In recent months the debate about the NHS has intensified as all three political parties begin to outline their plans for the health service in greater detail. While each party continues to argue why they are best placed to run the country's health system, all three acknowledge the NHS is facing the most severe funding challenge in its history.

A survey of senior NHS managers has found widespread support for the idea of giving patients their own healthcare budgets, but raised concerns about how they might work in practice.

Yet again GP's face further changes that will reduce their income when the Finance Act 2009 comes into force in April 2010. Rosemary Smith, a senior healthcare manager, Whittingham Riddell LLP goes through some of the changes and how these will affect GP's.

Johnny Marshall Chairman NAPC (National Association of Primary Care) and John Stapleton from Thomas Eggar LLP look at the reasons why Commissioning remains an unattractive commercial activity.

Revised estimates for average GP pay spanning 2004 to 2006 could result in claw back of overpaid seniority pay, comments Neal Carter member of UK200 Healthcare Group.

Scope for negotiating with the Inland Revenue has now been replaced by a more rigid statutory system, with inevitable consequences. Clare Munro - Tax partner at Haslers Chartered Accountants explains.

One of the consequences of the current economic climate will be an increase in HM Revenue and Customs enquiries into business accounts, says Debbie Wakefield, specialist healthcare accountant, Edmund Carr LLP and member of UK200 Healthcare Committee.

At difficult times like these, it is inconceivable that so many GP surgeries do not prepare detailed budgets to be agreed with their partners and teams. Mike Ogilvie from AISMA outlines how practices can plan their way through the hard times ahead.