“I am sure you are aware that Harrow PCT is facing a serious financial overspend this year. Previously when this has occurred the PCT has managed to shift expenditure and arrange short-term loans from other parts of northwest London. Such ‘bail outs’ are no longer possible and Patricia Hewitt, Secretary of State for Health, has made it clear that there will be ‘zero tolerance’ for trusts who do not balance their budgets. At present Harrow PCT is forecasting an £8-12 million deficit which clearly puts us in a dire financial position. This . . . is partly due to more operations, outpatient attendances and emergency admissions that we can afford within our budget.

“As a result we have reluctantly asked the acute trust to do the minimum required to meet national targets. This means that patients sent for outpatient appointments will only be seen at 10-13 weeks (national target 13 weeks) and elective surgery will be delayed until the sixth month (national target six months). This will not affect two-week cancer referrals and urgent cases.

“You will all have been told about the PCT initiatives to reduce referrals to secondary care . . . Practices who have signed up to this will have received payment to follow the referral protocols to reduce outpatient referrals.

“We also need to reduce emergency referrals wherever patients can be safely treated or maintained in the community. The PCT is piloting community matrons to support patients most at risk of unnecessary admission to hospital but please use . . . the specialist nursing teams to deliver care at home.”

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