Primary care trusts will be able to call on a rich network to help find their way with world class commissioning

The Department of Health's world class commissioning team says it aims to help primary care trusts find the way, not hog the driving seat. "Ensuring that PCTs have the support that they need to improve is not the responsibility of any one organisation," says Sarah Walter from the team.

"Development may be self-managed by PCTs, directed by strategic health authorities or led by the DH, where it makes sense to do things at a national level," she says. "For example, we are working on a national board development programme. The most important thing won't be where support comes from, but to ensure that PCTs understand what their development gaps are, and have access to high-quality tools and resources to help them improve."

Commissioning support can also be found in existing structures in and around the NHS. West Kent PCT chief executive Steve Phoenix emphasises there is also the "self-help" option for PCTs. Mr Phoenix has been leading work for South Coast SHA on creating programmes for PCTs to help themselves and each other. He suggests PCTs can operate at three levels. Nationally, "many PCTs already work collaboratively on new development programmes, designed to support boards in readiness for change. This is part of what [NHS chief executive] David Nicholson calls the 'look out, not up' approach," says Mr Phoenix.

PCTs can also work regionally, as in West Kent. "We're close to agreement with Brighton and Sussex University medical school to run an MSc in health commissioning," he says. "By April 2009, we'll have a commissioning accelerated development programme, to fast-track middle managers in clinical roles who want to become generalists, to tap into their wealth of frontline knowledge and expertise in areas like community services."

The third level is local. West Kent is creating a local, PCT-run commissioning graduate development programme which will be complementary to, but not part of, the national management trainee scheme.

NHS West Midlands commissioning director Eamonn Kelly is clear that since world class commissioning is about high-performing organisations, SHAs' performance management and capacity- and capability-building objectives give them a core role in helping PCTs develop.

Mr Kelly says: "Over the last 18 months, we've been supporting a range of relevant work through the Fitness for Purpose reviews and diagnostic process. We've been holding co-production workshops on PCT self-assessment, and identifying areas for collaboration (joint working, staff development, external support).

"Our emphasis on leadership development is essential. SHAs' workforce deanery responsibility is key to making this happen. Each regional director needs to provide professional leadership - it's not just down to the director of commissioning.

"SHAs need to offer their PCTs a blend of collaboration, support and challenge. Where organisations struggle, the SHA needs to be much more closely involved".

So how supported and developed are PCTs feeling? Birmingham East and North PCT chief executive Sophia Christie admits that, until recently, she and colleagues had concerns about a lack of investment and attention in a national programme of commissioning development, "so it's positive to see good progress on the assurance framework", she says. To succeed, she argues, PCT leaders will need "clear understanding on our core purpose over the next three to five years; how to deliver that; and what people, processes and measurement systems we need to deliver".

At a national level, activities under way include the design of a national board development programme and roll-out of the framework for procuring external support for commissioners.

Simon Morgan of the DH world class commissioning team says: "The framework is a tool in the toolbox: not the solution, but one of a number of choices around the 'share, learn or buy' options for PCTs. If people choose to buy, the framework provides a list of pre-qualified independent organisations offering a variety of support (contract management, health needs assessment, procurement, engagement). They can be selected by PCTs through a local mini-competition process, and we provide templated documents to help PCTs through that."

Sarah Walter concludes: "The development challenge for PCTs is significant. All parts of the system need to work together to ensure a range of available resources, from which PCTs can pick and choose according to their specific needs."