Joint Working: The Health Service Agenda

The purpose of this article is to examine the policy and practice of collaboration between health and local government from a health servicesperspective. Within this remit, the authors primarily focus on the area of primary care. Four key elements of the post-1997 policy context are discussed: the move from GP fund-holding to Primary Care Groups and Trusts (PCG/Ts); a shift from treating to preventing illness; a drive for implementation by central government; and an emphasis on collaboration. Within this broad context, there are a number of factors which may support enhanced collaboration: the size, scope, responsibilities and budgets of PCG/Ts may well provide an organisational framework which is supportive of joint working. However, the ‘Berlin Wall’ between health and social care has proved to be enduring, and there are aspects of the post-1997 policy context which will continue to inhibit effective joint working, in particular centrally designed performance management systems and the dominance by GPs of PCG/Ts.