Abstract copyright UK Data Service and data collection copyright owner.

The new 2004 General Medical Services (GMS) contract for general practitioners (GPs) exemplified trends across the public services towards increasing definition, measurement and regulation of professional work. Significantly increased resources are now available, with up to one third of GPs' income now dependent on the quality of care they provide measured against 146 clinical and organisational indicators as measured by the Quality and Outcomes Framework (QOF). The central aim of this project was to examine how the organisation and culture of general medical practices both shape and constrain the effects of the 2004 GMS contract in terms of formal structure (contractual relationships between practice staff, and between practice and primary care trust), process (division of work among practice staff, and practice systems for delivering care) and culture (the renegotiation of professional identities and the division of labour, in the context of changing relationships between professions and the state). The project comprised three key components. The first component involved focus group interviews with a range of primary care professionals in three Scottish health board areas in order to map a broad range of organisational responses to the new GMS contract. The second phase involved ethnographic case studies in two practices in one health board in order to contextualise these responses within particular organisational settings. The third phase of the study involved individual interviews with professionals working at health board level who have been involved in implementing the new contract in order to explore how the new contract has affected other quality improvement work at a regional level and their relationship with the general practices in the region.

Main Topics:

The dataset comprises qualitative interview transcripts, from three focus groups and 24 individual respondents, and participant observation notes from four primary health care general practice settings. Topics covered in the interviews included role clarification and the GMS contract, changes to work in general practice, impact on job and changes to working relationships with primary care and social care professionals, and outstanding issues in general practice work.

Purposive selection/case studies

Face-to-face interview

Observation

Focus group