Obtaining value from information technology (IT) is important for organizations to survive and flourish in the highly competitive economy of the 21 st century. Especially when that organization is the UK's National Health Service (NHS), to whom an heavy investmentfor IT improvement-of $7 bn is being injected to cope with pressures exerted within a more demanding population with constantly evolving healthcare needs. This paper explores the emergence of primary service provision (PSP) from

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... tives that span the macro-level of national health policies, the mezzo level of local strategies and the micro-level of IT procurement. These interrelations are studied at a greater depth within Case Study using the NHS. PSP is used in this paper as a sub-set of the application provision service (ASP) business model. In healthcare, the study of technology implications cannot be removed from an understanding of the processes of conceptualising, conceiving and using such technology. The authors argue the risk of falling into the trap of technological determinism or considering the impacts as a result of rationally planned actions guiding implementation of technologies. This research has shown there are thousands of hospitals, most doing different business processes in different ways thereby presenting an impossible task of successfully implementing a complex national project consisting of electronic patient records and booking systems. This study of PSP processes does not clearly show how and by whom the meanings of PSP are created, whose interests are voiced and taken into account, what are the overriding aims expressed by ASP vendors and what ethical concerns guide these developments being spearheaded by the NHS Information Authority.