Whither British general practice after the 2004 GMS contract? Stories and realities of change in four UK general practices.
OBJECTIVE
The purpose of this article is to provide answers to two questions: what has been the impact of nGMS on practice organisation and teamwork; and how do general practice staff perceive the impact?


METHODS
The article is based on comparative in-depth case studies of four UK practices.


RESULTS
There was a discrepancy between changes observed and the way practice staff described the impact of the contract. Similar patterns of organisational change were apparent in all practices. Decision-making became concentrated in fewer hands. Formally or informally constituted "elite" multidisciplinary groups monitored and controlled colleagues' behaviour for maximum performance and remuneration. This convergence of organisational form was not reflected in the dominant "story" each practice constructed about its unique ethos and style. The "stories" also failed to detect negative consequences to the practice flowing from its adaptation to the contract.


CONCLUSIONS
The paper highlights how collective "sensemaking" in practices may fail to detect and address key organisational consequences from the nGMS.
Huby
Guro
G
School of Health in Social Science, University of Edinburgh, Edinburgh, UK. guro.huby@ed.ac.uk
Guthrie
Bruce
B
Grant
Suzanne
S
Watkins
Francis
F
Checkland
Kath
K
McDonald
Ruth
R
Davies
Huw
H
D003284:Contract Services / Q000458:organization & administration*; D003659:Decision Making, Organizational; D005194:Family Practice / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D007324:Institutional Management Teams; D019982:Organizational Case Studies; D009936:Organizational Innovation; D011216:Practice Management, Medical; D011635:Public Health Administration; D013222:State Medicine / Q000458:organization & administration*; D017749:Total Quality Management; D006113:United Kingdom; D000078329:Workforce