Towards primary care groups: the development of local healthcare cooperatives in Scotland.

The plan for the NHS in Scotland mapped out in the white paper Designed to Care shares common values and goals with the plans for England and Wales. The organisational structures proposed to underpin Scotland’s strategy for the health service (box) are, however, substantively different from those proposed for England and Wales. Primary care trusts are new statutory organisations scheduled to go live in April 1999. Participation in local healthcare cooperatives (LHCCs) is voluntary. Designed to Care specified that primary care trusts will be funded by health boards and will include community health services, all mental health services, services for people with disabilities, and continuing care of elderly people as well primary care services based in general practice. There will no longer be commissioning in Scotland. Service development will be based on collaborative strategic planning between trusts and health boards. The abandonment of commissioning has left continuing uncertainty about general practitioners’ public health and strategic roles. Designed to Care recommended, but did not insist, that general practitioners should form new bodies called local healthcare cooperatives but gave no detailed vision of cooperatives’ role, function, or structure. Until recently the Scottish Office has deliberately kept central guidance to the minimum on the grounds that there should be opportunity to allow diversity in response to local circumstances; that collaborative working among general practitioner practices is at different stages of evolution in different parts of the country; and that it was inappropriate for detailed decisions on local structures to be taken until the primary care trusts could be involved. Recent planning guidance concentrated on the role of primary care trusts, but offered a vision for local healthcare cooperatives as “clinically led networks focused on improving services, quality, and standards” and “supported by the primary care trust.” The reconfiguration of existing trusts brought major change throughout the system, to be implemented within a short timescale. From the perspective of the Scottish Office, “A key issue has been to keep various parts of the system in step.” The NHS Management Executive explained that although it recognised that general practitioners wanted to grasp the opportunities offered, “in practice the primary care trusts of which local healthcare cooperatives are a part have to be involved in discussions.” This report focuses on the development of two contrasting local healthcare cooperatives within Lothian’s new primary care trust.