This paper presents a critical evaluation of a GP referral process within Scotland, focusing on national policy development and the theoretical and practical implications of such schemes for local communities. Findings are based upon a case study of the Scottish Borders’ GP Referral Scheme (GPERS) through a series of semi-structured interviews with participating GP practices, senior leisure and facilities’ management. Additionally, the paper draws on earlier quantitative research by the authors of all GP referral schemes within Scottish local government and utilizes national policy and strategic documentation on the general process of exercise/activity referral. It argues that the policy partnerships and alliances, advocated by central government to promote healthy public policy and a best value regime, are rhetorically admirable but naïvely neglect local realities. This study indicates that without pragmatic national-local recognition and support, integrated policy will remain an area of fragmentation and contention.