Exploring the impact of clinical governance on the professional autonomy of general practitioners in a primary care trust in the North West of England

• Main Author: Hewitt, Janet
• Published: University of Sheffield 2006
• Subjects: 362.1
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.627739

Employing a single-site exploratory case study research methodology, this study seeks to paint a rich and detailed picture of managerial and professional perspectives of the impact of clinical governance on the professional autonomy and self-regulation of general practitioners (GPs) in a Primary Care Trust (referred to as the Utopian PCT), in the North West of England. The study defines clinical governance in the context of general practice; identifies the requirements for and barriers to its implementation; explores the role of GP Medical Advisers to the PCT and determines whether clinical governance is contributing to the deprofessionalisation (Haug 1973; 1975; 1977; 1988), proletarianisation (McKinlay and Arches 1985; McKinlay and Stoeckle 1988; McKinlay and Stoeckle 2002; Coburn 1992; Coburn et al 1997) or restratification of general practice (Fried son 1975; 1983; 1984; 1985; 1986). There are a small number of existing studies examining the impact of clinical governance on the professional autonomy and self-regulation ofGPs (SheafTet a12002; 2003; 2004; Locock et at 2004). This study focuses on the whole process of clinical governance whilst others focus on the implementation of National Service Frameworks. This is the only study employing a single-site exploratory case study methodology seeking to 'particularise' rather than to 'generalise' and to paint a rich and detailed picture of the 'human-side' of the Utopian peT and the associated general practices. Whilst never intending to be generalisable, the results of the study add to the growing body of evidence that the restratification of general practice has begun in England through GP Professional Representatives (referred to as GP Medical Advisers at Utopian PCT), employed in hybrid advisory/supervisory roles within PCTs. My study also supports Sheaff et aI's (2004) findings, suggesting that in the case of general practice, restratification does not divide the profession into separate occupational groups (Fried son 1984). Instead, knowledge management, supervision and general practice are different aspects of the same role (Sheaff et a12004; Courpasson 2000). The study demonstrates that despite the structural constraints imposed by clinical governance on general practice GPs are by no means helpless victims of government policy. Where possible they use clinical governance to their own advantage and to the advantage of their patients. They unenthusiastically implement those aspects of clinical governance they dislike but cannot avoid. The GPs participating in the study objected to what they perceived to be the managerial interference embodied in clinical governance and continued to adhere to a professional rather than a 'neo-bureaucratic' culture. The study suggests that in the future the new General Medical Services Contract (2004) will be influential in reinforcing the implementation of clinical governance in general practice.