Soft governance,restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams |
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| Authors: | Suzanne Grant Adele Ring Mark Gabbay Bruce Guthrie Gary McLean Frances S. Mair Graham Watt David Heaney Catherine O'Donnell |
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| Affiliation: | 1. Division of Population Health Sciences, Medical Research Institute, University of Dundee, UK;2. Department of Health Services Research, University of Liverpool, UK;3. General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK;4. Centre for Rural Health Research and Policy, University of Aberdeen, UK |
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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. |
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| Keywords: | general practice primary care performance management soft governance restratification professional autonomy |
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