For society, state and self: juggling the logics of professionalism in general practice appraisal

Abstract

Sociologists repeatedly appeal to notions of altruism, bureaucratisation and self interest in their efforts to explain the changing place of the professions in contemporary society. We treat these three readings as 'institutional logics' key to understanding the way in which doctors respond to the appraisals system at the heart of the UK's approach to revalidation. Our analysis of a survey of 998 GPs working in Wales points to an altruistic commitment to learning and improvement, bureaucratic demands for the reporting of information and self-regarding resentment of changes in the occupational package provided by general practice. But the data also demonstrate that the maintenance of the appraisal regime is dependent on the preparedness and capacity of individual GPs to do micro-level institutional work on all these fronts.

The general practitioner workforce crisis in England: a qualitative study of how appraisal and revalidation are contributing to intentions to leave practice

“…Several comments linked appraisal and revalidation together as part of an increasingly intrusive, overarching performance management process that included other processes, such as Care Quality Commission (CQC) inspections. These were described as being part of an overall de-professionalisation of general practice that is being driven by political goals and suspicions, as has been discussed elsewhere [ 18 ].…”

“…GPs are known to have more positive attitudes towards appraisal that has local ownership, is educationally oriented, and where the GP feels they have more control over the process [ 18 ]. Hence, appraisal could offer a mechanism to provide support and direction which might help to delay retirement [ 4 ].…”

Policing the profession? Regulatory reform, restratification and the emergence of Responsible Officers as a new locus of power in UK medicine

“…Such an approach has previously been used successfully to develop theoretical contributions from existing empirical datasets ( Martin et al, 2015 ). Reporting qualitative survey data separately has also been demonstrated to be an effective way to explore views across a population of interest ( Dale et al, 2016 ) and as providing adequate data to support theory driven interpretations of professional activities ( Entwistle and Matthews, 2015 ). In this case, the high response rate overall resulted in broad coverage across a cohort little studied elsewhere, and provided sufficient content to support this exploratory analysis of the RO role.…”

In Service of the Society? Medical Associations as Agents of Social Change—Implications for Health Policy and Education in Israel

“…According to Parsons [21], the importance of professions, with a special emphasis on the medical profession, stems not so much from their intrinsic features but from their distinctive institutional framework. This approach is akin to Durkheim's conception of professions as a positive force, possessing the potential to unify and contribute to solidarity and the social order in an increasingly complex and fragmented modern society, and thus offering a benevolent portrayal of the medical profession [22][23][24].…”