The establishment of primary care trusts (PCTs) is a radical reorganization of the NHS. This paper examines primary care groups (PCGs) making an early change to trust status, comparing them with those adopting a longer timetable for the change. The data are derived from the National Tracker Survey of primary care groups and trusts (random sample of 72 PCGs, 15% of the 481 PCGs in England, and five purposively sampled early PCTs) conducted in 1999 and 2000. The main source of data consisted of interviews with Chief Officers (response rates: 1999, 100%; 2000, 97%). In total, 43% of PCGs had become PCTs by April 2001, and 90% expect to become PCTs by April 2002. Integration of primary and community health services, focusing on local needs and innovation in service development, were common reasons for wanting to become a PCT. These trusts were more likely to cite autonomy as a reason, and were also more likely to believe that they had the support of professional stakeholders, but a substantial minority reported that they did not have the active support of GPs and other primary care staff. Although early trusts had slightly more experience of GP-led commissioning, there was no evidence that they were performing better than later trusts in their core functions of developing primary care, improving quality and commissioning services. The rapid progress from PCGs to PCTs does not seem to reflect the process of developmental learning and building on experience initially envisaged by government. Evidence from earlier NHS reforms indicates that time taken to build capacity, develop relationships and secure stakeholder support is associated with success. There appears to be a tension between central control over the implementation of NHS reforms and the desire to devolve budgets and responsibilities to local level.

In the UK, primary care groups and trusts (PCG/Ts), also known as primary care organizations (PCOs), are the organizations that will drive forward the primary care development agenda outlined by the government. We undertook a study to investigate the views of PCOs on the place of research in primary care development and their role as participants in the research process. The study population consisted of all PCOs in south London (n = 23). An initial structured questionnaire explored the organizations’ perceived research needs, the potential of the primary care research community to meet those needs and their current research activity. This was followed by semistructured interviews during which the participants were asked to discuss their views on the place of research in their primary care development agenda and in particular how research might inform the development of clinical skills and services in the short and medium term. The third stage of the project was an action based workshop at which general practitioners (GPs) and primary care nurses developed research questions arising from the earlier stages of the study. The PCOs identified three key areas of research support: public health, health economics and nursing research expertise. Research support was needed to help them identify population health needs and to evaluate new models of care and shifting professional boundaries. In contrast to traditional primary care research, PCOs required rapid delivery of research results, particularly when these were used to inform the commissioning of services. Our study has highlighted that PCOs have a development agenda requiring rigorous research and evaluation to ensure the best outcomes for patients. The differing skills, roles and responsibilities of PCOs, PCRNs and academic departments show how partnerships might develop to further research and development in primary care.

Primary care groups (PCGs) and primary care trusts (PCTs) are the way forward for primary care in the UK. These groups of general practitioners (GPs) and community nurses, organized along geographical lines, will need to forge relationships with other organizations and key players to a much greater extent than has been necessary hitherto. Currently PCGs most closely resemble the total purchasing pilots (TPPs), which have been the subject of a national evaluation. This paper reports on the evidence collected by interviewing key stakeholders – lead GPs, health authority (HA) leads, project managers and social services representatives – about how relationships developed in TPPs and how this might be relevant to PCGs and PCTs. The importance of good relationships with HAs was recognized by the TPPs, and the HAs were seen as having an important strategic role. Relationships with social services were slow to start for historical reasons, and had not progressed particularly far by the end of the study. Similarly, involving patients and the wider public in TPPs was problematic, and there was a lack of guidance about the most appropriate ways of proceeding. The evidence suggests that progress will be slow and the problems encountered by TPPs are likely to become apparent as PCGs develop, and with the transition to trust status. There is much for the primary care groups and trusts to learn from the TPPs.

General practitioners have always had special interests. Recent policy initiatives in the UK, organizational changes and changing attitudes by the Royal Colleges have meant that there is an increasing interest in the development of a new role for GPs with special interests (GPSIs). This paper considers what methodology is best suited to examining change, while that change is still developing. Specifically, it offers a model that identifies different forms of knowledge; anticipated, explicit and tacit and considers how these can combine in an evaluative model for innovations in primary care. The paper goes on to identify potential benefits and risks of a shift towards GPSIs. It develops a picture of GPSI services in one PCT and focuses on two disciplines, orthopaedic medicine and urology. Views of those GPs providing these services are reported and are linked with the possibilities that a new form of general practice might emerge without general practitioners.

As new organizations with responsibility for the health and health care of their local populations, primary care trusts (PCTs) need to engage with patients and the wider public. This paper identi. es the challenges faced by PCTs in implementing patient and public involvement and reports on a qualitative study of four PCTs in one health district. Findings from two pieces of data collection are reported on: an audit of community involvement activity and 16 semi-structured interviews with individuals working in the PCTs. The findings show that organizational capacity for undertaking patient and public involvement activities increased considerably over an 18 month period. The PCTs were found to be engaging with individuals and groups from the community and voluntary sector through a range of different structures and processes. Considerable commitment to patient and public involvement was reported but there were concerns over implementation. A number of influencing factors were identified including national policy, organizational factors, leadership, workload, access to experienced involvement workers and the pattern of local community activity. The paper discusses the implications for the development of patient and public involvement in PCTs including the importance of cultural change and the need for organizational development. The potential for PCTs to be involved in a range of participatory activities and to work with other partner organizations in localities is also discussed. The paper concludes that, despite challenges, progress can be made in implementing patient and public involvement as a mainstream activity in PCTs.