Around 18 months after the Department of Health began outlining its vision for world class commissioning, we have the first tangible measure of how well primary care trusts have prepared.

Analysis by strategic health authorities of PCTs' plans for the coming year reveal a good number have made a promising start, in what was always going to be a difficult first attempt.

The traffic light system indicates roughly half of PCTs have got their boards in shape, while well over a third perform similarly well on financial management.

But the distance still to travel to achieve world class commissioning is immense. Well over half of PCTs revealed inadequate financial management and more than two thirds need to raise their game on the strategy.

Heightened impatience

The progress many PCTs have made has only heightened the sense of impatience in the Department of Health that, after all the policy debates, training days, strategy discussions, consultations, conferences and guidance, there are a small number of managers and PCTs who still appear to be a light year away from world class.

Any PCT suspected of serious failures in governance or financial management can expect rough treatment.

Ministers and SHAs are considering what action to take against the laggards. Nothing appears to be ruled out, which raises the spectre of the private sector taking over parts of a PCT's operations.

Meanwhile even the most effective PCT has months of intense work ahead. Implementing the strategy, improving systems and developing skills such as procurement and need assessment are all tough challenges. Deploying all this in a way which produces measurable improvements in health outcomes will be daunting.

But at least it will be easier than next year, when the DH tightens the performance screw a little more.

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