The presentation was a real opportunity for delegates to get down to the nitty-gritty of running a PCT. And its three chief officers made it clear that, to date, things had worked well because they got on well as individuals and were all committed to the trust.

What had been important to them was local support and local knowledge. Chief executive Audrey Bradford told the conference: 'One of the things that pushed us to a PCT was the strong support from GPs.'

Executive committee chair GP Dr David Bevan said that if he had the last six months over again, the thing he would do differently would be to 'consult, consult, consult, consult'.

When asked, in a round table discussion, what an ideal PCT would look like, delegates were absolutely clear that strong management and, more important, leadership, was what made an organisation work. Delegates spoke of 'lacking charismatic management in the NHS' and having lots of management 'but no leaders'.