A simple device could improve clinical coding and costing at a stroke: all providers should put the cost of the patient episode (provisional if necessary) with the clinical discharge summary letter to the GP as the patient leaves hospital.

All the elements for pricing are known by then - working diagnosis, tests and procedures carried out, discharge medication.

Standard tariffs make pricing easy in most instances. Handover of clinical responsibility already requires a high level of clinical coding accuracy, so adding the cost should be straightforward. The GP is well placed to spot and correct obvious charging inaccuracies immediately, or detect unintended trends such as consultant-to-consultant referrals during a hospital stay.

Real-time awareness

As practice based commissioner, the GP benefits from having real-time awareness of calls on the budget, and it would give an instant assessment of value for money. GPs are much better placed to assess these than primary care trusts.

PCTs could then get on with the job of managing the wider picture, confident that the clinical and costing data are being scrutinised by those best placed to check.

Dr Peter Brambleby, director of public health, North Yorkshire and York PCT