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KeywordsCommunity participation, public involvement, citizenship, governance, PCTs
IntroductionThis article examines the role the public can play in the "policy space" (King and Stoker, 1996) created by the shift from government to governance, using insights from research in two primary care groups/trusts (PCG/Ts). These organisations were inserted into an NHS said to be changing from its traditional monolithic, hierarchical form to a looser 2 network structure (Milburn, 2003) 1 . Burns et al (1994) have argued that the more pluralistic institutional environment created by the move from hierarchies of government to networks of governance, offers better possibilities for democratic involvement than traditional representative systems. They suggest that "an adequate democratic project must centre itself upon recognition of the need for a plurality of power bases, modes of expression and participatory forms" (p282). Plurality alone, however, seems likely to be insufficient to achieve the desired objectives. Research into public participation in primary care has previously identified a danger that "initial efforts to engage communities will become little more than token gestures" (Alborz, Wilkin and Smith, 2002, p26) In this article we suggest that an analysis founded solely in the democratic basis of legitimacy ignores other motivations for public involvement. We draw on Jessop"s account of heterarchy and Bang"s discussion of participation to identify a a range of 1 498 PCGs were established during 1998, as subcommittees of Health Authorities, to cover "natural communities" of 100,000 people. They had three main roles: to improve health; develop primary care; and commission secondary care. General Practitioners chaired their Boards and were numerically dominant, though nurses and social services were represented and there was also one lay member. PCGs were replaced by PCTs, freestanding bodies with their own budgets, a lay chair and a lay majority on the board.