The new NHS: an ethnographic case study of the role of professionals in policy reform

Clegg Smith, Katherine (2002) The new NHS: an ethnographic case study of the role of professionals in policy reform. PhD thesis, University of Nottingham.

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The National Health Service (NHS) holds an esteemed position within Britain's `welfare state'. Since its inception, however, it has been subject to near constant reforms, seemingly intended to balance public expectations with available resources. Successive governments have required professional collaboration to gain crucial popular support, and increasingly, general practitioners have been prioritised within reform initiatives.

Sociologists assert that professionals' reactions to reforms are often shaped by estimations of such reforms' influence on claims to professional status. Professionals react particularly defensively when they estimate that reforms challenge the foundation of status based on professional identity. Indeed, professions perceived as having `weaker' professional claims may engage more diligently with such defensive work, and general practitioners have been particularly virulent opponents to reforms.

I spent eighteen months conducting ethnographic research into the role of GPs in the implementation of the reform initiative, ‘The New NHS: modern, dependable' (1997). I explored the translation of policy ideas into `real' working structures, seeking to address a gap in the literature between considerations of the formulation of official policy rhetoric and evaluations of reform effectiveness. Data revealed `clinical governance' and `delegation of authority to local professionals' as key concepts in shaping local reform implementation. In particular, official policy rhetoric outlined initiatives as unproblematic, whereas the data illustrated their complexity.

Furthermore, contrary to expectation, interaction between GPs and the state was not overtly confrontational. Rather, local actors engaged multiple strategies seemingly intending to maintain locally formulated co-operation. Policy implementation was shaped more by efforts to protect existing local networks, than by professional efforts to defend against any one reform initiative. Professionals' engagement with policy objectives to protect their privileged status served to facilitate the operationalisation of ideas. The influence of particular local actors being such that they were often able to mould policies to serve their own agenda.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Dingwall, R.W.J.
Murphy, E.A.
Keywords: National Health Service, professional employees, physicians (General practice), medical policy, Great Britain
Subjects: R Medicine > RA Public aspects of medicine
Faculties/Schools: UK Campuses > Faculty of Social Sciences, Law and Education > School of Sociology and Social Policy
Item ID: 11754
Depositing User: EP, Services
Date Deposited: 14 Jan 2011 12:16
Last Modified: 16 Dec 2017 17:51

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