The revolution in primary care could end in failure unless the government relaxes its continual drive for reform.That is just one of the stark warnings to emerge from the national tracker survey - a three-year examination of the progress of primary care trusts and groups carried out by the National Primary Care Research and Development Centre.

The survey claims that the stream of NHS initiatives - policy guidance, implementation of national service frameworks, Commission for Health Improvement inspections and government targets - is creating ever-growing tensions between 'expectation and capacity'.

It says this is made worse by a significant lack of sufficiently skilled managers at virtually all PCGs and PCTs.

Professor David Wilkin, project director of the survey, said: 'PCTs and PCGs are beginning to make real improvements to the services they are offering. They are developing the roles of frontline staff - like nurse practitioners - so the focus is shifting from setting up the organisations themselves to the delivery. But there is a real danger the management of the organisational changes is going to divert attention from the core functions of improving care.' He said the pace of change was being dictated by government timetables rather than a 'process of learning and building on experience'.

With prime minister Tony Blair staking his government's reputation on the delivery of better public services, the report is not without political weight.

Professor Wilkin said: 'I think the improvements can be made before the next election. Patients will experience better services.

But It is important to make sure we are not trying to do everything at once. We need some significant wins, otherwise we could see the whole process of change being deemed a failure. Many improvements can be made in the next two years; commissioning and general health improvement may take longer.'

Despite the extra responsibilities PCT/Gs are taking on, the survey found 29 per cent employed fewer than three managers - making continued progress 'extremely challenging'. One in seven had no finance staff at all.

'It is not really a question of extra resources to sort out this issue - to an extent the government is right, ' Professor Wilkin said. 'What is needed are managers with the right skills and experience coming through the system.Managers from trusts and health authorities can be taken on, but we are dealing with primary care and they do not necessarily have the skills needed.'

Chief officers also told the survey that many HAs had not raised their support for PCG/Ts since 1999 - particularly in areas such as finance, organisational development and training.

And what Professor Wilkin described as the 'black hole' of IT is also a key concern. The tracker survey reveals that PCG/Ts are struggling with 'very limited' resources to support IT, with many claiming they will not meet national targets. And with little evidence of any planned investment, the report says that it will leave most with inadequate information to support core functions.

Professor Wilkin said maintaining morale throughout the service would be crucial in the face of the continued challenges presented by the government's pledge to reform the NHS.

'Substantial progress has been made in developing primary care.

But it will be important to keep frontline workers on board. . .

Mutual goodwill has yet to yield seamless services. There is a long way to go to realise the ambitions for a fully integrated service as envisioned in the NHS plan.'

The National Tracker Survey of Primary Care Groups and Trusts 2000/2001: modernising the NHS.

www. npcrdc. man. ac. uk