Annual report2008/09

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I am immensely proud tohave taken over aspermanent chief executiveat such a significant timefor the NHS Confederationand for the whole of theNHS. Over the past year,our family of networks hascontinued to grow anddevelop and the NHSConfederation is now oneof the largest and most

inclusive independent membership organisations in thehealth and social care sector.

In view of the rapid growth and accomplishments of the organisation, the board of trustees commissioned a strategic review over the summer of 2008 to help ensure that the Confederation is best placed to buildupon its success, has a clear vision and direction for thefuture and is able to provide the best possible service to its members.

The NHS Confederation annual report sets out therecommendations from the review and describes indetail how we will be taking the organisation forwardover the next two to three years.

The networks will remain at the heart of the organisationand will act as the gateway by which we engage andinvolve our members in our work. We will use theintelligence, energy and resources within the networks to build our legitimacy to speak on behalf of ourmembers and increase the strength and influence ofthe Confederation.

Thank you for your continued support and I look forwardto working with David Stout and the rest of theleadership team in meeting the challenges that lie aheadand ensuring the NHS Confederation remains a first-classmembership organisation and a leading voice in healthand social care.

Steve Barnett,

Chief Executive, The NHS Confederation

Chief executive’s statement

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Annual repor t 2008/09 1

Contents

Foreword from the chair 2

About the Primary Care Trust Network 3

Key achievements in 2008/09 4

Looking ahead: our work priorities 8

and future direction

Governance 10

Finance 11

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In just over two years, the Primary Care TrustNetwork (PCTN) hasachieved much for ourmembers to be proud of.Now representing 95 percent of primary care trusts(PCTs) across the country,the network is theauthoritative voice forPCTs, working to influencethe national agenda and

giving members the opportunity to help shape their own development.

At a time of huge change and challenge for PCTs, thePCTN has achieved a growing influence since our launchin 2007. We have provided a strong voice for PCTs on keypolicy developments over the last year, with the networkoften being formally represented during the policydevelopment process. For example, we have had seatson the NHS Next Stage Review Primary and CommunityCare Advisory Board and the World Class Commissioning Board.

At the same time, the network has maintained anindependent voice when we have felt PCT views are notbeing heard. We have continued to argue for a greateremphasis on PCT development within the world-classcommissioning programme and for associated freedomsfor PCTs.

Our second year has seen us produce 16 separatepublications for our members, including briefings whichhave focused on topical issues and discussion paperswhich aim to stimulate debate.

The second PCTN annual conference and exhibition inJanuary this year was a great success. The event attracted

over 200 delegates as well as high-calibre speakers suchas Mark Britnell, Director General of Commissioning andSystem Management, Department of Health (DH), and Dr Jonathan Fielden from the British Medical Association(BMA). We plan to run two separate conferences in2009/10. One conference will focus on commissioningissues for our members and the other will be oncommunity health services.

The year ahead will see a number of key opportunitiesand challenges for PCTs with the current economicsituation and the drive to improve quality of services. The Transforming Community Services programme willbring renewed focus on the provider responsibilities ofPCTs. We will continue to speak out and influence onbehalf of PCTs to support our members.

We will also take advantage of being under the umbrellaof the Confederation to help share learning across thesystem and improve interaction on cross-cutting issues.We will contribute to the NHS Confederation’s collectivestrength and influence to help shape overriding policyand drive sector-wide improvements in patient care. In the run-up to the next general election we will be contributing to the NHS Confederation’s challenges for Government document which will set out keypolicy challenges for all politicians in advance of thegeneral election.

We need member input to help drive a range of workprogrammes. This annual report includes the details ofthese programmes for the coming year. If you wouldlike to get involved in any area of our work included inthis report, please let us know – we’re always looking for volunteers.

Lise Llewellyn

Chair, Primary Care Trust Network

2 Annual repor t 2008/09

Foreword from the chair

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Annual repor t 2008/09 3

The Primary Care Trust Network (PCTN) was establishedin 2007 as part of the NHS Confederation to provide adistinct voice for PCTs in England.

Our aim is to improve the system for patients and staff by raising the profile of the issues affecting PCTs,strengthening the influence of PCT members andenhancing their reputation within the NHS and withwider stakeholders.

We aim to do this through influencing policy and thepublic debate, providing a distinctive voice for PCTs andsupporting PCT leaders through networking, events,publications and sharing information and learning.

