Purchasing in markets and networks : the relationship between general practitioners and National Health Service Trusts
The GP purchasing role is considered in the light of two market policy objectives which are explored within the broader context of the nature of the purchase-provider relationship in terms of both its content and process. The two policy objectives, outlined in the Government's White Paper "Working for Patients" (Department of Health 1989), are that GPs would stimulate: (1) improved efficiencies in secondary care services; and (2) a transfer of resources from secondary to primary care. The study adopts a qualitative approach, gaining insight into purchasing relationships by way of interviews and non-participant observation, and by interpreting the data both inductively and deductively. Economic and social theories, in particular transactions cost theory and network theory, are used as a framework for the fieldwork and to inform the analysis and discussion. This thesis argues that GPs have fulfilled the two original market policy objectives of stimulating secondary care efficiencies and resource transfer from secondary to primary care. The means by which they have achieved this, however, is not via neoclassical contracts negotiated in a competitive market context, as market proponents envisaged, but through economically efficient, relational contracts within ideologically/culturally and socially embedded networks, for which the market policy has been a catalyst. These networks have developed at an inter-GP practice and at a purchase provider level, and are characterised by knowledge creation, innovation, learning, service (re)design, partnering and the pursuit of economic and social goals, in particular the enhancement of professional autonomy. The study affirms the need for a socio-economic perspective in organisational studies, and suggests directions for theory development and future research which can follow from this study and which will further understanding and analysis of network relations and of the NHS context in particular.