Localization and Partnership in the 'New National Health Service': England and Scotland Compared

This article examines some important and interesting differences in the designs of the 'New NHS' in England and Scotland in respect of two common guiding imperatives – localization and partnership. In examining the view of key local stakeholders faced with introducing the changes, we contrast the generally more flexible and less prescriptive approach in Scotland. In England there was, initially, a raft of guidance from the centre: in Scotland, by contrast, there was virtually none. In England the prime bases for localization will be PCGs and PCTs: in Scotland they will be Local Health Care Co-operatives (LHCCs). The latter, like the English PCGs, are to be GP-led; but unlike PCGs, membership is voluntary. Underlying such redesign of the organizational architecture are some important changes in cultures and modes of governance. In particular, we note the rhetoric of a shift, at macro-level, from hierarchies and quasi-markets to networks and the perceived reality of a micro-level shift from individualism to collegiality amongst GPs.