Is bigger better for primary care groups and trusts?

The organisation of primary care services and their role as gatekeepers to more expensive specialist services have become key issues for policymakers, managers, and health professionals in many healthcare systems. The importance of primary care in delivering accessible, high quality services while constraining escalating costs is widely recognised.

In England the Labour government elected in 1997 made the formation of primary care groups and trusts the organisational centrepiece of its reforms to the NHS.1 Primary care groups, established throughout England in 1999, are expected to play a leading role in improving health, reducing inequalities, managing a unified budget for the health care of their registered populations, modernising services, improving quality, and integrating services through closer partnerships. Initially operating as subcommittees of health authorities, they bring together general practitioners, nurses, other health professionals, managers, and representatives of other service providers to manage local services. As they show their ability to manage their budgets and services, they take increased responsibility by becoming freestanding primary care trusts. In April 1999, 481 primary care groups were established in England; 17 of these became primary care trusts in April 2000, and many more are currently in the process of moving to trust status.