The PCTN has an independent board elected by thenetwork’s member organisations, which ensures all ouractivities are member driven.

To reflect the strategic health authority (SHA) regions,the PCTN board consists of one chief executive and onechair from each region. Please see the Governancesection of this report for a full list of PCTN boardmembers during 2008/09.

David Stout is the director of the PCTN. He oversees adedicated team of staff and steers the work programmeon behalf of our members. David and the PCTN’s boardare also supported by NHS Confederation staff from thepolicy, membership, public affairs, publications andevents teams.

How to get involved as a member

The network is a member-driven organisation. We arecommitted to involving members in developing andshaping our work programme. We provide our memberswith a range of involvement opportunities such asconferences, member consultations, policy seminars andworkshops, and speaking at events.

Membership is open to all PCTs that are already memberorganisations of the Confederation. We currently have144 PCTs across England and we look forward to growingthe membership over the coming year.

For more information on our membership andforthcoming events, please contact Martin Panther in themembership team at martin.panther@nhsconfed.org

About the Primary Care Trust Network

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4 Annual repor t 2008/09

Our work programme for 2008/09 focused on five keywork programmes which were agreed by the PCTNboard and endorsed at our 2008 annual general meeting.These included:

• strengthening commissioning

• primary and community services

• health inequalities and partnership with local government

• regulation and system management

• enhancing PCT reputation.

Strengthening commissioning

Throughout the year, the PCTN has been working closelywith the Department of Health (DH) World ClassCommissioning programme. We have been influential in the design and implementation of the programme,including:

• promoting engagement with PCTs and challenging the DH and SHAs to consider the development needs of PCTs, as the world-class commissioning assurance framework develops

• regular two-way communication with Mark Britnell and Gary Belfield, director of commissioning at the DH

• network representation on the World Class Commissioning programme board

• representation on the national calibration process in January which reviewed the draft World Class Commissioning panel assessment reports to ensure there was a consistency of approach across the country

• support to the DH on the design of the communication pack for PCTs for the results of the assurance assessments

• a PCTN discussion paper – Practiced-based commissioning: delivering the vision – which was fed into the DH’s own vision for reinvigorating practice-based commissioning on 4 March 2009; David Stout was invited to speak at the DH’s launch event.

The PCTN also worked on a number of other important areas of commissioning during the year, including:

• coordinating significant PCT input into the development of the new standard NHS contracts for ambulance, community and mental health services

• influencing the design of the Commissioning for Quality and Outcomes (CQUIN) policy, working closely with the DH through co-hosted events to test the initial policy

• supporting the work of the National Prescribing Centre on the development of guidance to support PCTs on their decision-making on funding for new drugs and treatments, and handling individual funding requests

• the network is represented on the Payment by Results (PbR) programme board and has contributed to the changes to the PbR system.

Primary and community services

The PCTN’s key focus for the year was influencing theprimary and community care strategy within the NHSNext Stage Review and its subsequent implementation:

• David Stout was invited to join the advisory board for the development of the strategy and helped shape the vision of the report that was produced alongside the NHS Next Stage Review report

• the network successfully lobbied for the commitment to the abolition of Minimum Practice Income Guaranteein the GP contract

• the network is represented on the Transforming Community Services programme board and had significant input into a range of policy developments over the last year.

During the year, the PCTN also established a separateand distinct voice for PCT provider services within thePCTN in recognition of the increased separation betweencommissioning and service provision responsibilities. Thiswork has included the establishment of a PCT ProviderForum within the PCTN.

Key achievements in 2008/09

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Annual repor t 2008/09 5

The Provider Forum:

• has its own steering group and chair who is co-opted onto the PCTN board

• has held a series of events, including three very successful forums attracting up to 100 delegates, including the network’s first provider chair event which was themed around the issue of renumeration and governance for chairs and non-executive directors

• has published the Community health services, making a difference report, which highlighted the contribution that community services can make

• undertook a straw poll about the future organisational structure of community services; the poll led to a challenge to the DH regarding the restriction in the number of community foundation trusts.

