What do you do with a private finance initiative hospital when it becomes the subject of service reconfiguration?

That was the question posed last week by Jackie Daniel, chief executive of Manchester Mental Health and Social Care Trust, as it won backing to move services out of a PFI premises in the grounds of Manchester Royal Infirmary.

The dilemma is that whatever the benefits of reconfiguration it potentially leaves the building’s owner, Central Manchester University Hospitals Foundation Trust, with an additional £3.6m-a-year cost, unless it can find another use for the building.

One possibility being discussed by some is for NHS organisations to agree rules for sharing the risks associated with reconfiguration in the post-PFI world.

Elsewhere in the region, Tameside Hospital FT’s three-year plan identified “delivery of the [primary care trust] demand management initiatives” as the key risk in its contract this year, given that over-performance on emergency work is paid at sharply reduced rates. “The trust ‘lost’ income of £1.1m in 2010-11 and further growth [in demand] is expected in 2011-12 at circa 4.4 per cent, offset in part by one planned PCT initiative regarding the provision of additional capacity in the community.”

“[Emergency care] was a key area of over-performance in 2010-11 whereby the PCT had estimated reductions of £5.2m of activity but initiatives did not deliver reductions in the planned areas.”

Those who think demand management will be easier for GPs will be interested to follow Bolton’s fortunes. The area’s clinical commissioners’ delegated budgets were £479,000 overspent at the end of July, says a PCT finance report.