Managing change in the community 1: the case of PCGs

Abstract

The government's White Paper The New NHS; Modern, Dependable (Department of Health, 1997) proposes a major change in the way primary care is organized and managed through the development of primary care groups (PCGs). It emphasizes that community nurses and GPs should work in partnership and play a lead role in both the strategic and operational levels of PCGs. Significant strategic change such as this can be a dynamic force for innovative and cooperative developments which enhance the community's health but it also threatens core occupational beliefs and values especially within multidisciplinary groups. Such threats to professional territories can create barriers to successful change as political manoeuvres and power relations are employed which aim to dominate the change agenda. This article discusses the major influencing factors in the change process and proposes models of implementation. It emphasizes that although participation and involvement of all parties is required for a successful outcome, this represents a significant challenge for community nurses to act as partners because of nursing's historical and enduring subordinate relationship with the medical profession.