Declining professional dominance?: Trends in the proletarianisation of primary care in New Zealand

This paper explores the relevance of the proletarianisation thesis to the emergence of new forms of managed primary care in New Zealand. This concern is of particular interest because the primary care sector has persisted virtually unchanged, since the birth of the welfare state in 1938, despite numerous past state attempts at reform. Since 1993 collective action on the part of general practitioners has resulted in the formation of Independent Practice Associations (IPAs). In terms of Light's (1993) idea of countervailing trends to proletarianisation, IPA development represents a pre-emptive strategy designed to prevent the introduction of the kind of managerialism imposed on the secondary sector where some loss of autonomy has been sustained by health care professionals. At the macro-level, therefore, there has been little change in GP autonomy although at the micro-scale there has been some loss of freedom as the development of IPAs ironically has meant that the degree of control by GPs over the content of their work has changed. The results suggest that the notion of the profession acting as a countervailing force has been borne out. Furthermore, the proposition inherent in modern organisation-environment relations literature, that organizations not only adapt to their environment but may actively seek to change it receives some support.