The Implementation of Priority Setting. GP Gatekeepers between Health Authorities and Health Care Users, 2008

The Norwegian health care system is increasingly dependent on the general practitioner (GP) gatekeeper function for cost containment and fair and effective resource allocation, and the same development is seen in many other countries with a gatekeeper system. The GP is expected to act as a rationing agent on behalf of society and to adhere to governmental guidelines for prescriptions and referrals. At the same time the power and rights of patients have been strengthened through several organisational and legal reforms encouraging the doctors to share decisions with patient. There is an inherent dilemma in this situation, which emerges in the GPs everyday role as gatekeeper. This calls for increased understanding of how GPs allocative decision making takes place between governmental control and user participation. This project explores the GPs gatekeeper role in two comparative settings (Norway and UK) to gain an understanding of how GPs balance considerations of professional autonomy with the demands of governmental control and user participation.To achieve this aim focus group interviews were conducted with GPs in Norway and the UK. In order to gain a picture of the present knowledge of GP adherence to guidelines in different countries, a systematic review of the qualitative literature on this subject were also carried out.