds in the recently announced allocations for 2006-07 and 2007-08 - the chosen few 'are not happy'.

'We were led to believe we were going to receive a significantly bigger sum of money to help us close our bigger health inequalities, ' they tell HSJ, adding that they have growing fears that the extra cash will end up just replacing non-recurrent funding such as 'health action zone' money that they have received previously, and which is already committed.

Meanwhile, primary care managers and clinicians are digesting the long-awaited practice-based commissioning technical guidance. One manager dismissed it entirely saying, 'well, It is not technical, and It is not guidance'.

One primary care director was 'very disappointed' that the guidance removed any levers for PCTs to influence GPs' choice of locality commissioning partner. 'If two practices at opposite ends of our patch want to link up because they're mates, we have no way of stopping them even if the services they provide are inconvenient for patients.' Mary-Louise Harding