Medicine and Management in English Primary Care: A Shifting Balance of Power?

Rod Sheaff*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

The English NHS has been repeatedly restructured since 1991. Drawing on multiple case studies in English primary health care from 1998 to 2005 and on (other) published studies, this article uses Therborn’s theory of power to make a framework analysis of how these reforms redistributed power between medicine and management in NHS primary care. Legal changes ended the GP monopoly of primary medical care provision and, with greater managerial discretion in NHS spending, allowed more diverse organisational forms of primary care provision to appear, although general practice remained predominant. Changes in managerial and professional ideologies relaxed the restrictions on managerial decisions about general practice. Re-negotiations between the medical profession and the state mostly tended to increase managerial power. Evidence-based medicine has tended to weaken the impersonal sources of medical power. On balance, these events have tended to increase managerial power over medical practice. They also suggest adjustments to Therborn’s conceptualisation of power.
Original languageEnglish
Pages (from-to)627-647
Number of pages0
JournalJournal of Social Policy
Volume38
Issue number4
DOIs
Publication statusPublished - 9 Sept 2009

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