Primary care trusts or PCTs are the public authorities in England responsible for planning, securing, funding and coordinating all of the NHS services in a defined geographical area. That area may be a county, borough, town, or city region. Collectively PCTs spend around 85% of the total NHS budget.
PCTs make decisions about how NHS resources are invested and what health services are provided at a local level. These decisions are made in the context of national policies and standards set by the Department of Health, regional strategies agreed with other PCTs and Strategic Health Authorities, and the specific health needs and priorities of the local population. PCT strategies include both short term plans setting out what changes will be made over the next year, and longer-term plans for improving the whole health care system.
The latter might include changes to the configuration of hospitals and health centres across a region, the introduction of programmes to help people improve their own health and to care for themselves and their families more effectively, and plans to introduce new technologies and ways of working to make health services more efficient.
PCTs ensure people have access to health services by either providing services directly, or by agreeing and managing contracts with a range of NHS, voluntary and independent sector healthcare providers.
Most PCTs directly provide community health services. These services include district nursing, health visiting, and various therapy services and disease prevention services such as smoking cessation support. Some also provide specialist mental health services, or run community hospitals, walk-in centres, hospices and other facilities.
PCTs commission most health services from other organisations including GPs, dentists, community pharmacists, optometrists, NHS hospital and foundation trusts, voluntary sector organisations, and private healthcare providers.
When a PCT wishes to introduce a new service or make substantial changes to existing provision it may run a competitive tendering process to secure a new provider. Once new services are up and running, or where existing services are in place, PCTs are responsible for managing contracts with the providers. This includes monitoring service quality, ensuring standards are being met, and intervening if things go wrong or if patient satisfaction is low.