During the early 1990s, community mental health nurses (CPNs) based in Wirral decided to actively negotiate with GP fundholders in order to raise their own profile and aim for greater professional independence, rather than accept the more traditional ways of working, e.g. accepting consultant only referrals. The CPNs became an increasingly potent force in the purchasing arena; many negotiations focused on practices having named CPNs who were practice-attached, running independent psychological clinics. Some fundholders actually refused to sign up with acute provider Trusts until the named individuals were identified.