A realistic evaluation of practice-based commissioning

Abstract

The tendency of governments to recycle policy from previous periods presents analysts with the opportunity of assessing their likelihood of success in new time periods. This article presents a theoretical and empirical contribution toward this goal. Its theoretical contribution utilises the work of Pawson and Archer by exploring how context from previous and current periods can be compared and separated from generic policy mechanisms that underpin reforms in order to be able to show how outcomes from the past might be reproduced or transformed in current policy. Its empirical contribution applies this framework to the case of GP fundholding from the 1990s and practice-based commissioning of the 2000s, to show how the latter policy both addresses the difficulties of its predecessor but also makes significant errors that jeopardise its potential for success.

Cutting the Cord: Mutual Respect, Organizational Autonomy, and Independence in Organizational Separation Processes

“…For instance, the majority of local NHS management agencies continued to provide community care services-including health visits and care for housebound patients-themselves, via their own community care units that employed nurses, pediatricians, social workers, and members of many other occupations. Moreover, general practitioners (GPs or family doctors), who as ''primary carers'' refer patients to hospitals and community services for particular forms of treatment, were represented on their local management agency's board and worked together with managers to plan, redesign, and monitor local healthcare services (Greener and Mannion, 2009).…”

A full blooded market system: at what cost to the NHS?

“…This reform had certain advantages-exerting downward pressure on secondary care admissions for elective surgery-although most studies noted that high transaction costs also increased. 10 Similar conclusions apply to the payment by results funding regime introduced in 2002. Giorgia Marini and Andrew Street, for example, find that the shift from block to activity based funding was associated with higher costs for primary care trusts, associated with "volume control of data collection, contract monitoring, and contract enforcement."…”

Bringing critical realism to nursing practice: Roy Bhaskar's contribution

“…Realist methodology reflects the open system perspective of realists, where the world may be more complex and less predictable, as a ‘constellation of interconnected structures, mechanisms and contexts’ (Kazi, : 5), and how people themselves can influence the success or failure of any given programme (Timmins & Miller, ). Realist methodology is theory‐driven (Greener & Mannion, ) and is focused on uncovering programme mechanisms through a process of unravelling what are unobservable but plausible components. Pawson (): 472 explained the theory‐testing philosophy of evaluation which ‘seeks to discover whether programmes work; programmes are theories.…”