I keep hearing about NHS PCT here in the UK putting there own medium MOSS farms in, which means each one is designed by their own teams and differ. So the NHS is getting a mass of not only AD implementations but a mixture of 64 and 32 bit, of virtual and hardware, and each PCT is evolving its own governance.
After the utter failure of the Records system and SPINE I can imagine the NHS does not want to have a fully central IT roll-out of SharePoint, but that is not a good excuse for going the other way.
I think Whitehall should really think of promoting clubs of PCTs. These should be located near each other with common local issues and flows of staff, and be just large enough so that all the PCT can invest on a state of the art full DRed Data Centre taking advantage of Virtual, 64 bit and SAN while still preserving local control and giving cost savings.
The current PCT after PCT roll out is insuring that corners are being cut by the installers to insure profit and that no project ever has the resources to really be properly vetted and tested. PCT are both small and important so they need to find ways to reduce cost while becoming more agile and quality controlled.
SharePoint is an excellent start but having a PCT by PCT installation with different Gold Partner just insures that the PCT boxes won't match up and the partners will try to cut corners to insure profit.
Probably best if 4 or 5 PCT form together to create a Club to provide the MOSS infrastructure as SaaS than allow each PCT to run its own AD and governance.