The government has set out demanding modernisation plans for the NHS.
It wants providers to be more responsive to patients, and market excesses to be curbed by better regulation and new models of social ownership.
Meanwhile primary care trusts (PCTs) have been struggling to rise to the challenge.
As a result, two new policy themes have emerged: stronger market incentives and decentralisation of budgetary power.
This paper looks at how PCTs can adapt to these new policies and strengthen their commissioning role.