Soft governance, restratification and the 2004 general medical services contract

the case of UK primary care organisations and general practice teams

Suzanne Grant (Corresponding Author), Adele Ring, Mark Gabbay, Bruce Guthrie, Gary Maclean, Frances S. Mair, Graham C. Watt, David Heaney, Catherine O'Donnell

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.
Original languageEnglish
Pages (from-to)30-51
Number of pages22
JournalSociology of Health & Illness
Volume37
Issue number1
Early online date20 Jan 2015
DOIs
Publication statusPublished - Jan 2015

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Contract Services
medical services
General Practice
Primary Health Care
Organizations
governance
manager
National Health Programs
General Practitioners
general practitioner
health service
elite
acceptance
autonomy
Safety
leadership
efficiency

Keywords

  • general practice
  • primary care
  • performance management
  • soft governance
  • restratification
  • professional autonomy

Cite this

Soft governance, restratification and the 2004 general medical services contract : the case of UK primary care organisations and general practice teams. / Grant, Suzanne (Corresponding Author); Ring, Adele; Gabbay, Mark; Guthrie, Bruce; Maclean, Gary; Mair, Frances S.; Watt, Graham C.; Heaney, David; O'Donnell, Catherine.

In: Sociology of Health & Illness, Vol. 37, No. 1, 01.2015, p. 30-51.

Research output: Contribution to journalArticle

Grant, Suzanne ; Ring, Adele ; Gabbay, Mark ; Guthrie, Bruce ; Maclean, Gary ; Mair, Frances S. ; Watt, Graham C. ; Heaney, David ; O'Donnell, Catherine. / Soft governance, restratification and the 2004 general medical services contract : the case of UK primary care organisations and general practice teams. In: Sociology of Health & Illness. 2015 ; Vol. 37, No. 1. pp. 30-51.
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