Abstract
A long time series of surgical emergency admissions is used to demonstrate that bed occupancy (and costs) fluctuates in a manner which is far greater than expected from simple random variation. Periods of adverse environmental conditions can be discerned which presumably act to exacerbate existing conditions. Somewhere around 20% of cost variation between clinical commissioning groups (CCGs) may be explained by the wider environment (weather, air quality, infectious outbreaks). Future generations of the capitation formula will need to incorporate a greater proportion of environmental factors and at a local level some form of yearly risk payment (or risk equalisation via larger financial risk pools) may be needed to account for adverse events not experienced elsewhere.
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