Soft governance and attitudes to clinical quality in English general practice.
OBJECTIVE
English primary care organisations (primary care groups and trusts - PCGs, PCTs) were, and are, responsible for the quality of general practice but lack hierarchical structures and, frequently, contractual relationships through which to influence it. The theory of soft governance describes how managers can influence professional practice by other means. This study examines the hypothesis that PCG/Ts have used 'soft' clinical governance.


METHODS
Survey in 2000/01 of general practitioners' (GPs') attitudes, opinions and self-reported activity in six PCGs and six PCTs using a semi-structured mailed questionnaire. To assess how representative respondents were of English GPs generally, four questions from a national sample survey of English GPs were included and the results compared.


RESULTS
Responses were obtained from 437 (52%) GPs. They most often mentioned the technical aspects of clinical governance. Managerial, policy and resourcing implications were next most frequently mentioned, usually in unfavourable terms. Most GPs reported that their clinical practice had changed because of clinical governance activities, although nearly 40% also reported little difference in the quality of care provided. The National Service Framework for coronary heart disease influenced practice independently of PCG/T activities.


CONCLUSIONS
English primary care organisations are exercising soft governance (although not by that name) over some but not all aspects of GPs' clinical practice. However, this soft governance is complex, not easy to sustain and appears hard to extend beyond essentially clinical domains.
National Primary Research and Development Centre, Manchester University, Manchester, UK.
Rod
R
Sheaff
Bonnie
B
Sibbald
Stephen
S
Campbell
Martin
M
Roland
Martin
M
Marshall
Susan
S
Pickard
Linda
L
Gask
Anne
A
Rogers
Shirley
S
Halliwell
D001291:Attitude of Health Personnel; D003657:Decision Making; D004739:England; D005194:Family Practice / Q000592:standards*; D006801:Humans; D008485:Medical Audit / Q000458:organization & administration*; D010821:Physicians, Family / Q000523:psychology*; D011320:Primary Health Care / Q000592:standards*; D017009:Professional Autonomy; D036301:Qualitative Research; D013222:State Medicine / Q000458:organization & administration / Q000592:standards