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This paper affirms the importance of making connections between learning disability services and primary care groups/trusts, while acknowledging the challenges. Ideas for local action indicate the need for clarity about the roles of learning disability specialists and for determination to continue moving forward during organisational change.

In April 1999, 481 English Primary Care Groups (PCGs) were created. The National Primary Care Research and Development Centre is leading a three year longitudinal study, in conjunction with the King’s Fund, to track the development of PCGs. The implementation of clinical governance is an important responsibility of PCGs. This survey aimed to describe initial progress in implementing clinical governance in primary care, and to describe barriers to change. Data were collected in autumn 1999, using a questionnaire to clinical governance leads, in a random sample of 72 PCGs. PCGs have put considerable effort into the development of clinical governance and an extensive range of activities were planned for tracking quality of care. However, PCGs face barriers in implementing clinical governance and they must foster a culture of engaged participation by practices and practice staff. PCGs must also be given the time and resources needed to implement clinical governance.

This qualitative study aims to examine key stakeholders' perspectives of primary care group/trust prescribing strategies. Within the context of general practice prescribing, the paper also debates the wider issue of whether GPs' prescribing autonomy is under threat from managerial expansion following recent organisational changes in primary care.

Data were obtained from focus groups and a series of individual semi‐structured interviews with GPs and key primary care organisation stakeholders.

The data underlie a tension between the managerial objective of cost‐restraint and GPs' commitment to quality improvement and individual clinical patient management. In presenting both managerial and medical narratives, two divergent and often conflicting discourses emerge, which leads to speculation that managerial attempts to constrain prescribing autonomy will achieve only limited success. The contention is that GPs' discourse features as a challenge to a managerial discourse that reflects attempts to regulate, standardise and curtail clinical discretion. This is due not only to GPs' expressed hegemonic ideals that clinical practice centres on the interests of the individual patient, but also to the fact that the managerial discourse of evidence‐based medicine encapsulates only a limited share of the knowledge that GPs draw on in decision making. However, while managers' discourse presented them as unwilling to impose change or directly challenge clinical practice, evidence also emerged to suggest that is not yet possible to be sufficiently convinced of the future retention of prescribing autonomy. On the other hand, the use of peer scrutiny posed an indirect managerial influence on prescribing, whilst the emergence of prescribing advisors as analysts of cost‐effectiveness may threaten doctors' dominance of medical knowledge.

There is a continuing need to analyse the impact of the new managerial reforms on primary care prescribing.

This study provides a snapshot of managerial and GP relations at a time of primary care transition.

Primary care groups and trusts, social services and wider local authority departments are making good progress in developing partnerships in a rapidly changing policy environment. These partnerships are developing at different levels (strategic planning, operational service delivery), both with social services departments and with a wider range of local authority functions. This paper draws on the latest round of the three‐year national Tracker Survey of Primary Care Groups and Trusts. The partnerships developed by PCG/Ts are considerably broader than the original key collaboration required with local social services departments; this raises questions about the role of the social services representative on the PCG Board/PCT Executive Committee. Some of the traditional obstacles to partnerships ‐ particularly differences in organisational boundaries ‐ and the imperatives of national policy priorities are continuing to shape local collaborative activity.

Alcohol Concern decided to develop the service for several reasons. Primary care is the main contact people have with the health service ‐ in any year 70% of the population will visit their general practitioner (GP). This makes primary care an ideal setting in which to detect and identify hazardous and dependent drinkers. While people experiencing difficulties or ill health because of their drinking will not necessarily attend a specialist alcohol service, they will probably visit their GP. Problem drinkers are known to consult their GPs twice as often as the average patient, the most common complaints are gastrointestinal, psychiatric and accidents (Heather & Kaner, in press).

This paper explores the resistance strategies of organisations to unwanted changes. It is concerned with the way satellite organisations are created to provide a counter force to environmental disturbances such as changes introduced in the context of what has come to be called New Public Management. Its particular focus is with the attempt to develop and institutionalize external, “public” forms of resistance rather than undertake more internal, “private” forms. The specific empirical focus is general medical practice in the UK, where commissioning groups were formed as an alternative to GP fundholding. To help analyse this empirical detail we draw insights from Habermas’s model of society, organisational change theory and institutional theory. In the process the paper not only amplifies the empirical reactions of GP practices in the UK but also uses this empirical detail to develop the nature of this theoretical base by adding new dimensions concerning organisational resistance.

Supporting People was originally promoted as a way of shifting resources out of the confines of ‘special’ housing towards a more flexible approach focused on people. As far as older people were concerned, it spoke of the desirability of giving more, low‐intensity support and of the opportunity for health services to become involved in the commissioning. But detailed proposals have so far been more concerned with protecting the status quo than with innovation, and have emphasised ‘assessment’ rather than the empowerment of service users. Change could still happen through Supporting People, and the practical housing support services older people need could be provided through the agency of primary care groups or through an extension of Attendance Allowance. The article concludes by addressing the problem of finding a suitable labour force to give older people support in their homes, and the need for joined‐up thinking on earnings restrictions for families living on benefits.

In the absence of central guidance on the development of integrated primary care organisations, a diversity of models is emerging. This paper examines the management arrangements of Scottish local health care co‐operatives (LHCCs). A postal questionnaire survey of all 79 LHCCs was conducted. The response rate was 35 per cent. LHCCs set up management bodies and created workgroups. Stakeholder representation was not socially inclusive: attempts to engage patients and local communities were limited and need to be stepped up to increase responsiveness and accountability to local health care users. LHCCs were also vehicles for local ownership and control of health care provision. To facilitate co‐operation among participating practices, LHCCs need to focus on issues of leadership, organisation, and involvement in decision making. Finally, management expenditure per capita was comparable with that of other types of integrated primary care organisations.