title: Competing and coexisting logics in the changing field of English general medical practice.
abstract: Recent reforms, which change incentive and accountability structures in the English National Health Service, can be conceptualised as trying to shift the dominant institutional logic in the field of primary medical care (general medical practice) away from medical professionalism towards a logic of "population based medicine". This paper draws on interviews with primary care doctors, conducted during 2007-2009 and 2011-2012. It contrasts the approach of active management of populations, in line with recent reforms with responses to patients with medically unexplained symptoms. Our data suggest that rather than one logic becoming dominant, different dimensions of organisational activity reflect different logics. Although some aspects of organisational life are relatively untouched by the reforms, this is not due to 'resistance' on the part of staff within these organisations to attempts to 'control' them. We suggest that a more helpful way of understanding the data is to see these different aspects of work as governed by different institutional logics.
authors.affiliation: University of Nottingham, Jubilee Campus, Nottingham NG8 1BB, United Kingdom. ruth.mcdonald@nottingham.ac.uk
authors.forename: Ruth
authors.initials: R
authors.lastname: McDonald
authors.forename: Sudeh
authors.initials: S
authors.lastname: Cheraghi-Sohi
authors.forename: Sara
authors.initials: S
authors.lastname: Bayes
authors.forename: Richard
authors.initials: R
authors.lastname: Morriss
authors.forename: Joe
authors.initials: J
authors.lastname: Kai
mesh_terms: D004739:England; D018166:Health Care Reform; D006801:Humans; D008128:Logic; D009313:National Health Programs; D058007:Physicians, Primary Care; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research
keywords: England; Health policy; Incentives; Institutional theory; Organisations; Primary care