Reducing health inequalities and partnership

with local government

The focus during 2008/09 has been on influencing thetransformation agenda in social care and, in particular,contributing to the debate about future funding models and integration with health services. Specificwork included:

• regular dialogue with key senior officials across government departments and with representative bodies such as the Local Government Association (LGA) on the transformation of social care and children’s health and social care issues

• membership of the Transforming Adult Social Care (TASC) Delivery Board, the Commission for Social Care Inspection (CSCI) group reviewing fair access to care services, and the ministerial groups on the carers strategy and adult social care

• contributing to the development and implementation of the carers strategy through the Standing Commission on Carers and the cross-governmental carers delivery boards

• giving evidence to the Health Select Committee (HSC) on health inequalities and being part of the Healthcare Commission’s (HCC) expert panel which informs their regulatory programme in this area

• submitting evidence to the LGA’s health commission, dealing with issues of local accountability and partnership working, and to the Department of Communities and Local Government (DCLG) select committee on local accountability

• working with the DH and taking part in the assessment processes for the integrated care organisation pilot sites

• running a DH-supported sounding board for local authority directors of children’s services and PCT chief executives on children’s policy issues

• working with the DH and the Department for Children, Schools and Families (DCSF) on the response to the Laming Review of children’s safeguarding arrangements and on the development of the child health strategy

• running two member groups looking at safeguarding issues for children and vulnerable adults and feeding this intelligence into relevant teams at the DH

• working with the regulators to update the children’s indicators in the data set for the next round of inspections.

Regulation and system management

The focus during 2008/09 has been on influencing theevolution of regulation and system management as newbodies have been established, while at the same timecontinuing to manage relationships with the existingregulators. Specific work included:

• dialogue with the DH, the HCC and the Audit Commission on the potential overlap between their various assessment, assurance and regulation regimes of PCTs

• influencing the HCC’s presentation of the Annual Healthcheck results for PCTs

• establishing good working relationships with:

– Cynthia Bower as the incoming chief executive of the new Care Quality Commission (CQC)

– the Co-operation and Competition Panel (CCP) – Lord Carter, chair of the CCP attended a PCTN board meeting, whilst his colleague Andrew Taylor, director of the CCP, attended the Provider Forum

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– Monitor – two successful dinners were held with Bill Moyes, the executive chairman of Monitor, and his senior team during the year

– input to the development of the DH’s procurement guide for PCTs and the transactions manual.

Enhancing PCT reputation

2008/09 has been a challenging year for PCT reputation.Much of the national media focus has been on the role ofPCTs in priority setting and a number of high-profilechallenges to decision-making by PCT exceptional casepanels. An associated policy and communicationschallenge has been the debate about top-ups whichculminated in the publication of the Richards Review,Improving access to medicines for NHS patients. For policy-makers in Whitehall and parliamentarians inWestminster, continued debate and discussion about therelative strength of PCT commissioning skills, both in thecontext of Professor Lord Darzi’s NHS Next Stage Reviewand the world-class commissioning assurance process,have created further challenges.

The network has been very active in its parliamentaryand media work. Some examples of this work arehighlighted below:

• we vigorously promoted the joint NHS Confederation/ PCTN publication on priority setting in the first part of the year

• there was extensive engagement with Professor Michael Richards, DH, in advance of his review and Greg Beales, the Prime Minister’s senior health and social care policy adviser, to raise awareness of the role of PCTs in decision-making on high-cost drugs

• PCTN and NHS Confederation speakers were made available for numerous debates in Westminster on related subjects including a seminar with Professor Mike Rawlins, National Institute for Health and Clinical Excellence (NICE), on the future funding of healthcare and a King’s Fund debate on top-ups with Andrew Dillon from NICE

• David Stout and NHS Confederation’s deputy director ofpolicy Jo Webber have both represented PCT views and perspectives on national and trade media. In particular, David Stout has had live debates with high-profile

clinicians such as Professor Karol Sikora and Professor Jonathan Waxman from Imperial College on the role of PCTs in decision-making on end-of-life drug treatments.

Awareness of the PCTN has continued to grow over thelast 12 months. News coverage has grown in the nationalprint media, matched by David Stout’s regularappearances on broadcast media – both radio andtelevision. News and commentary from the PCTN hasrapidly expanded in the Health Service Journal, whichnow perceives the network as the first port of call for PCT commentary.

