Grant Suzanne, Huby Guro, Watkins Francis, Checkland Kath, McDonald Ruth, Davies Huw, Guthrie Bruce
General Practice and Primary Care, University of Glasgow, Glasgow, UK.
Sociol Health Illn. 2009 Mar;31(2):229-45. doi: 10.1111/j.1467-9566.2008.01129.x. Epub 2008 Oct 2.
The 2004 new General Medical Services (nGMS) contract exemplifies trends across the public services towards increased definition, measurement and regulation of professional work, with general practice income now largely dependent on the quality of care provided across a range of clinical and organisational indicators known collectively as the 'Quality and Outcomes Framework' (QOF). This paper reports an ethnographically based study of the impact of the new contract and the financial incentives contained within it on professional boundaries in UK general practice. The distribution of clinical and administrative work has changed significantly and there has been a new concentration of authority, with QOF decision making and monitoring being led by an internal QOF team of clinical and managerial staff who make the major practice-level decisions about QOF, monitor progress against targets, and intervene to resolve areas or indicators at risk of missing targets. General practitioners and nurses, however, appear to have accommodated these changes by re-creating long established narratives on professional boundaries and clinical hierarchies. This paper is concerned with the impact of these new arrangements on existing clinical hierarchies.
2004年新的全科医疗服务（nGMS）合同体现了公共服务部门的一种趋势，即对专业工作的界定、衡量和监管不断加强，全科医疗的收入如今很大程度上取决于在一系列临床和组织指标方面所提供护理的质量，这些指标统称为“质量与结果框架”（QOF）。本文报告了一项基于人种志的研究，探讨新合同及其所含财务激励措施对英国全科医疗中专业界限的影响。临床和行政工作的分配发生了显著变化，权力出现了新的集中，QOF决策和监测由一个由临床和管理人员组成的内部QOF团队主导，该团队做出有关QOF的主要实践层面决策，监测目标进展情况，并进行干预以解决有未达目标风险的领域或指标。然而，全科医生和护士似乎通过重新构建关于专业界限和临床层级的长期既定说法来适应这些变化。本文关注的是这些新安排对现有临床层级的影响。
