Primary Care Trusts (PCTs) are single organisations that control a unified budget for delivering health care to  communities of around 100,000 people.  They are responsible for identifying and commissioning health care whilst being accountable to their Regional Strategic Health Authority.  PCTs nominally hold around 80% of the NHS budget, although much of their purchasing/ providing of services and spending is dictated by central government and associated bodies.

Their responsibilities include:

  • Assessing the health needs of all the people in their local area and developing an insight into the needs of their local community.

  • Commissioning the right services, for instance from GP practices, hospitals and dentists, to meet these needs.

  • Improving the overall health of their local communities.

  • Ensuring these services can be accessed by everyone who needs them.

  • Listening to patients’ views on services and acting on them.

  • Making sure that the organisations providing these services, including social care organisations, are working together effectively.

  • Carrying out an annual assessment of GP practices in their area.

South Gloucestershire Primary Care Trust is the commissioning body for Thornbury and surrounding localities. 

South Gloucestershire PCT area contains 30 GP Practices, 131 GPs, over 150 nurses and a total of 500 staff in primary care serving a population of nearly 250,000 people. The population is projected to rise to 290,000 by the year 2021 and is the fastest growing in the South West. The PCT annually spends over £143 million on commissioning and providing health services.

PCTs were established in England in 2002 following the merger and change from Primary Care Groups (PCGs), and eventually replaced the previous Health Authorities (e.g. Avon Health Authority). PCGs were founded in 1999 on the basis of enabling locally appropriate health services.  Following this period of proliferation of National Health Service administrative bodies, there now appears to be political will to change the cycle back to fewer and less locally based organisations by merging the existing PCTs back into larger structures not unlike ........ Health Authorities!  Some of these changes have undoubtedly resulted in considerable improvements to patient services, as well as better communication infrastructure within primary care. There have been an increase in NHS workforce numbers, both clinical and administrative. However, change is expensive, and these have all come at not inconsiderable cost - both to the beleaguered staff of the ever-changing organisational body, who are charged with delivering increasing services and medicines within stringent short-term budgetary restrictions, and to the British taxpayer. 

In May 2006, further national reorganisation and mergers of the PCT were announced. In the South West Region, 32 PCTs will become just 14. Locally, the two Bristol PCTs (Bristol North Teaching and Bristol South and West Teaching) will now form a single Bristol Teaching PCT, and although geographically South Gloucestershire PCT will remain intact, it is likely that there will be managerial changes which may impact local services. North Somerset, and Bath and North East Somerset will also stay. Elsewhere in the South West,  the remainder PCTs will be distilled down into the following:  Gloucestershire,  Swindon, Wiltshire, Dorset, Bournmouth and Poole Teaching, Somerset, Devon, Torbay Care Trust, Plymouth Teaching, and Corwall and Isles of Scilly. 

For a review on PCT mergers, try this British Medical Journal article by Kieran Walshe et al.

Link to South Gloucestershire PCT website


North Bristol NHS Trust is the biggest health trust in the South West Region and one of the largest in the country.  It was formed in April 1999 following the merger of the former Frenchay Healthcare NHS Trust and Southmead Health Services NHS Trust.

The Trust has specialist regional services including neurosciences, plastic surgery, orthopaedics, pathology and renal services for people living in the former Avon area, Gloucestershire, Somerset, Wiltshire and in some cases, further afield.  It provides other services, including maternity, paediatric, ENT and breast surgery for a local population of 500,000.

At Frenchay Hospital the specialist services include plastic surgery and burns, spinal surgery and neurosciences including neuro-surgery, neuropsychiatry and neurology.  At Southmead Hospital the specialist services include adult and paediatric urology, renal medicine, renal transplantation, infectious diseases and neonatal medicine.

Community services are used by a large number of health centres, health clinics and GP surgeries.  Services include district nursing, health visiting, treatment nursing, child and adolescent psychiatry, physiotherapy, speech therapy and family planning.

A programme of renovation of Southmead is in progress, with planned eventual transfer and centralisation of all acute and major services from the Frenchay to the Southmead site. This will involve temporarily moving more acute specialties to Frenchay (as Accident and Emergency has already done) while building work is in progress,  accompanied by a diversification of community services. Plans for a re-development of  Thornbury Hospital as part of this scheme are still presently on hold.

Link to North Bristol NHS Trust website

Since 2001, annual performance ratings have been published for NHS trusts , giving a rating  from zero to three stars.  A recent critique on the effectiveness of NHS targets, published in the British Medical Journal by Bevan and Hood (BMJ 2006 vol 332, p419-422) highlights the increased reported performance on key targets as a result of the star system. It also draws attention to the fact that in some cases data has been manipulated, and the perverse incentives that targets can create. 


In 2003-4, the 99 Health Authorities in England were finally abolished. Their old roles of purchasing (commissioning) and provision of in-patient, day-patient, out-patient hospital services and community services have been delegated down to the Primary Care Trusts.  To monitor the performance of local services and form the link to the Department of Health,  28 Strategic Health Authorities (SHAs) were formed,  each covering population of approximately 1-2 million. 

Avon, Gloucestershire and Wiltshire Strategic Health Authority are one of three SHAs covering the South West of England (the other two being Dorset & Somerset Strategic Health Authority, and  South West Peninsula Strategic Health Authority).

In May  2006, with mounting NHS deficits and bureaucratic cost-cutting urgently needed, the announcement came for the reduction and amalgamation of the SHAs by almost two-thirds from the 28 to ten.  On 1st July 2006, the Avon, Gloucestershire and Wiltshire SHA was incorporated into the South West SHA which stretches from Cornwall to the West Midlands. The changes are not too dissimilar in geographical terms to the old-style eight  Regional Health Authorities that were in existence prior to 1997, including the old South West Region. 

Under the Conservative-Liberal coalition voted into office in 2010, SHAs are planned to be replaced under a less political NHS.


Link to South West Strategic Health Authority website

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The Avon and Wiltshire Mental Health Partnership took its present form in April 2001 in order to provide specialist mental health services to people across Avon and Wiltshire. Its multi-professional teams include 
Psychiatrists, Psychologists Nurses, Healthcare assistants, Social Workers, and a wide range of therapists and support staff. Hospital sites include Barrow, Blackberry Hill and Southmead hospitals in Bristol. The local Community Mental Heath Team is based at The Elms, Gloucester Road in Thornbury. Referrals are made through the surgery.

Link to Avon and Wiltshire Mental Health Website

Last updated 16/6/10


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