Primary care's big challenge is acting on great expectations

This will be a huge challenge, even for world class commissioners. As the DoH's draft competency document sets out, primary care trusts will need to seek out and make the most of all information about their local populations - even down to individual street level.

Under the skills required by the framework, 'the PCT communicates openly and honestly with local people and communities about challenge and change'.

Central to this is the need for what has been described as 'ferocious engagement' with the public.

This means going far beyond the usual suspects, who shout loudest on any community issue, and finding new ways to draw out those who tend, for whatever reason, to go unheard.

For many, this level of engagement will be a departure. Primary care trusts can struggle for recognition locally, with the public often unclear what their PCT does for them.

World class commissioning and the patient involvement required to make it a reality are both laudable aims. But can they both be delivered quickly?

As the DoH and trusts proceed to work together on the commissioning vision, both sides seem up for the challenge. DoH director of commissioning Gary Belfield has already offered to work with interested groups such as the Picker Institute to map out how 'world class engagement' can be made a reality.

Trusts, too, recognise that finding better ways of seeking out and acting on public and patient expectations and experience is one of the greatest challenges they face.

And it is not the only one. But if they can overcome the hurdles, this presents the opportunity to demonstrate why primary care should be at the forefront of the 21st century health service.