Community services need to raise their sights if they are to be ready for the funding squeeze.

An HSJ snapshot of spending by primary care trust provider arms reveals wild discrepancies in costs and efficiency.

With more than half of provider arms working without any wireless IT system and some staff making only two or three visits a day, many providers seem closer to the 1950s image of a district nurse on a bicycle than an efficient, modern healthcare system.

HSJ’s findings come days after NHS chief executive David Nicholsonscrapped the deadline for PCTs to decide the strategies for their provider arms. He was concerned that too much time was being spent on deciding the organisational form and not enough on the function.

As money tightens and long term conditions multiply, community services provide a route to giving patients more independence while cutting costs.

But to do this they need to be leading reform and innovation, not pedalling to catch up.

Variation shows NHS community services ripe for efficiencies