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Primary care trusts lack the ability and incentives to meet the government's ambition to shift care out of acute settings into the community, a King's Fund report this week claimed.

The paper says that at several PCTs commissioning is too weak for them to invest in community services that prevent people from needing acute care, while targets for trusts set by strategic health authorities also emphasise the hospital sector.

The Department of Health's PCT reforms are designed to strengthen their commissioning by reducing their number, increasing their size, and curbing their role in provision.

But the report says the DH will have to reduce the emphasis on acute care in PCTs' performance regimes and invest in commissioning skills to achieve this result.

The Future of Primary Care from www.kingsfund.org.uk