From competition to collaboration in the delivery of health care: England and Scotland compared.

AIM: The purpose of this paper is to outline and critically appraise the NHS reforms that were operationalized in April 1999. DISCUSSION: 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. [ABSTRACT FROM AUTHOR]