Events held in 2008/09

Key to our success during our second year has beenengaging and bringing members together to discuss theissues of importance to PCTs. In 2008/09 we held anumber of events for members, including:

• the network’s second annual general meeting in June 2008 which provided an opportunity for membersto discuss the network's top priority work areas and have a Q&A session with David Stout

• a Provider Forum steering group was set up and has met six times this year to oversee the development of the Provider Forum work programme

• the PCTN Provider Forum ran three successful events in July, September and February, attracting between 70 and 100 delegates; the forum looked at issues such as separation, governance, quality and community services pilots

• a PCT Finance Directors Group (joint with the HFMA) was established; chaired by Gill Scoular, director of finance at Northampton PCT, the group addressed issues such as the panel assurance process, HRG4 and allocations, and speakers included Keith Derbyshire, Janet Perry and Martin Campbell from the DH

• three confidential forums for PCT chairs, whichgave them the opportunity to discuss current issuesin a confidential setting and to share examples ofbest practice

• two dinners with Bill Moyes to develop the relationship between PCTs and Monitor

6 Annual repor t 2008/09

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Annual repor t 2008/09 7

• monthly meetings of the network of ambulance commissioners

• a joint workshop with the Mental Health Network (MHN) on commissioning of mental health services to help ensure this links to the world-class commissioning agenda

• policy seminars on practice-based commissioning, PCT accountability, personal health budgets and commissioning of learning disabilities services

• joint seminars with the DH on CQUIN and the commercial strategy.

Publications

During 2008/09 we produced a number of reports andbriefings for PCTN members, the wider NHS and stakeholders:

• Pharmacy in England, which included the main points of the recent white paper on the future of pharmacy services

• Towards autonomy – lessons from aspirant community foundation trusts

• Priority setting: strategic planning

• Priority setting: legal considerations

• World-class commissioning assurance

• PCT Network Annual Report 2008/09

• World-class mental health commissioning

• NHS Next Stage Review: a vision for primary and community care

• The development of membership schemes for primary care trusts

• Health inequalities strategy (in conjunction with the NHS Confederation)

• Personal health budgets (in conjunction with the Mental Health Network)

• Practiced-based commissioning – delivering the vision

• The new standard NHS contracts

• Community health services – making a difference to local communities

• Commissioning of learning disabilities services.

Membership survey feedback

In the NHS Confederation’s annual survey of membersduring 2008 there were a total of 484 responses with 206responses from PCT members. Overall, the responseswere very positive about the PCTN, with some helpfulsuggestions for improvements.

The findings

• 57 per cent of respondents were positive aboutthe PCTN

• briefings, summaries and reports were important communications to our members and highly valued; this was proved with a satisfaction rating of 4.4, with 5 being excellent

• the top priority for members in terms of network priorities was strengthening commissioning, followed in order of priority by health inequalities/local government, primary and community services, enhancing PCT reputation, and regulation and system management

• in terms of satisfaction, strengthening commissioning was rated highest by members with a rating of 3.5(out of 5)

• members wanted the network to deliver more regional events, engagement and networking opportunities outside of London.

The overall finding from the membership survey was thatthe PCTN is on track with the work programme andmuch of the feedback has been included in the workprogramme for 2009/10.

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8 Annual repor t 2008/09

Building on the work programme from the previous year,our programme of work for 2009/10 centres around fivekey themes.

Strengthening commissioning

The PCTN will continue to work with the Department of Health (DH) on the World Class Commissioning (WCC) initiative, with a major focus on the accelerateddevelopment programme for PCTs built around the WCC competencies. Specific objectives are to:

• support members on delivering world-class commissioning

• focus on the accelerated development programme for PCTs to build around WCC competencies

• raise PCTs’ capacity and confidence in their ability to deliver better health, better care and better value through better commissioning

• support PCTs in developing their capacity, capability and confidence in three priority areas: priority setting and decision-making; public engagement; and communications and clinical engagement in commissioning

• constructively challenge and positively influence the DH on world-class commissioning

• influence and support the development of commissioning policy and practice in five priority areas, including: commissioning for quality, innovation and patient safety; primary care and community health services; integrated care; mental health; and urgent and emergency care.

PCT provider services

PCTs have increasingly separated their responsibilitiesbetween commissioning and service provision. Inrecognition of this separation, during 2008/09 the PCTNetwork established a PCT Provider Forum to establish a distinct voice for PCT provider services. The keyobjectives for 2009/10 are to:

• work with provider services to offer support and act as aconduit for shared learning as well as influencing the DH and SHAs to have dialogue directly with PCT providers

• promote greater freedom of work for providers through lobbying for greater flexibility to appoint independent chairs/non-executive directors for provider services within PCTs, as well as for community services to remain as arms-length providers within PCTs

• establish relationships with the CQC, Monitor and the NHS Litigation Authority (NHSLA)

• develop support networks and development for provider board chairs and non-executive directors through developing links with the Appointments Commission and sharing good practice examples.

