From competition to collaboration in the delivery of health care: England and Scotland compared.
OBJECTIVE
The purpose of this paper is to outline and critically appraise the NHS reforms that were operationalized in April 1999.


CONCLUSIONS
The paper recognizes that there are important differences between England and Scotland in the design and implementation of change. Differences are discernible in terms of the organization of the commissioning role and of the acute hospital sector, but more significant differences are evident in terms of the nature and organization of primary care.


CONCLUSIONS
The paper concludes by indicating that a major challenge exists in the change management agenda with reference to primary care. Thus, while differences exist both north and south of the border, a shared feature is that the change management agenda in both England and Scotland is formidable. The main element of this challenge is that GPs have, in different ways, had to be drawn into the mainstream of the NHS.
Benson
L
L
Health Services Management, University of Bradford, 25 Trinity Road, Bradford BD5 0BB, UK. L.A.Benson@bradford.ac.uk
Bruce
A
A
Forbes
T
T
D003163:Competitive Behavior; D003299:Cooperative Behavior; D004739:England; D005194:Family Practice / Q000458:organization & administration; D018166:Health Care Reform / Q000458:organization & administration*; D006285:Health Planning / Q000458:organization & administration; D006302:Health Services Research; D006801:Humans; D007373:Interinstitutional Relations; D009936:Organizational Innovation; D011057:Politics; D011320:Primary Health Care / Q000458:organization & administration; D012606:Scotland; D013222:State Medicine / Q000458:organization & administration*