The study Public health governance and primary care delivery: A triangulated study was carried out from 2007 to 2010 and funded by the National Institute for Health Research Service Delivery and Organisation public health research programme. The study adopted mixed methods, drawing together quantitative and qualitative analysis from a range of research activities. An initial exploratory phase involved one national and two regional focus groups across England, and mapping and scoping exercises, including reviews of economic perspectives on incentives, prioritisation tools, public health governance and performance management arrangements in force at the time, including targets, standards and incentives. Fieldwork was carried out in 10 case study sites across England, selected to reflect different levels of disadvantage, urban and rural areas, a range of population size and different levels of performance in relation to public health targets.

A total of 99 interviews were carried out between 2008 and 2010, in two phases, one year apart. Participants included primary care trust (PCT) chief executives, chairs and other non-executive directors, directors of commissioning, finance and public health; practice-based commissioning (PBC) leads; professional executive committee (PEC) chairs; chairs of local overview and scrutiny committees (OSCs) for health; voluntary and community sector (VCS) representatives on health and wellbeing partnerships of the local strategic partnership and chairs of the recently formed local involvement networks (LINks). Documentary analysis was also carried out for each site. In order to locate case study findings in a national context, a national survey of PCTs was sent to 508 individuals across 146/152 PCTs (some shared boards) with responses from 65% of PCTs. The report drew together findings from qualitative and quantitative studies from the different phases of research, locating fieldwork in a national context and interpreting data in a governance framework. A brief summary of case study snapshots is included below to provide a context for study findings.

Case study sites

Site 1: an ethnically and culturally diverse PCT with a population of over 250,000. Life expectancy was higher than the English average but rates of TB and diabetes were high, as was child poverty and homelessness. There was a high population turnover. The director of public health (DPH) was a joint appointment with the local authority and public health was well integrated into governance arrangements and strategic development.