Salford is the only primary care trust to achieve double excellent scores, having improved its quality rating from good last year.
Chief executive Mike Burrows says there is no single secret, but that its approach was ambitious across the board.
"We never accepted we could not achieve even the extremely challenging targets, and that achieved a degree of lateral thinking.
"For example on chlamydia screening, we had to come up with direct marketing to reach out to young people."
He says the PCT's strong provider neighbour is also vital to its success. Salford Royal foundation trust achieved double excellent for a second successive year.
They have set up a joint board to make decisions that affect both and bring together primary and secondary clinicians.
Mr Burrows adds: "Health economics has got to underpin much of our decision making."
The PCT developed its own quality metrics and benefits from a strong commissioning partnership with other Greater Manchester PCTs.