Partnership with local government

Partnership working with local government and otherpartners is fundamental to the delivery of health andwell-being and the world-class commissioning agenda.Specific priorities are to:

• support PCTs to achieve their own key objectives of improving the health of their local population and reducing health and inequalities

• continue to develop our position on the green paper on social care and support through response to consultations and briefings for members

• contribute to the transformation of social care through continued work with the LGA, Association of Directors of Adult Social Services (ADASS) and the Association of Directors of Children’s Services (ADCS) to promote good working

• further develop our work programme around safeguarding children following the Laming Review recommendations and responding to the child health strategy

• maintain our position on the development of public health

• influence the debate on local accountability.

Looking ahead: our work priorities and future direction

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Annual repor t 2008/09 9

Regulation and system management

Significant changes to regulation systems are takingplace, with the CQC replacing the HCC and theestablishment of the new Co-operation and CompetitionPanel (CCP). We will continue to contribute to the overallNHS Confederation aims of encouraging proportionateand effective regulation and minimising unnecessaryburdens. Specific objectives are to:

• establish and maintain good working relationships with the CCP and to support the panel to work effectively with PCTs across the country

• establish and maintain good working relationships with the CQC to promote effective regulation of PCTs as commissioners and providers

• influence the development of the comprehensive area assessment

• continue to contribute to the NHS Confederation’s overall aim of minimising the burden of regulation on the NHS and ensuring the PCT voice is heard

• promote clarity and transparency in the system management between PCTs, the DH, SHAs and the regulators.

Communication, engagement and

reputation management

Supporting the work of the PCTN through effectivecommunication, engagement with key audiences andidentifying appropriate reputation management will be akey area of work during 2009/10. To support this work,our overarching aims will be to:

• broaden our analysis of the relative knowledge of key influencers and decision-makers for PCT policy and reputation

• raise awareness of the role, functions and impact of PCTs amongst key opinion formers, including political and media audiences

• ensure effective communication around key announcements of interest to PCTs

• work with an external agency to develop improved communication of PCT priorities.

Engagement of members

To ensure our members are fully engaged in our workprogramme, a number of events are planned, includingtwo conferences – one for providers and one forcommissioners. We are also organising provider andcommissioning forums for both chief executives andchairs as well as high-level policy seminars, bi-monthlyboard meetings and provider steering groups. We willhold other events such as confidential forums for chairs,dinners with stakeholders, policy seminars and ad hocevents with the DH and other organisations.

We also plan to publish a number of briefings andreports to keep members updated with the latest policydevelopments, both for commissioning and provision, aswell as publications that help to tackle some of thedifficult issues facing PCTs.

The views of our members are central to the work of thenetwork and ensure we are representative and effective.We are committed to involving members in developingand shaping our work programmes and providing arange of involvement opportunities.

To read more about our work programmes and eventsand to access our publications online, go towww.nhsconfed.org/PCTNetwork

The wider NHS

The NHS Confederation is unique in its ability to bringtogether all parts of the modern NHS and we will takeadvantage of being under the umbrella of theConfederation to work more closely with our family ofnetworks, share learning and improve interaction on issuesthat affect the whole of the health and social care system.

We will contribute to the NHS Confederation’s aim ofbuilding upon its collective strength and influence toshape overriding policy and help drive sector-wideimprovements in patient care. We will also becontributing to the NHS Confederation’s challenges forGovernment document which will set out key policychallenges for all politicians in advance of the nextgeneral election.

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PCTN board members 2008/09

The PCT Network has an independent board elected byour members, comprised of ten chief executives and tenchairs of PCTs. The board is chaired by Lise Llewelyn,Chief Executive, Berkshire East Primary Care Trust. Ourvice-chair is Paul Sabapathy, Chair, Birmingham East and North PCT.

