Abstract
1. Julia Segar[1][1] 2. Kath Checkland[1][1] 3. Anna Coleman[1][1] 4. Imelda McDermott[1][1] 5. Stephen Harrison[1][1] 6. Stephen Peckham[2][2] 1. 1University of Manchester, UK 2. 2University of Kent, Canterbury, UK 1. Julia Segar, Centre for Primary Care, University of Manchester, 5th Floor, Williamson Building, Oxford Road, Manchester M13 9PL, UK. Email: julia.segar{at}manchester.ac.uk The English National Health Service (NHS) is undergoing significant reorganization following the 2012 Health and Social Care Act. Key to these changes is the shift of responsibility for commissioning services from Primary Care Trusts (PCTs) to general practitioners (GPs) working together in Clinical Commissioning Groups (CCGs). This article is based on an empirical study that examined the development of emerging CCGs in eight case studies across England between September 2011 and June 2012. The findings are based on interviews with GPs and managers, observations of meetings, and reading of related documents. Scott’s notion that institutions are constituted by three pillars—the regulative, normative, and cognitive–cultural—is explored here. This approach helps to understand the changing roles and identities of doctors and managers implicated by the present reforms. This article notes the far reaching changes in the regulative pillar and questions how these changes will affect the normative and cultural–cognitive pillars. [1]: #aff-1 [2]: #aff-2
Highlights
The Institution of the National Health Service (NHS)In July 2012, London hosted the Olympic Games and television viewers across the world tuned in to watch the opening ceremony
In terms of Scott’s three institutional pillars, it is clear that the regulative pillar of the NHS institution has undergone profound change. We argue that these changes call into question the normative and cultural scripts held by general practitioners (GPs) who must understand themselves as commissioners as well as providers of services
We focus on the experiences of GPs and managers as they came to terms with their new responsibilities, answering the following broad research question: “How are GP and managers adapting to their new responsibilities, and what issues are arising?”
Summary
The Institution of the NHSIn July 2012, London hosted the Olympic Games and television viewers across the world tuned in to watch the opening ceremony. Amid depictions of a selection of key moments in British history and cultural life was a tribute to the National Health Service (NHS). A newspaper headline later proclaimed, “Americans baffled by ‘left-wing tribute’ to free healthcare during Opening Ceremonies,” with a Los Angeles Time sports reporter, Diane Pucin commenting, “For the life of me, though, I am still baffled by NHS tribute at opening ceremonies. Danny Boyle, director of the ceremony, said, “He chose to feature it because ‘everyone is aware of how important the NHS is to everybody in this country’” (Stebner, 2012). The prominence of the sequence in the ceremony alongside references to important moments in the nation’s social history certainly suggests that the NHS is an institution sufficiently deeply embedded within Britain to contribute significant meaning to its society
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