Charles Webster’s definitive book on the early years of the National Health Service 1 gives a comprehensive overview of the advent of the NHS in terms of national policy formation and implementation, but the variations in experiences of the introduction of the NHS in different localities are only beginning to be explored systematically. These tend to focus on the regional hospital boards, the main administrative innovation of the new service and subject of reorganisation in 1974, and pay less attention to general practice and local authority provision. 2 , 3 The importance of a regional or local perspective is clear from John Pickstone’s work, showing how local concerns and initiatives produced a distinctive, innovative pattern of development of psychiatric units in district general hospitals in Manchester around 1950, ‘not in response to national policy but because of the way new regional decision-makers reacted to peculiar problems in the provision and staffing of mental health services.’ 4 At the same time he stresses the importance of long-term patterns in the development of health services ‘both generally and for features peculiar to the Manchester region’.