title: The impact of pay-for-performance on professional boundaries in UK general practice: an ethnographic study.
abstract: The 2004 new General Medical Services (nGMS) contract exemplifies trends across the public services towards increased definition, measurement and regulation of professional work, with general practice income now largely dependent on the quality of care provided across a range of clinical and organisational indicators known collectively as the 'Quality and Outcomes Framework' (QOF). This paper reports an ethnographically based study of the impact of the new contract and the financial incentives contained within it on professional boundaries in UK general practice. The distribution of clinical and administrative work has changed significantly and there has been a new concentration of authority, with QOF decision making and monitoring being led by an internal QOF team of clinical and managerial staff who make the major practice-level decisions about QOF, monitor progress against targets, and intervene to resolve areas or indicators at risk of missing targets. General practitioners and nurses, however, appear to have accommodated these changes by re-creating long established narratives on professional boundaries and clinical hierarchies. This paper is concerned with the impact of these new arrangements on existing clinical hierarchies.
authors.affiliation: General Practice and Primary Care, University of Glasgow, Glasgow, UK. sg93f@clinmed.gla.ac.uk
authors.forename: Suzanne
authors.initials: S
authors.lastname: Grant
authors.forename: Guro
authors.initials: G
authors.lastname: Huby
authors.forename: Francis
authors.initials: F
authors.lastname: Watkins
authors.forename: Kath
authors.initials: K
authors.lastname: Checkland
authors.forename: Ruth
authors.initials: R
authors.lastname: McDonald
authors.forename: Huw
authors.initials: H
authors.lastname: Davies
authors.forename: Bruce
authors.initials: B
authors.lastname: Guthrie
mesh_terms: D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D006801:Humans; D009722:Nurse Practitioners / Q000706:statistics & numerical data; D010816:Physician Incentive Plans / Q000191:economics*; D010819:Physician's Role; D019555:Physician-Nurse Relations; D010821:Physicians, Family / Q000458:organization & administration* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D036301:Qualitative Research; D013637:Tape Recording / Q000706:statistics & numerical data; D006113:United Kingdom