Intended for healthcare professionals


Primary care trusts

BMJ 2004; 329 doi: (Published 14 October 2004) Cite this as: BMJ 2004;329:871
  1. Kieran Walshe, professor of health policy and management (,
  2. Judith Smith, senior lecturer,
  3. Jennifer Dixon, director of health policy,
  4. Nigel Edwards, director of policy,
  5. David J Hunter, professor of health policy and management,
  6. Nicholas Mays, professor of health policy,
  7. Charles Normand, Edward Kennedy professor of health policy and management,
  8. Ray Robinson, professor of health policy
  1. University of Manchester, Manchester M13 9PL
  2. University of Birmingham, Birmingham B15 2RT
  3. King's Fund, London W1G 0AN
  4. NHS Confederation, 1 Warwick Row, London SW1E 5ER
  5. Wolfson Research Institute, University of Durham, Queen's Campus, Thornaby, Stockton on Tees TS17 6BH
  6. London School of Hygiene and Tropical Medicine, London WC1E 7HT
  7. Trinity College Dublin, 3-4 Foster Place, Dublin 2
  8. London School of Economics and Political Science, London WC2A 2AE

    Premature reorganisation, with mergers, may be harmful

    Just over two years ago, in a reorganisation of the NHS in England, 303 primary care trusts were created, each with responsibility for providing primary health care, improving health, and commissioning secondary care services for a population of around 180 000. With about 80% of NHS funding flowing directly to primary care trusts on a capitation based formula, hopes were high that these new organisations would be powerful agents for change in a more devolved, clinically driven, and locally responsive NHS.1

    Some in the NHS, however, believe that primary care trusts have failed to fulfil these expectations. There is a growing belief that many trusts are perhaps ineffective organisations—too weak to stand up to providers of acute care in tough negotiations on commissioning and too small to fulfil their public health responsibilities. Some would argue that they have so far been unable to establish strong and credible management teams.2

    The unsurprising solution being mooted is a further reorganisation, in which widespread mergers of primary care trusts would reduce their number to …

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