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Welfare Reform on the Web (November 2009): National Health Service - primary and community care

Medicine and management in English primary care: a shifting balance of power?

R. Sheaff

Journal of Social Policy, vol. 38, 2009, p. 627-647

The English NHS has been repeatedly restructured since 1991. Drawing on multiple case studies in English primary healthcare from 1998 to 2005 and (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. Legal changes ended the GP monopoly of primary medical care provision and, combined with greater managerial discretion in NHS spending, allowed more diverse organisational forms of primary care provision to appear. Re-negotiations between the medical profession and the state mostly tended to increase managerial power. Evidence-based medicine has tended to weaken GP autonomy and authority.

Patients to rate GP surgeries 'like online hotel critics'

R. Smith

Daily Telegraph, Oct. 14th 2009, p. 10

Patients will be able to rate their GP practices online by answering a series of questions such as how easy it was to get through on the telephone, whether they could get an appointment when they needed one, and whether they were treated with dignity and respect. The system could mean that unpopular practices with poor ratings could lose patients to ones with better ratings.

'A potential fifth column': conflicts and struggles for control in the context of local NHS privatization

R. Aldred

Health, vol.13, 2009, p. 543-561

This article uses case study data to discuss how a new procurement policy (Local Improvement Finance Trust, or LIFT) in English primary care may affect GP's control over their work. LIFT, a series of 51 public-private partnerships, will enable over time a shift towards the corporate ownership of surgeries and the creation of polyclinics. This research explores the struggles over work autonomy and control within these new LIFT structures, as expressed by clinicians and managers in meetings and interviews.

Update on enquiry into Take Care Now and out-of-hours services

Care Quality Commission


A review of out-of-hours GP services has shown that the NHS is only scratching the surface when looking at their quality. The review follows the death of a patient due to being given an overdose of diamorphine by a foreign GP employed by Take Care Now. The report finds that the five NHS trusts that have used this company have not been monitoring the quality of the out-of-hours care they offer.

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