The last 18 months has seen a process of PCTs streamlining their provider services, identifying the cost of the services and the benefits and risks of various models for future provision. 2009 will see most provider services taking the plunge. Some community foundation trusts will hopefully be authorised, an increasing number of provider services are now looking at social enterprise, at least for some services, and some smaller PCTs are looking at integration of different services with different providers by way of both vertical and horizontal integration. With legal separation, PCTs can more easily achieve some of the world class commissioning competencies without the concerns of conflict of interest issues and take a more robust stance to contracting.