The top tier of National Health Service management is being axed since the coalition wants NHS administrator costs to be slashed by almost half over the next four years. All primary care trusts (PCTs) will be gone in three years’ time in order to save billions from the NHS budget. Health Secretary Andrew Lansley refused to give any guarantee that PCT staff (including clinicians, managers and administrators) would find similar jobs in the new set-up, where managing care will be the responsibility of family doctors. Much of the work is expected to be contracted out by GPs.