Published: 02/06/2005, Volume II5, No. 5958 Page 3

The developing role of primary care trusts is 'best not driven by strategic health authorities, ' according to Dr Tim Riley, chief executive of North and South Trafford PCTs (Good Management, pages 22-23) Speaking as chair of the Association of Greater Manchester PCTs, arguably the most coherent model to emerge for the future of PCTs, this is not empty rhetoric.

The famous North Western municipal pride shines through when Dr Riley declares that PCTs are best left to get their own houses in order. With one eye perhaps on the forthcoming primary care white paper, he also cautions government that PCT evolution 'does not need to be legislated for to make it happen faster'.

Some of the more hands-on SHAs have imposed - or are considering doing so - structures on 'their' PCTs which do little to reflect local concerns or aspirations.

However, Dr Riley's understandable optimism about the Manchester Association's ability to shape its own future cannot be shared throughout the UK and, because of this, the role of SHAs in some areas is likely to continue to be much greater than he would ideally want.

The analysis by Kieran Walshe and colleagues of the role of SHAs gives them a qualified thumbs up (news analysis, pages 14-15). Their most telling comment is that, in general, SHAs have provided 'a greater degree of 'NHS ownership' of problems and policies...and have had the influence both 'upwards' and 'downwards' to shape policy and to achieve change'.

Dr Riley, rightly, 'looks forward to the day when there is a national alliance of PCT associations, shaping as much as responding to policy'.

But that day is not likely to arrive within the next couple of years. In the meantime, SHAs have a vital role to perform in helping to give birth to what the prime minister's outgoing policy adviser, Professor Julian Le Grand, calls the 'quasi-market' for publicly provided healthcare and assisting local PCTs to find the right solution for their future.

For even Manchester's PCTs would not have achieved so much without the cooperation and encouragement of an enlightened SHA.