Hello.

I'm going to be stupidly busy today, so would offer for your edification this excellent analysis piece form Sally Gainsbury for HSJ.

Financial governance matters greatly; the more so when other departments are having 25% of their budgets cut so that health can have protected, real-terms growth. Whatever 'real-terms' may mean.

There is a fascinating tension between GPs who, as small businessmen, usually don't make losses and what we have seen of the indicative (i.e. not real) budgets of GP practice-based commissioning.

As we pointed out yesterday, the number of PBC survey respondents reporting that their PCT provides them with an indicative budget has been in continual retreat from three years ago (84%) to now (73%).

The 27% with 'no' budget clearly have one - it's just that either the PCT doesn't tell them what it is, or that this 27% correlates with the steady level of GPs (27-28%) whom the DH survey shows actively oppose the policy of PBC.

How the new system proposes to engage those GPs is a fascinating question.