Perceptions of the impact of primary care organizations and the unified budget on GP prescribing: the iron fist in the velvet glove?

Prosser, H and Walley, T 2007, 'Perceptions of the impact of primary care organizations and the unified budget on GP prescribing: the iron fist in the velvet glove?' , Journal of Health Organization and Management, 21 (1) , pp. 5-26.

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Purpose: this qualitative study aims to examine key stakeholders' perspectives of primary care group/trust prescribing strategies. Within the context of general practice prescribing, the paper also debates the wider issue of whether GPs' prescribing autonomy is under threat from managerial expansion following recent organisational changes in primary care. Design/methodology/approach: data were obtained from focus groups and a series of individual semi-structured interviews with GPs and key primary care organisation stakeholders. Findings: the data underlie a tension between the managerial objective of cost-restraint and GPs' commitment to quality improvement and individual clinical patient management. In presenting both managerial and medical narratives, two divergent and often conflicting discourses emerge, which leads to speculation that managerial attempts to constrain prescribing autonomy will achieve only limited success. The contention is that GPs' discourse features as a challenge to a managerial discourse that reflects attempts to regulate, standardise and curtail clinical discretion. This is due not only to GPs' expressed hegemonic ideals that clinical practice centres on the interests of the individual patient, but also to the fact that the managerial discourse of evidence-based medicine encapsulates only a limited share of the knowledge that GPs draw on in decision making. However, while managers' discourse presented them as unwilling to impose change or directly challenge clinical practice, evidence also emerged to suggest that is not yet possible to be sufficiently convinced of the future retention of prescribing autonomy. On the other hand, the use of peer scrutiny posed an indirect managerial influence on prescribing, whilst the emergence of prescribing advisors as analysts of cost-effectiveness may threaten doctors' dominance of medical knowledge. Research limitations/implications: there is a continuing need to analyse the impact of the new managerial reforms on primary care prescribing. Originality/value: this study provides a snapshot of managerial and GP relations at a time of primary care transition.

Item Type: Article
Themes: Health and Wellbeing
Schools: Schools > School of Health and Society > Centre for Applied Research in Health, Welfare and Policy
Journal or Publication Title: Journal of Health Organization and Management
Publisher: Emerald
Refereed: Yes
ISSN: 1477-7266
Depositing User: H Prosser
Date Deposited: 05 Sep 2011 12:21
Last Modified: 16 Feb 2022 12:17

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