期刊
SOCIOLOGY OF HEALTH & ILLNESS
卷 31, 期 2, 页码 229-245出版社
WILEY
DOI: 10.1111/j.1467-9566.2008.01129.x
关键词
general practice; primary care; quality and outcomes framework; professional boundaries; managerialism
资金
- Economic and Social Research Council (ESRC) Public Services Programme
- East of Scotland Primary Care Research Network (EastREN)
- National Primary Care Research and Development Centre (NPCRDC)
- Health Foundation
- Scottish Executive Health Department
- Economic and Social Research Council [RES-153-25-0043] Funding Source: researchfish
- National Institute for Health Research [CL-2006-06-008] Funding Source: researchfish
- Chief Scientist Office [CZF/2/16] Funding Source: researchfish
The 2004 new General Medical Services (nGMS) contract exemplifies trends across the public services towards increased definition, measurement and regulation of professional work, with general practice income now largely dependent on the quality of care provided across a range of clinical and organisational indicators known collectively as the 'Quality and Outcomes Framework' (QOF). This paper reports an ethnographically based study of the impact of the new contract and the financial incentives contained within it on professional boundaries in UK general practice. The distribution of clinical and administrative work has changed significantly and there has been a new concentration of authority, with QOF decision making and monitoring being led by an internal QOF team of clinical and managerial staff who make the major practice-level decisions about QOF, monitor progress against targets, and intervene to resolve areas or indicators at risk of missing targets. General practitioners and nurses, however, appear to have accommodated these changes by re-creating long established narratives on professional boundaries and clinical hierarchies. This paper is concerned with the impact of these new arrangements on existing clinical hierarchies.
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