The establishment of primary care trusts (PCTs) is a radical reorganization of the NHS. This paper examines primary care groups (PCGs) making an early change to trust status, comparing them with those adopting a longer timetable for the change. The data are derived from the National Tracker Survey of primary care groups and trusts (random sample of 72 PCGs, 15% of the 481 PCGs in England, and five purposively sampled early PCTs) conducted in 1999 and 2000. The main source of data consisted of interviews with Chief Officers (response rates: 1999, 100%; 2000, 97%). In total, 43% of PCGs had become PCTs by April 2001, and 90% expect to become PCTs by April 2002. Integration of primary and community health services, focusing on local needs and innovation in service development, were common reasons for wanting to become a PCT. These trusts were more likely to cite autonomy as a reason, and were also more likely to believe that they had the support of professional stakeholders, but a substantial minority reported that they did not have the active support of GPs and other primary care staff. Although early trusts had slightly more experience of GP-led commissioning, there was no evidence that they were performing better than later trusts in their core functions of developing primary care, improving quality and commissioning services. The rapid progress from PCGs to PCTs does not seem to reflect the process of developmental learning and building on experience initially envisaged by government. Evidence from earlier NHS reforms indicates that time taken to build capacity, develop relationships and secure stakeholder support is associated with success. There appears to be a tension between central control over the implementation of NHS reforms and the desire to devolve budgets and responsibilities to local level.