Primary care trusts (PCTs) are the cornerstone of the NHS locally. Their equivalents in Scotland, community health partnerships, manage primary and community health services, as do local health boards in Wales. Northern Ireland is proposing to create seven local commissioning groups that will be driven by GPs.

PCTs run some primary and community services or commission them from other providers, and are involved in commissioning secondary care. PCTs are now responsible for more than 85 per cent of the NHS budget.

PCTs have three main functions:

• improving the health of the community - assessing its health needs and preparing plans, tackling health inequalities and leading partnership working with local authorities and others
• developing primary and community health services - managing and integrating all medical, dental, pharmaceutical and optical primary and community services, as well as ensuring their quality
• commissioning services, either by themselves or in partnership with a local authority, or through devolving indicative budgets to practice-based commissioners.

PCTs must work collaboratively, involving patients and the public as well as their own GP practices and partners. They must co-ordinate all agencies delivering healthcare in their area, taking responsibility for creating strong local partnerships to address the broader influences on health, and be ready to work with each other across boundaries. Strategic health authorities are responsible for managing the performance of PCTs.

From 1 October 2006, PCTs have been reduced from 303 to 152. This is intended to bring health, social care and emergency services closer together, resulting in better emergency planning as well as producing savings for frontline services.