1.2 The formation of NHS trusts
Under the NHS and Community Care Act 1990, health care providers in the hospital and community sectors could for the first time bid to become self-governing trusts. Trusts are in principle free to develop their own management arrangements, to use their assets as they see fit, and to set terms and conditions for their staff. A first wave of 57 units was granted trust status in April 1991, and successive waves of successful applications in subsequent years meant that over 95 per cent of providers were trusts by 1996. Trusts bid for contracts with GP fund-holders and with health authorities to provide services for an area. They compete with directly managed units, with private and voluntary providers and with each other. They are still part of the NHS, accountable to the Secretary of State through outposts of the NHS Management Executive.
Primary Care Organisations (Trusts) have been established and are in the process of maturing their services and the ways in which they will work with the Acute Trusts to provide seamless care for patients.