What Changes When Incentives Change in Primary Medical Care, 2005-2006

<P>Abstract copyright UK Data Service and data collection copyright owner.</P><br>The new 2004 General Medical Services (GMS) contract for general practitioners (GPs) exemplified trends across the public services towards increasing definition, measurement and regulation of professional work. Significantly increased resources are now available, with up to one third of GPs' income now dependent on the quality of care they provide measured against 146 clinical and organisational indicators as measured by the Quality and Outcomes Framework (QOF). The central aim of this project was to examine how the organisation and culture of general medical practices both shape and constrain the effects of the 2004 GMS contract in terms of formal structure (contractual relationships between practice staff, and between practice and primary care trust), process (division of work among practice staff, and practice systems for delivering care) and culture (the renegotiation of professional identities and the division of labour, in the context of changing relationships between professions and the state).<br>
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The project comprised three key components. The first component involved focus group interviews with a range of primary care professionals in three Scottish health board areas in order to map a broad range of organisational responses to the new GMS contract. The second phase involved ethnographic case studies in two practices in one health board in order to contextualise these responses within particular organisational settings. The third phase of the study involved individual interviews with professionals working at health board level who have been involved in implementing the new contract in order to explore how the new contract has affected other quality improvement work at a regional level and their relationship with the general practices in the region. <br><br><B>Main Topics</B>:<BR><br>The dataset comprises qualitative interview transcripts, from three focus groups and 24 individual respondents, and participant observation notes from four primary health care general practice settings.<br>
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Topics covered in the interviews included role clarification and the GMS contract, changes to work in general practice, impact on job and changes to working relationships with primary care and social care professionals, and outstanding issues in general practice work.

本摘要版权归英国数据服务中心（UK Data Service）及数据集采集版权所有者所有。
2004年全新推出的全科医生（general practitioners, GPs）全科医疗服务（General Medical Services, GMS）合同，体现了公共服务领域中不断强化对专业工作进行明确界定、量化评估与规范监管的整体趋势。当前可支配资源已大幅提升，全科医生收入中最高可达三分之一与其提供的医疗服务质量挂钩，该质量需依据《质量与结果框架》（Quality and Outcomes Framework, QOF）设定的146项临床与组织管理指标进行评估。本项目的核心目标，是从正式结构（全科诊所员工间的合同关系，以及诊所与初级保健信托机构间的合同关系）、运行流程（诊所员工的工作分工与医疗服务提供体系）与组织文化（在职业与国家关系持续变革的背景下，职业身份的重新界定与劳动分工调整）三个维度，探究全科诊所的组织模式与文化氛围如何塑造并制约2004年GMS合同所产生的影响。

本项目包含三大核心组成部分。第一部分为焦点小组访谈：研究团队在苏格兰三个卫生管理局辖区内，对多名初级保健专业人员开展访谈，以此全面梳理各机构针对全新GMS合同所做出的各类组织层面应对举措。第二阶段为民族志个案研究：在某一卫生管理局辖区内的两家全科诊所开展研究，以将上述应对举措置于具体的组织场景中进行情境化分析。第三阶段为个人访谈：访谈对象为在卫生管理局层面参与推动新合同落地的专业人员，旨在探究新合同对区域层面其他质量提升工作产生的影响，以及其与辖区内全科诊所的协作关系。

【核心主题】：本数据集包含两类核心资料：一是来自3个焦点小组与24名受访个体的定性访谈转录文本，二是来自4家初级保健全科诊所的参与式观察记录。

访谈涉及的议题包括：岗位权责界定与GMS合同、全科诊所的工作变革、对从业者职业的影响、与初级保健及社会护理专业人员的工作关系调整，以及全科医疗工作中存在的突出问题。