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The purpose of the paper is to investigate the inter‐ and intra‐organisational relationships in the commissioning of secondary care by primary care trusts in England, using a principal‐agent framework.

The methodology is a qualitative study of three case studies. A total of 13 commissioning‐related meetings were observed. In total, 21 managers and six consultant surgeons were interviewed.

There are a number of different levels at which contractual and managerial control take place. Different strengths of control at one level can affect willingness to comply with agreements at other levels. Agreements at one level do not necessarily result in appropriate or expected action at another.

The system for commissioning in the National Health Service (NHS) has changed with the introduction of payment by results and practice‐based commissioning. However, the dynamics of the inter‐ and intra‐organisational relationships studied remain.

Incentives within organisations are as important as those between organisations. Within a chain of principal‐agent relations, it is important that a strong link in the chain does not result in the exploitation of weaknesses in other links. If government targets and frameworks are to be met through commissioning, it may be advantageous to concentrate efforts on developing incentives that align clinician with NHS trust objectives as well as NHS trust with primary care trust (PCT) and government objectives.

This paper is based on original empirical work. It uses a principal‐agent framework to understand the relationships between PCTs and NHS trusts and highlights the importance of internal NHS trust governance systems in the fulfilment of commissioning agreements.

Findings and good practice are reported from a project promoting engagement of PCTs with the health experiences of people with learning disabilities. Project work was most successful where it linked into mainstream NHS priorities, using good information and specialists' expertise to support mainstream practitioners.

This paper aims to report results from a national survey of primary care trusts (PCTs) that explored the strategic, organisational and practice context of services for people with long‐term neurological conditions (LTNCs). It seeks to provide benchmarks for integrated service provision and to discuss possible reasons for the variability in progress.

Earlier phases of the research identified three models of care that promoted continuity of care for people with LTNCs: community interdisciplinary neurological rehabilitation teams, nurse specialists and pro‐active day opportunities. Based on this evidence, a benchmarking questionnaire was developed and a telephone survey of PCTs in England undertaken in 2009.

The survey found that the prevalence of models of good practice varied widely across and within PCT areas. Strategic support and commissioning arrangements were also variable. A little over half of responding PCTs had completed a joint strategic needs assessment (JSNA) that included a reference to LTNCs and a quarter of PCTs had no joint commissioning arrangements in place for LTNCs. The complex interplay between strategy, organisational structures and models of delivery, in a context of competing priorities, may account for this variation and patchy progress.

Service provision for people with LTNCs is an under‐researched area, despite having major implications for long‐term care and support. The paper will be valuable to policy makers and commissioners in benchmarking organisational activity and models of good practice for integrated services.

Research Governance has been introduced to regulate research involving National Health Service (NHS) patients and staff but the process is lengthy and bureaucratic and has improved little since its introduction. The paper seeks to investigate changes over time.

A comparison between two studies, one in 2003‐2004 and the second in 2004‐2005, provided the opportunity of observing the process of Research Governance as it was developing. Both studies included postal questionnaire surveys and interviews with study participants.

In order to achieve Research Governance approval, application forms have to be completed, reviews undertaken, sponsors and indemnity information identified and honorary contracts from individual PCTs applied for. Honorary contracts can require references and health and Criminal Records Bureau checks. The process reduces the time available for research and employs large numbers of people, yet is still inefficient. Some of the requirements reduce the quality of the research and researchers' rights are marginalised.

The studies took place in a rapidly changing research environment. Further studies should continue to assess the situation and report any progress in making Research Governance less onerous for researchers.

There is an urgent requirement to investigate how procedures can be simplified and made less bureaucratic and costly, and to protect the rights of researchers. Without this, primary care research will be seriously disadvantaged and may become impossible to pursue.

The study compares process over time and shows that achieving Research Governance approval is seriously limiting research in primary care.

The UK National Health Service (NHS) is undergoing cataclysmic change following the election of the first Labour Government in 18 years. This is primarily embodied in the implementation of the White Paper The New NHS Modern‐Dependable, which has resulted in the creation of primary care groups (PCGs) and primary care trusts (PCTs). The task facing both PCGs and PCTs is a radically new and complex one, requiring a new set of leadership skills to the traditional command and control style management. Leadership theories have evolved over the past 70 years. However, it was not until the 1980s that a major change in the paradigm of thinking around what is the nature of leadership occurred. The interaction between the leader and his/her followers is explored in what has become known as transformational leadership theories, developed by Bass and Avolio. Recent studies have, however, questioned the applicability of leadership models derived in the USA, to other cultures. This paper explores the leadership behaviours required for the management boards of PCGs and PCTs. A qualitative research method “Grounded Theory” approach was chosen for this study of leadership. The Repertory Grid technique was used to collect data. There are a number of implications arising from the findings of this study for both leadership models in general, and more specifically, for the development of leadership skills in both PCGs and PCTs.

