Winner: Sandwell PCT

Reconfiguration posed a challenge that our winner more than met, notching up great achievements in public health, MRSA reduction and finances

Sandwell PCT has gone through a period of considerable development since its reconfiguration in 2006. Following Healthcare Commission ratings in 2006-07 of fair in quality of service and financial management, the trust went on to achieve all but one of its 44 Healthcare Commission standards.

It is one of only four primary care trusts in the country with a Healthcare Commission rating of "excellent" for its public health function.

The trust has also achieved the highest number of health improvement targets in the West Midlands. MRSA rates have halved since 2005, stop-smoking service access and quitters have increased by 10 per cent over the last year and waiting times for GUM access have been halved over 12 months. For the first time in Sandwell, a 90 per cent uptake for all childhood immunisations has been reached, with numbers of people attending the Expert Patient Programme also going up.

Standards of financial management and governance are high. Having inherited a deficit, Sandwell was able to achieve its financial control targets in 2007-08, maximising its use of resources.

The PCT plays an active part in local strategic partnership activities and has been part of the year-long consultation over the Sandwell plan. Fully involved in all eight priority areas of the local area agreement, the primary care organisation leads on two. These are Improving Health (including coronary heart disease reduction, smoking and obesity management) and A Better Start to Life, covering infant mortality reduction, childhood obesity and breast feeding, for which a 4.6 per cent increase in initiation rates has been achieved.

Sandwell's vision and values have been developed through a year-long dual-stream programme, firstly of staff engagement and then through a patient and public involvement strategy that ultimately saw community stakeholders and service users determining what the vision and values should look like.

A strong tradition of clinical involvement with protected learning events for primary care teams has been upheld. Clinical issues and management themes, such as priority setting and practice-based commissioning development, have all featured in an extensive programme.

The trust leads the Towards 2010 action plan to improve health and social care in Sandwell and the heart of Birmingham.

This includes extensive programmes of clinical service redesign in preventive, primary and secondary care, combining changes in service delivery and a programme of capital build - with Lyng and Oldbury health centres and the Priory Family Centre, winner of the 4Ps award for design excellence, already completed.

The public consultation exercise for Towards 2010, undertaken with Heart of Birmingham PCT, was the largest ever by the health service in the UK.

The judges said of Sandwell: "It is a primary care organisation with strength and depth, a clear strategy, strong community and local authority engagement, demonstrating significant achievement."

Highly Commended: City and Hackney teaching PCT

A range of public health campaigns with impressive outcomes, productive working relationships with its local acute provider trusts, a strong involvement in local regeneration schemes and an extensive and impressive use of practice-based commissioning are among the stand-out features of City and Hackney teaching PCT's work.

With a third of the working age population economically inactive, Hackney is the fifth most deprived borough in England. It is also home to significant Turkish, Kurdish, black African, black Caribbean and Jewish communities, with over a quarter of the population aged under 20.

In 2007-08, City and Hackney targeted health inequalities, reducing teenage pregnancy rates by double the national average, significantly increasing investment in psychological therapies and launching new services for homeless people, travellers and gypsies, and vulnerable pregnant women.

One-stop shops have been set up for disabled children and their families and for children's health generally, while services such as mobile dentistry, foot health and speech and language therapy have all been strengthened.

City and Hackney was the first PCT in England to commission several pharmacy-enhanced services including flu vaccination and chlamydia screening. Finalist Bolton PCT

Bolton PCT's clear strategy and partnership working contain a range of innovative practices that reach into the local community and drive both quality improvements and service redesign.

One of only two European sites participating in Triple Aim, a worldwide initiative with the Institute for Healthcare Improvement, Bolton's scheme focuses on the delivery of better population health, best care and value for money.

Launched this year, Big Bolton Health Check aims to provide cardiovascular and diabetic risk screening for all residents over 45 (an estimated 88,000), with£1m being spent on enhanced services, marketing and community activity to reach the target population. Practices can enlist help from health trainers to assess their population and GPs are incentivised to achieve full take-up. By July, 44,000 people had been screened.

Work done by the PCT with two other trusts and Connecting for Health to pilot GP practice dashboards received attention in the NHS next stage review. The dashboard is a visual means of determining real-time performances at practices across a range of measures.

Bolton PCT has a risk-sharing pool to stimulate innovation in practice based commissioning - with no risk to the practices. Clusters can bid for funding to develop proposals that could generate savings in prescribing or in secondary care.

Finalist: Milton Keynes PCT

The PCT has made big strides to drive service improvement, turn around a financial deficit and strengthen its credibility as a commissioner. There is a clear focus on public health, and the old ways of doing things are being challenged.

Changes in the organisation's structure and partnership working have been implemented. After one year under a more organised and systematic approach, the benefits are becoming apparent.

Since April 2008, caesarean section rates have decreased and reductions in the provision of antenatal education have been reversed. The Children's Trust has helped forge strong links between the maternity service and an expanding network of children's centres.

Immediate public health improvements have resulted: more smoking cessation advice and referrals; more training of midwives to recognise and care for women who have been victims of domestic violence; and better identification of women at risk of mental ill health.

Primary care clinicians have been involved in developing a care pathway for diabetic patients. General practices are being incentivised to use a case management approach and, working with the local branch of Diabetes UK, patients are engaged in supporting this change. Specialist community input from hospital consultants is being written into the 2009-10 hospital contract.

Finalist: Salford PCT

Impressive partnership working across the community, strong clinical leadership and good progress engaging with the public and patients are all in evidence at Salford PCT.

The PCT leads the Healthy City Forum, overseeing the development of approaches to health and well-being, including alcohol, obesity and tobacco control strategies, providing governance for both development and implementation.

At the local level, health improvement teams deliver strategy through health action plans. These are developed using guidance models for each of the lifestyle areas: smoking, obesity, exercise, alcohol, sexual health and mental health.

Guidance models encourage the involvement of communities, promote health as a way of life and use approaches that reflect the way people live.

To raise its profile, the PCT takes health campaigns out into the community. The health MOT bus takes PCT staff on a tour of the city, encouraging residents to stop by for health checks.

Salford PCT received a rating of "excellent" for use of resources and "good" for quality of services in the 2006-07 Annual Health Check.

This put Salford as the highest performing PCT in the North West and in the top three PCTs nationally. In the 2007-08 annual health check, it was commended for its strong planning and risk management.

Finalist: Walsall teaching PCT

Walsall teaching PCT has an impressive array of initiatives to improve care and address health inequalities.

Its CDR Intell, a chronic disease report system, extracts data from all GP practices overnight, giving practice based commissioners and other staff the ability to benchmark and monitor GP performance, while enabling systematic interventions.

Data intelligence and profiling has enabled the health promotion department to commission an online weight management programme as part of a social marketing obesity campaign, The Weight's Over. With the local council, the PCT uses a social marketing model to introduce healthy weight products and services, including free slimming programme membership, access to physical activity, online weight management and NHS health trainers.

During March this year, 3,000 callers responded to campaign advertisements on buses, bus shelters and in newspapers, with 80 per cent taking up a range of interventions.

In early 2008, Walsall established the first PCT membership organisation, MyNHS Walsall. Membership grew to 2,600 by May 2008 and enabled MyNHS Walsall to push ahead with elections to what BBC Radio 4 called the first "Patients' Parliament". The PCT has been in financial balance every year since its inception.