Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams

Grant, S., Ring, A., Gabbay, M., Guthrie, B., McLean, G., Mair, F. , Watt, G., Heaney, D. and O'Donnell, C. (2015) Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams. Sociology of Health and Illness, 37(1), pp. 30-51. (doi:10.1111/1467-9566.12175)

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Abstract

In the UK National Health Service, primary care organisation (PCO) managers have traditionally relied on the soft leadership of general practitioners based on professional self-regulation rather than direct managerial control. The 2004 general medical services contract (nGMS) represented a significant break from this arrangement by introducing new performance management mechanisms for PCO managers to measure and improve general practice work. This article examines the impact of nGMS on the governance of UK general practice by PCO managers through a qualitative analysis of data from an empirical study in four UK PCOs and eight general practices, drawing on Hood's four-part governance framework. Two hybrids emerged: (i) PCO managers emphasised a hybrid of oversight, competition (comptrol) and peer-based mutuality by granting increased support, guidance and autonomy to compliant practices; and (ii) practices emphasised a broad acceptance of increased PCO oversight of clinical work that incorporated a restratified elite of general practice clinical peers at both PCO and practice levels. Given the increased international focus on the quality, safety and efficiency in primary care, a key issue for PCOs and practices will be to achieve an effective, contextually appropriate balance between the counterposing governance mechanisms of peer-led mutuality and externally led comptrol.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mair, Professor Frances and O'Donnell, Professor Catherine and McLean, Dr Gary and Watt, Professor Graham
Authors: Grant, S., Ring, A., Gabbay, M., Guthrie, B., McLean, G., Mair, F., Watt, G., Heaney, D., and O'Donnell, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
Journal Name:Sociology of Health and Illness
Publisher:Wiley
ISSN:0141-9889
ISSN (Online):1467-9566

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