This article follows an earlier article in this journal (Goldman, 2010), examines the emerging government policy on integration and considers some of the implications for joint financing. Most primary care trusts (PCTs) and councils with adult social care responsibilities are engaged in joint financing and wider health and social care partnership arrangements. But, with the demise of PCTs and the growth in GP commissioning, there are issues and questions about the future of such arrangements. However, despite these organisational changes, partners must continue to be able to demonstrate the outcomes that integrated health and social care services are achieving.

The purpose of the study is to examine how Non-Executive Directors (NEDs) in the English National Health Service (NHS) commissioning bodies experienced their role and contribution to governance.

Semi-structured interviews were conducted with a purposive sample of 31 NEDs of Primary Care Trusts (PCTs) and 8 Clinical Commissioning Group (CCG) NEDs. Framework analysis was applied using a conceptualisation of governance developed by Newman, which has four models of governance: the hierarchy, self-governance, open systems and rational goal model.

NEDs saw themselves as guardians of the public interest. NEDs’ power is a product of the explicit levers set out in the constitution of the board, but also how they choose to use their knowledge and expertise to influence decisions for, as they see it, the public good. They contribute to governance by holding to account executive and professional colleagues, acting largely within the rational goal model. CCG NEDs felt less powerful than in those in PCTs, operating largely in conformance and representational roles, even though government policy appears to be moving towards a more networked, open systems model.

This is the first in-depth study of NEDs in English NHS local commissioning bodies. It is of value in helping to inform how the NED role could be enhanced to make a wider contribution to healthcare leadership as new systems are established in the UK and beyond.

Adult protection has been a relatively recent concept for staff working within the health economy. Priorities have focused on raising awareness, developing an understanding of safeguarding responsibilities, challenging established practices and attitudes and embedding the concept within the culture of NHS organizations and the daily work of staff at all levels. Although social services have the lead for safeguarding activities (Department of Health, 2000), statutory health bodies have now begun to integrate their adult protection activities more effectively and positively with social services and the police. This paper reviews the journey undertaken by the three primary care trusts (PCTs) in Kent and Medway in developing adult protection expertise and sharing multi‐agency adult protection practice with both social services and the police. The three safeguarding vulnerable adults leads from the PCTs have joined together to look at how far we have come and what we still need to achieve.

This article reports on the fourth in a series of annual Pavilion conferences, charting the gritty texture of real‐time organisational development set against the formal policy agenda. Those engaged in PCT development will find the messages instructive and reassuring.

With the advent of the Darzi review in 2008, and more recently the White Paper “Equity and Excellence: Liberating the NHS” (2010), the NHS in England is being redesigned to provide high quality, person‐centred services with improved capacity and performance. In this change oriented scenario, stakeholder consultation has a critical role to play given the widespread advocacy in government policy and healthcare literature. In order to support informed decision making, the purpose of this paper is to: explore healthcare infrastructure planning through various approaches to stakeholder consultation within English Primary Care Trusts (PCTs); and develop a conceptual approach to strategic asset management (SAM) based on the findings of stakeholder consultation and engagement exercises.

A multi‐method triangulation approach including action research has been adopted to evaluate current stakeholder consultation practices with a local PCT and to explore their approach to healthcare infrastructure planning through: a literature review of stakeholder engagement and theory; evaluation of a local consultation exercise; and a web based document review of consultation practices within 149 English PCTs.

PCT estate managers and healthcare planners have to operate within constantly changing dynamic healthcare environments and need to reduce uncertainty and indecision that often surrounds the debate of reconfiguration of healthcare facilities and services. Consultations by the PCTs vary in: the level of detail provided to the public; sample sizes; detail and transparency of the consultation; distribution and analyses of the consultation; and techniques and approaches.

The findings of this study can be used by healthcare policy makers to: inform how clinical commissioning groups (CCGs) could be better involved during patient and public engagement; and determine practical ways of putting patients at the heart of General Practitioners (GP) commissioning.

The research identifies gaps within current stakeholder consultation practices in English PCTs and develops a conceptual approach to SAM that accounts for stakeholder consultation; decision making levels within healthcare infrastructure planning within a wider competency based organisational view, which currently does not exist.