Checkland Kath
National Primary Care Research and Development Centre, University of Manchester, Manchester, UK.
Br J Gen Pract. 2004 Oct;54(507):734-9.
Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these.
To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract.
In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract.
Three general practices in England, chosen using purposeful sampling.
Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents.
Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance.
The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the management of performance in this role.
一般医疗业务中的管理人员扮演着多种角色，从纯粹的行政工作到高层战略规划。很少有研究详细调查他们如何履行这些角色以及所遇到的问题。新的全科医疗服务（GMS）合同带来了新的管理挑战，目前尚不清楚各医疗业务机构将如何应对这些挑战。
增进对一般医疗业务中管理人员所扮演角色的理解，并考虑这对新GMS合同实施的影响。
涵盖赞成新GMS合同投票前后时期的深入定性案例研究。
在英格兰通过目的抽样选取的三家全科医疗业务机构。
对每家机构的所有临床和管理人员进行半结构化访谈、参与式和非参与式观察以及文件审查。
对于一般医疗业务中管理人员的合法角色构成，各机构内部以及不同机构之间的理解存在差异。在本研究中，那些聘请管理人员在战略层面工作并为组织方向提供意见的机构，在实践中遇到了重大问题。这些问题包括对管理人员合法角色的界定不明确、在合伙关系背景下管理人员的权威问题以及他们开展高层工作的时间不足。此外，全科医生（GP）对管理其管理人员绩效的能力缺乏信心。
新的GMS合同将对医疗业务管理提出重大要求。这些结果表明，不能简单地认为聘请具有高级技能的管理人员就能满足这些要求；首先必须明确管理人员应该做什么，并且必须关注此类管理人员的合法性、其权威的限度以及该角色的绩效管理等问题。
