The development of English Primary Care Group governance. A scenario analysis

At present there is a policy vacuum about what English Primary Care Groups' (PCGs) governance will be when they develop into Primary Care Trusts (PCTs ). Draft legislation leaves many options open, so PCT governance is likely to 'emerge' as PCTs are created. It also remains uncertain how general prac titioners (GPs) will react to the formation of PCTs and how the UK governme nt will then respond in turn. A scenario analysis suggests three possible l ines of development. The base (likeliest) scenario predicts a mainly networ ked form of PCT governance. An alternative scenario is of PCT governance re sembling the former National Health Service internal market, A third scenar io predicts 'franchise model' PCTs employing some GPs and subcontracting ot hers. To different degrees all three scenarios predict that PCTs will retai n elements of networked governance. If it fails to make GPs as accountable to NHS management as the UK government wishes, networked governance may pro ve only a transitional stage before English PCTs adopt either quasi-market or hierarchical governance. Copyright (C) 1999 John Wiley & Sons, Ltd.