The Impact of Successive Neoliberal Policy Reforms Since 1980 on a Case Study Group of Doctors, Nurses and Managers in Primary Care Trusts (PCTs) in the National Health Service (NHS) in England

摘要

This study investigates the relations between doctors, nurses and managers in a primary care trust in South East England in an era of neoliberal reform since the 1980s. Using two concepts from the work of the cultural theorist Raymond Williams – ‘epochal’ analysis and ‘structures of feeling’ – the case study group is seen as an ‘occupational tripartite’ within a dynamic cultural totality. Using interpretive phenomenological analysis, interview data is examined and reveals aspects of tradition being used by both doctors and nurses in ways that tend towards organisational inertia and support existing dominant structures. Residual elements are employed by managers in an attempt to maintain their influence in the face of organisational change. The three groups are highly differentiated in their views and feelings, only agreeing on the difficulty of working together. The study suggests that any attempt to create more effective cooperation between the three groups needs to acknowledge and deal with the differences that exist between them rather than rely on the dominance of hybridized clinical and non-clinical roles.