The implementation of a local primary care incentive scheme: medical vs management priorities

Abstract

Treats GPs’ perceptions of their level of influence in designing the primary care development scheme as a litmus test of their professional involvement in driving NHS policy and whether a corporate role for e´lite practitioners affords increased influence over rank‐and‐file colleagues. Documenting medical involvement in policy formulation distinguishes the response of those GPs who perform a management role on the professional executive committee (PEC) from those concentrating on clinical practice. The research findings are based on the responses of a sample of 27 GPs who were interviewed across two PCT sites in northern England. A form of restratification was evident from the pattern of consultations with a select group of GPs who mediated policies. The attitudes of rank‐and‐file practitioners towards the e´lite stratum of GPs reinforced notions of a new division in general practice. Incentive scheme proposals may have been rejected in their entirety by rank‐and‐file GPs and medical representative bodies, had it not been for the intervention of PEC GPs who played a vital role in promoting acceptance of PCT policies. Yet PEC GPs also experienced a sense of disempowerment vis‐a`‐vis managers.