ABSTRACT
Introduction Following recent developments in NHS management and the current reform agenda that followed the review undertaken by Lord Darzi, High Quality Care for All,1 there has been an increasing recognition that doctors need to be more involved in financial and commissioning functions and to have greater engagement in the overall financial and efficiency agenda. This includes budget management to ensure the best use of resources, to benefit those who use services. The history and rationale for this are set out in Chapter 1. In the current economic climate, the NHS has entered a period that is more financially challenging than ever previously seen. The efficiency challenge over the coming years increasingly requires that doctors and other clinicians are engaged in service redesign and modernization to ensure that services are delivered as efficiently as possible, without compromising on service quality or safety. In England, the overall financial challenge is to make savings of £20 billion across the NHS over the 4 years from 2011/12. The principles of QIPP – quality, innovation, productivity and prevention – are being implemented nationally as the approach to delivering the efficiency agenda, while improving quality through innovative working methods and increasingly focusing on prevention, recognizing the benefits of this approach in terms of both health and efficiency. QIPP initiatives are being developed across primary and secondary care, with less delineation between individual organizations and increased collaboration across the health economy. This chapter considers the key points, provides an overview and sets out numerous definitions to enable a basic understanding of current NHS financial matters, including how money flows, the principles of budget management and the current financial regime and regulatory framework. Indicative current values are given, where appropriate, and sources of additional information are referenced for those who desire a more thorough understanding.
