The new GP contract in English primary health care: an ethnographic study
International Journal of Public Sector Management
ISSN: 0951-3558
Article publication date: 23 January 2009
Abstract
Purpose
The purpose of this paper is to discuss the impact of contracts on general practise in the UK National Health Service. In particular, it is concerned with the response of practitioners to the apparent flexibilities offered in the new contract with its focus on outcomes rather than processes.
Design/methodology/approach
Ethnographic studies of two general practices, using non‐participant observation, documents and interviews with staff over a five‐month period.
Findings
Conclusions suggest that the new contracts, far from encouraging flexibility and responsiveness from general practitioners, have tended to strengthen bureaucratic forms in the way the contract is implemented.
Originality/value
The new contract has introduced greater clarity regarding roles and responsibilities within practises. At the same time, when operating in financially tight conditions, the contract can make rationing more explicit. Decisions are made not in accordance with the targets but in light of local pressures and constraints, causing tensions between primary and tertiary care.
Keywords
Citation
McDonald, R., Checkland, K. and Harrison, S. (2009), "The new GP contract in English primary health care: an ethnographic study", International Journal of Public Sector Management, Vol. 22 No. 1, pp. 21-34. https://doi.org/10.1108/09513550910922379
Publisher
:Emerald Group Publishing Limited
Copyright © 2009, Emerald Group Publishing Limited