ABSTRACT
This chapter provides a localised analysis of the division of labour between hospital-based emergency services and those provided by general practitioners over the contested terrain of 'out-of-hours' services. During the 1990s the National Health Service (NHS) in the United Kingdom (UK) underwent significant restructuring as the Conservative Government of the time introduced radical changes in the ways in which services were delivered. The 1991 reforms to the NHS not only radically altered the mechanisms by which health care was delivered, but also created a new set of relationships between purchasers and providers of such services. Out-of-hours cover was a particularly interesting case, which demonstrated the limitations of the internal market. The chapter discusses three case studies that vary from competitive entrepreneurialism through to collaboration. Relations between GPs representatives and A&E staff and discussions on emergency provision were well established in the Greenshire case, whereas no such cooperation was reported between GPs and A&E staff in Goldington competitive model.
