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Case management was highly valued by patients and their carers, but there were few major differences in outcomes between Evercare and other models.

In many countries governments are recruiting the medical profession into a more active, transparent regulation of clinical practice. Consequently the medical profession adapts the ways it regulates itself and its relationship to health system managers changes. This paper uses empirical research in English Primary Care Groups (PCGs) and Primary Care Trusts (PCTs) to assess the value of Courpasson's concept of soft bureaucracy as a conceptualisation of these changes. Clinical governance in PCGs and PCTs displays important parallels with governance in soft bureaucracies, but the concept of soft bureaucracy requires modification to make it more applicable to general practice. In English primary care, governance over rank-and-file doctors is exercised by local professional leaders rather than general managers, harnessing their colleagues' perception of threats to professional autonomy and self-regulation rather than fears of competition as the means of 'soft coercion'.Keywords: Soft bureaucracy, primary care, professions, clinical governance, networks, England, NHS Professions and soft bureaucracyFor many years European governments have tried to collaborate with, indeed co-opt, professional networks as one means of managing public services and implementing public policy (Harrison and Dowswell 2002). Their strategy is to develop workable coalitions between general ( i.e. lay) managers and leaders of the profession, thereby minimising practitioner opposition but still maintaining the principles of general management (Thompson

BackgroundHaving a tax-funded and supposedly ‘National’ Health Service (NHS), one might assume that the UK is well-positioned to roll out eHealth innovations at scale. Yet, despite a strong policy push, the English NHS has been limited in the extent to which it has exploited the potential of eHealth.Main bodyThis paper considers a range of macro, meso and micro factors influencing eHealth innovation in the English NHS.ConclusionsWhile barriers to eHealth innovation exist at all scales, the fragmentation of the NHS is the most significant factor limiting adoption and diffusion. Rather than addressing problems of fragmentation, national policy seems to have intensified the digital divide. As the recently published NHS Long Term Plan places great emphasis on the role of digital transformation in helping health and care professionals communicate better and enabling people to access the care they need quickly and easily, the implications for the digital divide are likely to be significant for effectiveness, efficiency and equity.