Health boards serving Scotland's two biggest cities are to press ahead with trust reconfiguration plans which run counter to the model set out in the government's Designed to Care white paper.
Both Lothian and Greater Glasgow health boards have rejected the idea of a single acute trust and a single primary care trust in each area. Lothian says it is bowing to public pressure - despite support for the model among doctors.
Lothian's plans - which will now go to ministers for approval - mean a reprieve for West Lothian trust, while in Glasgow, Yorkhill community and mental health trust will survive as a stand-alone trust 'for the time being'.
Lothian health board chair Margaret Ford admitted that most doctors, trusts and local authorities in Edinburgh supported the creation of two trusts.
But, she added, the board 'recognised the strong support' for the creation of a third trust in West Lothian 'from the general public, nurses and other NHS staff'.
A petition in support of the combined West Lothian trust, mounted by the West Lothian Courier, attracted 12,500 signatures. Local Labour MPs Robin Cook and Gavin Strang were also in favour of three trusts.
But more than 80 per cent of local GPs did not want three trusts, said Lothian local medical committee chair Sandy Sutherland.
West Lothian GP John Handley said political pressure had been put on the health board, which did not want to put forward the two-trust option because it would be overruled by the Scottish Office.
But he was mollified by the board's assurances that premises, computing and practice staff would be funded on a Lothian-wide basis.
It has also promised an independent evaluation after two years.
Although Greater Glasgow health board's proposals have always included two acute trusts - north and south of the river Clyde - the board has now also agreed to recommend that Yorkhill trust should also be retained.
'Our original plan to include Yorkhill in the primary care trust was felt by many to be premature,' said health board chief executive Chris Spry. 'For the time being retention of the trust would seem to offer the best alternative.'
But he added that this would depend on Yorkhill trust working with the primary care trust.
The board's proposal to create a south Glasgow university hospitals trust received almost 'a complete consensus', said Mr Spry. But there were still reservations about the creation of a north Glasgow university hospitals trust.
Health union Unison welcomed the Yorkhill reprieve but was worried about the size of the 'massive' north Glasgow trust - fears echoed by Glasgow health council chief officer Danny Crawford.