In 1997 the New Labour government instigated a period of radical reform for the National Health Service, a key element of which was the establishment across England of Primary Care Groups (PCGs), which subsequently became Primary Care Trusts (PCTs). These were local statutory governance bodies with responsibility to deliver and develop primary care and to improve the health of their local population: complex functions requiring collaboration with a range of organisations and agencies. The central aim of this study was to investigate whether and how PCG/Ts developed and facilitated collaboration within primary care, and between it and other NHS and non-NHS bodies, and to identify factors which enabled and inhibited collaboration. Using a theoretical framework which draws on a critical realist tradition, an approach was adopted to the analysis of organisational change which was attentive not only to rational, incremental processes of change but which took into account the political, cultural and economic context in which PCG/Ts operated. A key element of this context was the strong resemblance between New Labour's prominent `third way' discourse of collaboration and the defining characteristics of a network mode of governance: trust, loyalty, reciprocity and voluntariness. Inductive and deductive approaches were combined to test and develop theory about the interactions between context and organisational form, using multiple qualitative methods within a longitudinal nested case study. The study demonstrated that the locality-wide base of PCG/Ts, their explicit health improvement remit, budgetary arrangements and the presence of clinicians on their governing bodies were aspects of their organisational forms which equipped them to facilitate collaboration. However, over time, certain contradictions became apparent in New Labour's approach to organising the NHS which undermined many of the PCG/T's collaborative processes. This thesis argues that the alignment of the third way discourse with a network mode of governance exemplified 'symbolic politics. ' What was presented as a rational response to complex social problems and fragmentation of public services, was in fact largely a pragmatic political manoeuvre designed to distance itself from the perceived failure of previous administrations' hierarchy and market modes of governance.
Chisholm, A M
Faculty of Health and Life SciencesDepartment of Psychology, Social Work and Public Health
Year: 2007
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