National Health Service (NHS) Primary Care Trusts (PCTs) are to receive £164 billion funding for 2009-10 and 2010-11, representing an increase of around 5.5% for both years and with per capita spending set to average £1,612 by 2010-11 compared to £426 in 1996-7, the government has announced.

PCTs will control a greater proportion of funding, with more than 80% of the total NHS budget being allocated directly, which will allow them to tailor health services locally to meet local patient needs. In addition, a separate formula for health inequalities been developed which targets areas with the worst health outcomes, it says.

This week also sees publication of the NHS Operating Framework for 2009-10, which sets out Service priorities for the next year. The most important of these are: - improving standards of cleanliness and tackling health care-associated infections; - improving access to care through the achievement of the “18-week referral to treatment” pledge and improving access to general practice (GP) services, including at evenings and at weekends; - improving the health of adults and children and reducing health inequalities by focusing on improving care for cancer and stroke, and paying particular attention to children’s health, especially in the most deprived areas of the country; - improving patient experience, staff satisfaction and engagement; and – preparing to respond in a state of emergency, such as an outbreak of pandemic influenza.

In line with Lord Darzi's review of the NHS, PCTs will set their own additional local targets based on evidence about local needs. Efficiency savings can be delivered by enabling the NHS to design services locally that are led by clinicians and based on the needs of patients and communities, says the government.

London PCTs to clear hospital debts

Meantime, London’s 31 PCTs have announced plans to work together to wipe out the capital’s historic NHS debt, which is forecast to reach £579 million in 2011 unless action is taken.

All but five London PCTs are already free from debt and four more will complete their recovery programmes by 2010, but six are still “financially challenged” and another five are unlikely to exit from debt before 2011, says NHS London, the capital's Strategic Health Authority (SHA).

If put into practice, the proposal will see PCTs invest a proportion of their funding over the next two years and forgo the return of a similar amount of “topslice“ - a proportion of funding held by NHS London to manage risks during the period of financial recovery across London.

Over the next two years, the PCTs will invest in a collective fund consisting of the £304 million top-slice and a 1.3% levy on PCT funding, both non-returnable, to fund the remaining historic debt of £275 million. The levy will be applied to all PCTs except the five still repaying debts.

The impact of this investment will be to shift hospitals with debt onto an even financial footing, says NHS London.

“Making sure all of the capital's hospitals are financially stable with no historic debt is essential for the health services and choice available to all Londoners,” said Ann Radmore, chief executive of Wandsworth Teaching PCT, who is leading the PCTs through the proposal. NHS London’s finance director Paul Baumann added that the PCTs “are determined to ensure that there is no return to this deficit position in the future,” and said: “failure to deliver this proposal would mean that a number of organizations would be unable to deliver the improvements promised in Healthcare for London and health care access across London would remain patchy.”

The PCTs will discuss the proposal and make a decision on whether it should be implemented at their own Board meetings, which will run from 8-19 December.