The early days of primary care groups: general practitioners' perceptions.

摘要

English primary care is currently undergoing radical reform. Primary care groups (PCGs), effectively compulsory federations of general practices, came into legal existence in April 1999. This paper contains a review of general practitioners' (GPs') initial perceptions of the impact of these reforms on practice and considers the wider issue of changes in professional autonomy. A random sample of 49 GPs from two adjacent health districts in the North of England were interviewed as part of a longitudinal qualitative study. One round of interviews took place 7 to 9 months after the creation of PCGs and a further round of interviews was carried out 6 months later. We were interested in GPs' knowledge of recently formed (PCGs') plans and priorities, the impact of PCG activity to date, and the predicted future impact of such activity. After the published priorities of PCGs had been identified, thematic content analysis was used to ascertain GPs' perceptions of those priorities. GPs were generally unaware of their PCGs' published priorities. The wider strategic role of PCGs in commissioning services was rarely alluded to. Although over a third of GPs reported no current impact of the PCG, the majority expected PCGs to have considerable impact. In particular, control, management and accountability arrangements were all perceived as central issues in the expected developments. Performance management arrangements related to specific clinical priorities were widely expected. Although the new arrangements were inspiring little enthusiasm, the reforms did not appear to threaten GPs sufficiently enough to provoke active resistance.