Contracting in the National Health Service (NHS): recognizing the need for co‐operation

Joslyn, Erica

doi:10.1046/j.1365-2834.1997.00112.x

Cited by 4 publications

(5 citation statements)

References 3 publications

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“…There were also fears that competition had forced down prices and quality (RCN 1996) and caused unnecessary turbulence which made universities reluctant to share good practice. This echoed the problems found in contracting in the NHS (Joslyn 1997).…”

Section: Literature Reviewmentioning

confidence: 86%

“…A key question was how close relationships should be if competition and a market were to thrive? Annandale (1995) suggested that there should be some distance, but this view was contested by those who believed there were more benefits to be had in partnership such as stability, improved quality and service development (Joslyn 1997, Council of Deans and Heads of UK University Facilities for Nursing, Midwifery and Heath Visiting 1998). Corbett (1998) asserted that NMET contracting with consortia represented ‘an interface for mutual exploitation and negotiation’ (p. 529) which should be developed.…”

Section: Literature Reviewmentioning

confidence: 99%

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Competition or collaboration - the tensions within the purchaser provider relationship in nurse education

Burke

2006

J Nurs Manag

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There are a number of key lessons that can be learned about the nature of the relationship between purchasers and providers and applied to contemporary health care. Notably: .the value of clear policy aims; .the importance of context and history in shaping the relationship; .the necessity of ensuring that individuals involved have the ability and commitment to make the relationship work; .the need to view the contracting relationship as a dynamic 'project' that must be worked on; .the value of sharing good practice.

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Section: Literature Reviewmentioning

confidence: 86%

Section: Literature Reviewmentioning

confidence: 99%

Competition or collaboration - the tensions within the purchaser provider relationship in nurse education

Burke

2006

J Nurs Manag

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“…Purchaser-provider splits can lead to a failure in continuity in management, which is essential in securing effective outcomes Joslyn (1997) 165 Long-term contracts improve efficiency Two types of asset specificity are important in health care: site specificity (buyer and seller located near to each other reduces transport costs) and dedicated assets (investments by the supplier that if the contract were terminated would result in spare capacity). A long-term contract increases the likelihood that the least-cost 'transaction-specific' investment will be made rather than the lower-risk, more generalised investment Dawson and Goddard (2011) 24 The more important asset specificity is in the transaction, the longer a duration of the contract is required, until vertical integration is the most efficient arrangement Goddard and Mannion (1998) 28 …”

Section: Factors Which Influence Contractual 'Success'mentioning

confidence: 99%

Contracting with General Dental Services: a mixed-methods study on factors influencing responses to contracts in English general dental practice

Harris

Perkins

Holt

et al. 2015

Health Serv Deliv Res

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BackgroundIndependent contractor status of NHS general dental practitioners (GDPs) and general medical practitioners (GMPs) has meant that both groups have commercial as well as professional identities. Their relationship with the state is governed by a NHS contract, the terms of which have been the focus of much negotiation and struggle in recent years. Previous study of dental contracting has taken a classical economics perspective, viewing practitioners’ behaviour as a fully rational search for contract loopholes. We apply institutional theory to this context for the first time, where individuals’ behaviour is understood as being influenced by wider institutional forces such as growing consumer demands, commercial pressures and challenges to medical professionalism. Practitioners hold values and beliefs, and carry out routines and practices which are consistent with the field’s institutional logics. By identifying institutional logics in the dental practice organisational field, we expose where tensions exist, helping to explain why contracting appears as a continual cycle of reform and resistance.AimsTo identify the factors which facilitate and hinder the use of contractual processes to manage and strategically develop General Dental Services, using a comparison with medical practice to highlight factors which are particular to NHS dental practice.MethodsFollowing a systematic review of health-care contracting theory and interviews with stakeholders, we undertook case studies of 16 dental and six medical practices. Case study data collection involved interviews, observation and documentary evidence; 120 interviews were undertaken in all. We tested and refined our findings using a questionnaire to GDPs and further interviews with commissioners.ResultsWe found that, for all three sets of actors (GDPs, GMPs, commissioners), multiple logics exist. These were interacting and sometimes in competition. We found an emergent logic of population health managerialism in dental practice, which is less compatible than the other dental practice logics of ownership responsibility, professional clinical values and entrepreneurialism. This was in contrast to medical practice, where we found a more ready acceptance of external accountability and notions of the delivery of ‘cost-effective’ care. Our quantitative work enabled us to refine and test our conceptualisations of dental practice logics. We identified that population health managerialism comprised both a logic of managerialism and a public goods logic, and that practitioners might be resistant to one and not the other. We also linked individual practitioners’ behaviour to wider institutional forces by showing that logics were predictive of responses to NHS dental contracts at the dental chair-side (the micro level), as well as predictive of approaches to wider contractual relationships with commissioners (the macro level).ConclusionsResponses to contracts can be shaped by environmental forces and not just determined at the level of the individual. In NHS medical practice, goals are more closely aligned with commissioning goals than in general dental practice. The optimal contractual agreement between GDPs and commissioners, therefore, will be one which aims at the ‘satisfactory’ rather than the ‘ideal’; and a ‘successful’ NHS dental contract is likely to be one where neither party promotes its self-interest above the other. Future work on opportunism in health care should widen its focus beyond the self-interest of providers and look at the contribution of contextual factors such as the relationship between the government and professional bodies, the role of the media, and providers’ social and professional networks.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Management writers also promoted the idea that as organisations become more complex, domain‐specific and esoteric, employees must participate in co‐ordinated decision‐making so that the old tension between professional autonomy and bureaucratic control will diminish (e.g. Cavanagh 1996; Joslyn 1997).…”

Section: The Career Of the Culture Conceptmentioning

confidence: 99%

Theorising culture and culture in context: institutional excellence and control

Beil-Hildebrand¹

2002

Nursing Inquiry

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In this paper an attempt is made to focus on the ideological and practical implications of the new cultural forms of healthcare sector management variously described as institutional excellence, empowerment, total quality and human resource management. Thus, I look in detail at the managerial and academic claims concerning the mobilisation of corporate culture and go on to emphasise the impact which the literature of culture management has had on nursing employees and healthcare organisations. I also highlight the restrictions of the applied research approaches and argue that the managerial and poststructural literature is limited in that its conceptualisation of culture and change is incomplete. The focus switches then to a range of literature which has been used to study change with a labour process perspective and explains why an approach based upon the study of the disparity between the cultural rhetoric and the day-to-day practice, as well as how people experience and respond to that disparity, is to be preferred. Furthermore, I gain substance from a variety of viewpoints in order to discover a suitable way of putting the matter of interest into context. Drawing on the analytical framework of the sector model, which differentiates in the economy between private and state production sectors, it is possible to distinguish between the different modes of rationality governing each sector. As a basis for further contextualisation, the powerful and privileged positions of nursing as well as other healthcare professionals and the distinctive character of their employment relationships are considered. The paper concludes that an extended labour process analysis is necessary to challenge the way in which the concept of culture is applied by nursing academics and practitioners.

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Contracting in the National Health Service (NHS): recognizing the need for co‐operation

Cited by 4 publications

References 3 publications

Competition or collaboration - the tensions within the purchaser provider relationship in nurse education

Competition or collaboration - the tensions within the purchaser provider relationship in nurse education

Contracting with General Dental Services: a mixed-methods study on factors influencing responses to contracts in English general dental practice

Theorising culture and culture in context: institutional excellence and control

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