The fine print of the coming year's funding settlement indicates that, in contrast to NHS chief executive David Nicholson's protestations, the Department of Health will indeed have a significant sum - up to £870m - locked away in its Richmond House safe next year (for more background, click here).

This raises the question of what ministers have earmarked the money for. The top contenders are paying GPs even more to adopt 21st century opening times, and bankrolling a raft of new initiatives to be unveiled by junior health minister Lord Darzi in his next stage review over the summer.

This all adds to the fog surrounding funding. At present primary care trusts are unsure if they could lose any of their underspend from this year; the detailed funding allocations have only been announced for one year, not three; the review of the tariff system has still to be unveiled; and now another£870m is waiting in the wings, possibly with additional central targets attached.

This confusion maximises the risks of poor, short-term planning, underspending and conservative thinking, when investment, strategic thinking and effective use of all available resources are what the service needs.

The government needs to get a grip on the financial uncertainty if it is to help PCTs make the most of the current cash-rich position of the NHS.

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