Primary care trusts (PCTs) spend around 75 per cent of the NHS budget in England. How do they decide on their spending priorities? This paper examines the data collected by the Department of Health on the amounts PCTs spend on the 23 programmes of care based on medical conditions such as mental health, circulatory problems (including heart disease) and cancer. It also looks at changes in overall PCT spending between 2004/5 and 2006/7 and examines where the extra cash allocated to the NHS went. Fundamental differences are shown in PCT spending that are only partially explained by the different needs of local populations.