Managing to practice: managing to change? An exploration of general medical practitioners' orientations to work.

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Riggs, S.A., 1996. Managing to practice: managing to change? An exploration of general medical practitioners' orientations to work. PhD, Nottingham Trent University.

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Abstract

This study explores the managed change strategies that have affected general practitioners in England, and the NHS as a whole, since the turn of the century. Integral to the exploration is a discussion of the implementation of Working for Patients (Secretaries of State for Health, 1989a) and the ways in which general practitioners' experience, understand and make sense of this recent state-initiated managed change. A significant and novel focus of this investigation is the link between the broader historical and structural issues with individual interpretive ones.

There are four main parts to this thesis. In part I the origins, content and context of occupational and organisational change in general medical practice since the 1900s are explored and analysed. This historical and structural analysis develops Klein's (1989) general and influential work on the NHS. Themes and categories are identified, and comparisons and connections are made with wider NHS changes to improve our understanding of the occupational and organisational development of general medical practice. This analysis sets the context and historical foundations that help shape Working for Patients - the most recent governmental change to affect primary health care.

Part II presents the conceptual thinking which underlies the empirical investigative element of the study and considers the craft of researching. It is argued that individuals need to be placed at the centre of the inquiry to understand better organisational and occupational processes in which they are involved. The thesis as a whole adopts a reflexive style. It is here, however, that the processes undergone whilst forming and carrying out the investigation are discussed in some detail. The main issues that researchers face when conducting qualitative investigations are explored and addressed.

In part III, an exploration and analysis of how GPs account for the present health care situation is presented. Attention is given to how GPs make sense of their work and Working for Patients. GPs' sense-making rationales are guided by their orientations to work: how they derive meaning from their actual or possible attachment to an occupational group and their involvement in organisational activities. Tensions and dilemmas identified in the structural and historical analysis in part 1 are seen to manifest themselves in the talk of general practitioners today.

The thesis is concluded in part IV where the structural and micro analyses are brought together. In particular, tensions between occupational and administrative forms of control identified in the earlier parts are brought more sharply into focus. How individual GPs define and make sense of their work and Working for Patients, along with the analysis of conflicting principles of work control, is of great consequence in improving our understanding of these change processes.

Item Type:

Thesis

Creators:

Riggs, S.A.

Date:

1996

ISBN:

9781369313499

Identifiers: