The 'self-organising system' as a model for primary health care - can local autonomy and centralisation co-exist?

Peter Pritchard


A balance is needed between central control of primary care and local autonomy. The aim should be to maximise local autonomy but conform to central policies and guidelines where appropriate. The British NHS has mistakenly tried to exercise strict control of professionals ('centralised micromanagement') and this has seriously eroded mutual trust and innovation. Self-organising systems involve circular processes that exist widely in nature, and primary care has the potential to be much more autonomous if feedback loops are developed at local level. This paper describes and discusses ways of enhancing self-organising and learning in primary care, in which new and emerging information technology will play a major part.


local autonomy; primary care; self-organising system

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