Primary care groups and trusts: stages in a process of organizational evolution.

In this paper, the origins and early experiences of the new national network of primary care groups (PCGs) in the NHS are explored, emphasizing that they represent the latest stage in an evolutionary process in the development of primary care organizations. Using Greiner's five stages of organizational growth, an analysis is made of the development of PCGs and the future primary care trusts (PCTs). The author asserts that, having grown through creativity in the pre-1997 NHS, primary care organizations in the 'New NHS' are experiencing growth through direction, with a much greater degree of central control and management being brought to bear on PCGs. The likely future shape of PCGs and PCTs is then described, drawing on the analysis of PCGs within Greiner's framework for organizational growth. The paper concludes by setting out guidelines for managers and clinicians charged with the responsibility of developing PCGs and PCTs, based on the premise that these new organizational forms are not an end in themselves, but a stage in the organizational development of primary care in the NHS.