Lack of jobs, money and clarity on reform are the main ingredients of primary care trust managers' daily grind at the moment. It hardly makes an attractive package. One PCT senior manager told Inside Track that they are moving sector after a career in primary care, because they are 'buggered if they're going to stick around and let the local political willy-waving bugger up my career after the reconfigurations'.

Lack of jobs, money and clarity on reform are the main ingredients of primary care trust managers' daily grind at the moment. It hardly makes an attractive package. One PCT senior manager told Inside Track they are moving sector after a career in primary care, because they are 'buggered if they're going to stick around and let the local political willy-waving bugger up my career after the reconfigurations'.

One middle manager in the north said they were amazed at the number of senior people in strategic health authorities, as well as PCTs, who are grabbing the chance to get out under preferential early retirement packages.

They calculate that if they get new jobs in the new configurations they are likely to end up with a much reduced package as age discrimination rules kick in.

Meanwhile, the ongoing 'fumbling' over policy direction is being met with a wave of resigned shrugs. The shock and outrage that met Commissioning a Patient-led NHSalmost a year ago has been replaced by apathy over continuing 'policy incoherence'.

'Everyone just shrugged their shoulders and got on with it,' said a south-east primary care director after the Department of Health's hurried withdrawal of an advertisement aimed at bringing in the private sector to run PCT management functions. 'We're all just waiting to see what comes out of our fitness-for-purpose reviews.'

Elsewhere, some are increasingly nervous about money. 'There is real anxiety about the true financial position and whether it has really come out yet,' says a planning and commissioning manager from eastern England.

'There is an emerging consensus that it's going to be much worse as there is quite a lot of optimism built into local delivery plans,' they said.

Apparently, some LDPs are promising up to£30m savings via practice-based commissioning by April 2007, but have yet to show any savings at the end of the first quarter of 2006-07.

'When we look at the rate of growth compared to other public sector services, you have to question how much longer we can go on without losing our credibility entirely,' added the manager.