Community governance or corporate governance? Two models for primary care provision in England

This article discusses two models of primary care provision in England: a now-dominant corporate-led approach and a voluntary-led approach. Recent case study data are used to identify the differing implications of these contrasting ways of organizing care. The two approaches are examined with reference to claims that neoliberal welfare is characterized by a parallel shift from ‘passive’ to ‘active’ welfare, or from the citizen as recipient to the citizen as participant. In this analysis, the individualized, privatized self is encouraged by – and supports – a privatized welfare regime. By contrast, this paper finds that the increasingly hegemonic corporate-led model of welfare can actually inhibit the development of service users into active citizens. Instead, a voluntary-led model may be more flexible and more likely to promote welfare systems with citizen participation. However, the corporate-led model is increasingly favoured by the UK government, which is keen to include such firms in service planning as well as service provision. This creates a disjuncture between economics and governance that causes rhetorical and practical problems for neoliberal welfare regimes