Winner: North Bradford primary care trust The project was started to improve primary care within the PCT and to improve access to secondary and intermediate services for local people. A number of projects are taking place at various points along the patient pathway to manage capacity and demand.

Management The PCT has developed an Access database to record all referrals made by GP specialists, Bradford Hospitals trust, other trusts and care providers. Monthly comparative information is published - three-fold differences have been found in the total number of patients referred by practices, with large differences by specialty.

The database also shows the actual time each practice's patients wait to be seen (from the data of the referral decision). Monthly waiting-list meetings are held with the main hospital trust on a cross-district basis to ensure activity is delivered. Also, GP specialist services have been delivered in urology, dermatology, neurology, musculoskeletal services, diabetes and minor surgery. In many cases, routine referrals are made to GP specialists, who are able to deal with uncomplicated patients or triage them into secondary care.

Innovations and successesThese and other developments mean the PCT has been able to manage its waiting lists. Referrals to secondary care have been reduced. There is access to primary care within 24 hours and to a GP within 48 hours. Prescribing has improved and is within budget. Resources have been managed effectively, enabling growth funding for primary care. The PCT is an NHS beacon site for waiting-list management.

The judges said: From many high-quality, innovative projects, Bradford was the clear winner. It is leading the field - they haven't just talked the whole systems talk, they've walked it. The project illustrates the power of peer pressure in driving service improvement. It is a tribute to transformational leadership, building on joint working.

Project: PCT waiting list and activity management strategy Contact: Lesley Hill, tel: 01274-322183 Runner-up: Wakefield health authority Project: Wakefield primary care domestic violence project Contact: Val Barker, tel: 01924-814742 Wakefield primary care domestic violence project is a multi-agency initiative working with 12 practices in Wakefield. Its aim is to help staff identify domestic violence, make appropriate referrals and work with the criminal justice sector to improve attrition rates.

ManagementThe project is steered by a multi-agency sub-group of the Wakefield Community Partnership. It is managed by local charity Support and Survival.

Innovations and successesThe British Crime Survey suggests that one in four women experiences domestic violence, but research suggests health services have a poor reputation in tackling the issue. Many doctors are reluctant to broach it, through embarrassment or being unsure of what to do next (some wellmeaning doctors have referred victims to mental health services).

The project secured£242,000 funding from the Crime Reduction Programme - Violence Against Women Initiative. This funded a questionnaire of 1,200 women, one in five of whom disclosed experience of domestic violence.

It also paid for training for primary care teams and research at two practices on the collection of health information to assist prosecution. Women were found to be asking for safe and confidential help, rather than 'treatment'. The project includes resources for Support and Survival to cover demand.

The judges said: Bravely tackling an oftenneglected public health issue. The project is to be commended for ground-breaking research, its valuable audit and training tools and partnership working of the highest order.

Runner-up: South Lewisham primary care group Project: Downham Nutrition Partnership Contact: Jean Atkinson, tel: 020-8297 0707 Downham Nutrition Partnership is a primary care-led, grassroots project that works with local people on nutrition issues. The area has high levels of heart disease, asthma and tooth decay, all of which are linked with poor diet. South Lewisham PCG has made nutrition a priority. The project's key objective is to change people's eating habits so they eat more fruit and vegetables and drink more water, while eating less fat, sugar and foods with chemicals and additives.

ManagementSouth Lewisham PCG has engaged a project development worker one day a week to work with local people on shaping the Downham Nutrition Partnership. The PCG has also invested£6,000 in nonstaffing costs. The project has levered in more than£100,000 and decided to become a registered charity.

Innovations and successesWith advice from Lewisham Community Development Partnership, a youth and community worker has been appointed for two years to work in the community on a range of nutrition projects. These include six farmers' markets with 1,000 attendees, two schools piloting a free fruit scheme, three breakfast clubs, 15 organic allotments brought back into use for growing vegetables and a Looking Good, Feeling Fine open day in June.

The judges said: Wonderful presentation and enthusiasm. This is tackling a major, oftenneglected health issue and it is doing so flexibly, learning as it goes to ensure maximum impact. It is managing with limited resources, but is obviously enterprising and successful at securing long-term support.