Localization and partnership in the 'New National Health Service': Englandand Scotland compared

This article examines some important and interesting differences in the des igns of the 'New NHS' in England and Scotland in respect of two common guid ing imperatives - localization and partnership. In examining the view of ke y local stakeholders faced with introducing the changes, we contrast the ge nerally more flexible and less prescriptive approach in Scotland. In Englan d there was, initially, a raft of guidance from the centre: in Scotland, by contrast, there was virtually none. In England the prime bases for localiz ation will be PCGs and PCTs: in Scotland they will be Local Health Care Go- operatives (LHCCs). The latter, like the English PCGs, are to be GP-led; bu t unlike PCGs, membership is voluntary. Underlying such redesign of the org anizational architecture are some important changes in cultures and modes o f governance. In particular, we note the rhetoric of a shift, at macro-leve l, from hierarchies and quasi-markets to networks and the perceived reality of a microlevel shift from individualism to collegiality amongst GPs.