Members of the board

Chair: Lise LlewellynChief Executive, Berkshire East PCT

Vice-chair: Paul SabapathyChair, Birmingham East and North PCT

East Midlands SHA

John McIvor, Chief Executive, Lincolnshire PCTTom Fremantle, Chair, Nottinghamshire County PCT

East of England SHA

Maureen Donnelly, Chair, Cambridgeshire PCTPam Court, Chief Executive, South West Essex PCT

London SHA

David Smith, Chief Executive, Kingston PCTMarion Saunders, Chair, Ealing PCT (until December 2008)Toni Letts, Chair, Croydon PCT (from March 2009)

North East SHA

Richard Houlden, Chair, Northumberland Care TrustYasmin Chaudhry, Chief Executive, Durham PCT

North West SHA

Leigh Griffin, Chief Executive, Sefton PCTAlan Stephenson, Chair, Ashton, Leigh and Wigan PCT

South Central SHA

Prof Jonathan Montgomery, Chair, Hampshire PCTDr Lise Llewellyn, Chief Executive, Berkshire East PCT

South East Coast SHA

John Wilderspin, Chief Executive, West Sussex PCTEddie Anderson, Chair, Medway PCT

South West SHA

John Richards, Chief Executive, Plymouth Teaching PCTJane Barrie, Chair, Somerset PCT

West Midlands SHA

Sandy Bradbrook, Chief Executive, Heart of Birmingham PCTPaul Sabapathy, Chair, Birmingham East and North PCT

Yorkshire & Humberside SHA

Andy Buck, Chief Executive, Rotherham PCTMartin Drury, Chair, Leeds PCT (until January 2009)Karen Knapton, Chair, East Riding of Yorkshire PCT (fromMarch 2009)

Co-opted board members

Gill Scoular

Northamptonshire PCT, chair of the PCT FinanceDirectors Group

Joe Gannon

Westminster PCT, chair of the PCT Providers Forum (untilJanuary 2009)

Matthew Winn

Cambridgeshire PCT, chair of the PCT Providers Forum(from January 2009)

Role of the board

The role of the PCT Network board is to:

• contribute to the development of strategic direction of the PCTN to ensure it fulfils its objectives in supporting and advocating for PCTs

• take a lead on steering specific priority policy areas as agreed by the board

• ensure the board sets challenging objectives for the PCTN

• monitor the performance of the network in meeting the agreed work plans and targets

• ensure that financial controls and systems of risk management are robust and that the board is kept fully informed through timely and relevant information

• ensure that the PCTN values diversity and demonstrates equality of opportunity in its treatment of staff and in all aspects of its business

• seek views of colleagues within their area to ensure thatthese views are represented in discussions at the PCTN board and in the wider work programme of the board

• communicate the work of the PCTN within their local area

• represent the PCTN with external bodies as part of the PCTN work programme as agreed with the PCTN director.

10 Annual repor t 2008/09

Governance

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Annual repor t 2008/09 11

A summary of the PCTN outturn for 2008/09 is detailedin the table opposite. These figures are currently beingaudited and are therefore subject to unforeseenadjustments.

The network is reporting a surplus of £157,000 for2008/09 (against a budgeted surplus of £47,000),explained by:

• a planned surplus to build up reserves

• higher than budgeted number of PCTs in membership

• higher income from the PCTN conference than budgeted

• higher rates of sponsorship than anticipated; for example,free venues for a number of events, more planned meetings at the NHS Confederation offices in London

• a delay in recruiting the senior commissioning policy manager, additional public affairs capacity and administrative support

• deferring an element of the planned reputation management work to 2009/10

• some costs covered by the NHS Confederation’s core membership in 2008/09, rather than the PCTN specifically.

Summary of income and expenditure 2008/09

Finance

Forecast Budget Variance

outturn £k £k

£k

Total income 513.0 492.6 20.8

Expenditure – 224.8 224.7 0.1pay

Expenditure – 131.4 220.8 89.4non-pay

Expenditure – 356.3 445.5 89.2

total

Total 157.1 47.0 110.1

surplus/(deficit)

As a consequence of the surplus for 2008/09, thenetwork board is pleased to announce that networkmembership fees for 2009/10 will be frozen for thesecond year running at £3,300 per year.

The main NHS Confederation fee will also be frozen for2009/10.

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For more information on our work, please contact:The NHS Confederation29 Bressenden PlaceLondon SW1E 5DDTel 020 7074 3200Email enquiries@nhsconfed.org

www.nhsconfed.org

Further copies can be obtained from:NHS Confederation PublicationsTel 0870 444 5841 Fax 0870 444 5842Email publications@nhsconfed.org

or visit www.nhsconfed.org/publications

BOK60015

© The Primary Care Trust Network 2009. This document maynot be reproduced in whole or in part without permission.

ISBN 978-1-85947-167-8

This publication has been manufactured using paper producedunder the FSC Chain of Custody. It is printed using vegetable-based inks and low VOC processes by a printeremploying the ISO14001 environmental accreditation.

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