Whither British general practice after the 2004 GMS contract?

Huby, Guro; Guthrie, Bruce; Grant, S.; Watkins, Francis; Checkland, Kath; McDonald, Ruth; Davies, Huw

doi:10.1108/14777260810862416

Cited by 9 publications

(1 citation statement)

References 16 publications

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“…In common with our ndings, extensive qualitative work in four GP practices in the UK found that QoF templates seemed to both de ne the nature of work required, but also act to discourage recording of information not deemed to be important to the 'process'. 21 Although general practice still promotes a de nition of its core values being around patient centred, holistic practice, evidence in the eld of chronic disease management related to QoF suggests a different reality. Evidence based medicine leading to centrally de ned guidelines and protocols has led to researchers concluding that QoF 'pays doctors to conform' in the care of patients with certain de ned health conditions, reinforcing a biomedical model of care.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Liver disease as new work in the context of protocolised primary care — do GPs have a role? A qualitative interview study

Jarvis,

Sanders,

Hanratty

2024

Br J Gen Pract

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BackgroundLiver disease is common, but not part of routine chronic disease management in primary care.AimThe aim of this study was to explore the challenges of implementing pathways of care for liver disease within existing highly protocolised structures in primary care.MethodSemi-structured interviews with 20 health professionals working in primary care. Interviews were informed by normalisation process theory (NPT) and boundary theory. Data were subject to thematic analysis.ResultsThree themes were identified relating to chronic disease work; definitions; need and worth, and roles. Participants identified that understanding and value of roles within chronic disease management were pre-defined by targets imposed on them as part of national incentives schemes. Structural boundaries constrained professional autonomy and the potential to influence this area of primary care management, including taking on new work.ConclusionThe inability to influence care decisions blurs occupational boundaries and goes to the core of what it means to be a professional. Unless liver disease sits within this target-based system, it is unlikely to become part of routine work in primary care.

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Section: Comparison With Existing Literaturementioning

confidence: 99%

Liver disease as new work in the context of protocolised primary care — do GPs have a role? A qualitative interview study

Jarvis,

Sanders,

Hanratty

2024

Br J Gen Pract

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Observation of interprofessional collaborative practice in primary care teams: An integrative literature review

Morgan

Pullon

McKinlay

2015

International Journal of Nursing Studies

315

219

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Discretion or discretions? Delineating professional discretion: The case of English medical practice

Cheraghi-Sohi¹,

Calnan²

2013

Social Science & Medicine

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There has much debate about the extent to which professional discretion has been challenged by recent organisational changes such as through the new forms of governance associated with the introduction of the principles of the New Public Management (NPM) into health systems and other public sector services. What appears to be missing from these debates is a detailed analysis of the concept of professional discretion itself. This paper attempts to fill this gap by delineating the key concepts of professional discretion evident in the literature and exploring their significance in an empirical study of the influence of the 2004 new general medical services contract (nGMS) and the introduction of the Quality and Outcomes Framework (QOF), a prescriptive pay-for-performance system designed to standardise the quality of care provision in general medical practice in the United Kingdom. The study adopted a longitudinal design using semi-structured interviews with general practitioners (GPs, N = 62) working in the English National Health Service (NHS) between 2007 and 2009. A multi-dimensional conception of discretion was used to explore how GP discretion might have been influenced by contractual changes and in particular, QOF. The findings suggest that through a complex interplay of factors, a post-QOF reduction in GP discretion was identifiable, highlighting different potential sources of constraint such as in the social, organisational and economic dimensions of discretion. The evidence also suggested the emergence of a new form of organisational medical professionalism within general practice characterised by standardisation, bureaucracy and performance management.

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Whither British general practice after the 2004 GMS contract?

Abstract: The paper highlights how collective "sensemaking" in practices may fail to detect and address key organisational consequences from the nGMS.

Cited by 9 publications

References 16 publications

Liver disease as new work in the context of protocolised primary care — do GPs have a role? A qualitative interview study

Liver disease as new work in the context of protocolised primary care — do GPs have a role? A qualitative interview study

Observation of interprofessional collaborative practice in primary care teams: An integrative literature review

Discretion or discretions? Delineating professional discretion: The case of English medical practice

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