Professional power and managerial control : the case of GP assessments of the over-75s.
The creation of Family Health Services Authorities from the old Family Practitioner Committees in 1990 marked a turning point in the introduction of managerialism into primary health care services.
One of the FHSAs'first responsibilities was the administration of a new contract for general practitioners, which had generated considerable opposition from within the profession.
This contract included a new requirement for GPs to make, each year, a written offer of a health check, at home, to all patients aged 75 and over.
Particular scepticism was expressed by GPs about the value and effectiveness of routine annual assessments of this kind.
Drawing on interviews with FHSA managers and their professional medical and nursing advisors, this paper examines the strategies adopted by the FHSAs in tackling the administration of this particularly controversial requirement.
Although apparently effective in the short term, the paper concludes that these strategies may have considerable longer-term short-comings.
The constraints and pressures experienced by FHSAs and the strategies employed to deal with them provide a useful insight into the tensions generated in the course of developing a managerial relationship with professional practitioners who have traditionally enjoyed very high levels of autonomy and independence.
Mots-clés Pascal : Vieillard, Examen, Gestion, Médecin généraliste, Médecin, Contrat, Contrôle, Royaume Uni, Administration, NHS, Réforme, Pouvoir médical
Mots-clés Pascal anglais : Elderly, Examination, Management, General practitioner, Physician, Contract, Check, United Kingdom, Administration, NHS, Reform, Doctor power
Notice produite par :
ENSP - Ecole nationale de la santé publique (devenue EHESP)
Cote : 94/12 V
Code Inist : 002B30A04D. Création : 09/06/1995.