While the NHS accelerates towards an uncertain future, primary care trusts are braking hard on activity.

True, their ability to control emergency admissions appears limited, but the exclusive analysis carried out for HSJ by CHKS shows that where they have greater control, their performance is impressive.

In the three years from 2007-08 to 2009-10, overall outpatient referrals rose 33 per cent, with GP referrals up 25 per cent and consultant to consultant referrals higher by an astonishing 53 per cent.

With the financial writing on the wall, the need to slow the growth in referrals became an imperative. The result? Pro-rata figures suggest overall outpatient referrals will increase just 1.5 per cent in this financial year, with consultant referrals actually declining by 5 per cent.

It is worth asking, of course, why referrals were allowed to grow in such an unfettered way in the first place. Was the increase in volume entirely justified by the 18 week target? But it is clear that primary care trusts can manage demand when required.

Last August, HSJ ventured the unfashionable opinion that the final round of world class commissioning scores suggested many PCTs were beginning to master their brief. The performance on outpatient referrals strengthens that view.

The National Quality Board declared this week that PCTs should prepare “legacy documents” to ensure effective knowledge transfer to commissioning consortia. The secret to effective demand management will form a key element of this handover.

Leaving these positive messages about PCT success will also help staff avoid the strong temptation to follow the example of former Treasury secretary Liam Byrne, who left a note to his successor saying: “I’m afraid to tell you there is no money. Kind regards and good luck!”