title: Biomedicine, holism and general medical practice: responses to the 2004 General Practitioner contract.
abstract: In 2004 a new contract was introduced for General Practitioners in the UK, which introduced a significant element of 'pay-for-performance', including both clinical and organisational targets. The introduction of this contract has caused interest across the world, particularly amongst those responsible for commissioning primary care services. It can be argued that the clinical targets in the contract (known as the Quality and Outcomes Framework, QOF) represent a move towards a more biomedical model of health and illness, which is contrary to the ideal of providing holistic (or biopsychosocial) care that has been traditionally espoused by GPs. This paper reports results from two linked studies (in England and Scotland) investigating the early stages of the new contract. We describe the way in which four practices with different organisational approaches and espoused identities have all changed their practice structures, consultations and clinical care in response to QOF in ways which will result in patients receiving a more biomedical type of care. In spite of these observed changes, respondents continued to maintain discursive claims to holism. We discuss how this disconnection between rhetoric and reality can be maintained, and consider its implications for the future development of GPs' claims to a professional identity.
authors.affiliation: National Primary Care Research and Development Centre, University of Manchester, Manchester. k.checkland@btinternet.com
authors.forename: Kath
authors.initials: K
authors.lastname: Checkland
authors.forename: Stephen
authors.initials: S
authors.lastname: Harrison
authors.forename: Ruth
authors.initials: R
authors.lastname: McDonald
authors.forename: Suzanne
authors.initials: S
authors.lastname: Grant
authors.forename: Stephen
authors.initials: S
authors.lastname: Campbell
authors.forename: Bruce
authors.initials: B
authors.lastname: Guthrie
mesh_terms: D001291:Attitude of Health Personnel; D032982:Contracts; D004739:England; D018166:Health Care Reform / Q000191:economics / Q000379:methods; D006694:Holistic Health; D006801:Humans; D007407:Interviews as Topic; D009313:National Health Programs; D010819:Physician's Role; D010821:Physicians, Family / Q000191:economics / Q000523:psychology* / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards; D011787:Quality of Health Care / Q000191:economics; D012606:Scotland