ABSTRACT
This chapter describes the organisational roles needed to achieve integrated primary health care, at the same time as dealing with the nuts and bolts of daily work that is, by its nature, reactive and short-term. Primary care trusts came into being in 2003 in England. In other parts of the UK they are called 'primary care organisations' (PCOs). The chapter highlights some of the obstacles to achieving integrated primary health care and the potential of PCO localities to overcome these. The obstacles include incompatible understandings of science, health and change, and until these are resolved different players will reluctantly co-exist rather than truly integrate. The relevance of the principles of organisational learning to quality general practice has long been recognised. Some primary care educationalists have systematically applied this understanding across whole areas. Learning is not the property solely of one person, but a 'socio-cultural progression from ''newcomer'' to ''old-timer'' '.
