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Competing and coexisting logics in the changing field of English general medical practice

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  • McDonald, Ruth
  • Cheraghi-Sohi, Sudeh
  • Bayes, Sara
  • Morriss, Richard
  • Kai, Joe

Abstract

Recent reforms, which change incentive and accountability structures in the English National Health Service, can be conceptualised as trying to shift the dominant institutional logic in the field of primary medical care (general medical practice) away from medical professionalism towards a logic of "population based medicine". This paper draws on interviews with primary care doctors, conducted during 2007–2009 and 2011–2012. It contrasts the approach of active management of populations, in line with recent reforms with responses to patients with medically unexplained symptoms. Our data suggest that rather than one logic becoming dominant, different dimensions of organisational activity reflect different logics. Although some aspects of organisational life are relatively untouched by the reforms, this is not due to ‘resistance’ on the part of staff within these organisations to attempts to ‘control’ them. We suggest that a more helpful way of understanding the data is to see these different aspects of work as governed by different institutional logics.

Suggested Citation

  • McDonald, Ruth & Cheraghi-Sohi, Sudeh & Bayes, Sara & Morriss, Richard & Kai, Joe, 2013. "Competing and coexisting logics in the changing field of English general medical practice," Social Science & Medicine, Elsevier, vol. 93(C), pages 47-54.
    • Handle: RePEc:eee:socmed:v:93:y:2013:i:c:p:47-54
    DOI: 10.1016/j.socscimed.2013.06.010
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    References listed on IDEAS

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    1. McDonald, Ruth & Checkland, Kath & Harrison, Stephen & Coleman, Anna, 2009. "Rethinking collegiality: Restratification in English general medical practice 2004-2008," Social Science & Medicine, Elsevier, vol. 68(7), pages 1199-1205, April.
    2. Tovey, Philip & Adams, Jon, 2001. "Primary care as intersecting social worlds," Social Science & Medicine, Elsevier, vol. 52(5), pages 695-706, March.
    3. McDonald, Ruth & Campbell, Stephen & Lester, Helen, 2009. "Practice nurses and the effects of the new general practitioner contract in the English National Health Service: The extension of a professional project?," Social Science & Medicine, Elsevier, vol. 68(7), pages 1206-1212, April.
    4. Sharon C. Bolton, 2004. "A Simple Matter of Control? NHS Hospital Nurses and New Management," Journal of Management Studies, Wiley Blackwell, vol. 41(2), pages 317-333, March.
    5. Royston Greenwood & Amalia Magán Díaz & Stan Xiao Li & José Céspedes Lorente, 2010. "The Multiplicity of Institutional Logics and the Heterogeneity of Organizational Responses," Organization Science, INFORMS, vol. 21(2), pages 521-539, April.
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    Cited by:

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    2. Lander, Bryn, 2016. "Boundary-spanning in academic healthcare organisations," Research Policy, Elsevier, vol. 45(8), pages 1524-1533.
    3. Daker-White, Gavin & Rogers, Anne & Kennedy, Anne & Blakeman, Thomas & Blickem, Christian & Chew-Graham, Carolyn, 2015. "Non-disclosure of chronic kidney disease in primary care and the limits of instrumental rationality in chronic illness self-management," Social Science & Medicine, Elsevier, vol. 131(C), pages 31-39.
    4. Bryce, Marie & Luscombe, Kayleigh & Boyd, Alan & Tazzyman, Abigail & Tredinnick-Rowe, John & Walshe, Kieran & Archer, Julian, 2018. "Policing the profession? Regulatory reform, restratification and the emergence of Responsible Officers as a new locus of power in UK medicine," Social Science & Medicine, Elsevier, vol. 213(C), pages 98-105.
    5. Johan Alvehus & Sanna Eklund & Gustaf Kastberg, 2020. "Organizing Professionalism – New Elites, Stratification and Division of Labor," Public Organization Review, Springer, vol. 20(1), pages 163-177, March.
    6. Toth, Federico, 2015. "Sovereigns under Siege. How the medical profession is changing in Italy," Social Science & Medicine, Elsevier, vol. 136, pages 128-134.
    7. Reindersma, Thomas & Fabbricotti, Isabelle & Ahaus, Kees & Bangma, Chris & Sülz, Sandra, 2024. "Inciting maintenance: Tiered institutional work during value-based payment reform in oncology," Social Science & Medicine, Elsevier, vol. 347(C).
    8. O’Riordan Chris, 2018. "Balancing altruism and self-interest: GP and patient implications," The Irish Journal of Management, Sciendo, vol. 37(1), pages 1-15.
    9. Spendlove, Zoey, 2018. "Medical revalidation as professional regulatory reform: Challenging the power of enforceable trust in the United Kingdom," Social Science & Medicine, Elsevier, vol. 205(C), pages 64-71.
    10. Norman, Armando H. & Russell, Andrew J. & Merli, Claudia, 2016. "The Quality and Outcomes Framework: Body commodification in UK general practice," Social Science & Medicine, Elsevier, vol. 170(C), pages 77-86.
    11. Llopis, Oscar & D’Este, Pablo, 2016. "Beneficiary contact and innovation: The relation between contact with patients and medical innovation under different institutional logics," Research Policy, Elsevier, vol. 45(8), pages 1512-1523.
    12. Fudge, Nina & Swinglehurst, Deborah, 2022. "Keeping in balance on the multimorbidity tightrope: A narrative analysis of older patients’ experiences of living with and managing multimorbidity," Social Science & Medicine, Elsevier, vol. 292(C).

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