Sage Journals: Discover world-class research

Abstract

We take the 2004 contract between British general practitioners and the government as an example of dilemmas that confront all European health systems. The contract allowed doctors to withdraw from out-of-hours coverage, but enabled commercial providers to enter the primary care market. Our research suggests that the doctors underestimated the threat of commercialization posed by these new contracts. Only after the consequences of the reform became clear they took policy positions against the commercialization which was facilitated by the contract they had agreed. This case is an illustrative example of the way that wage bargaining partners in the health service become involved in the structural maintenance of the system as well as the pay and conditions of their members, with possible trade-offs between the two.

Keywords

health policy marketization primary care privatization professional associations trade unions

Get full access to this article

View all access options for this article.

References

Bach

Kolins Givan

(2008) Public service modernization and trade union reform: towards managerial led renewal. Public Administration 86(2): 523–539.

Blomqvist

(2004) The choice revolution: Privatization of Swedish welfare services in the 1990s. Social Policy and Administration 38(2): 139–155.

BMA (2007a) The Trade Union Role of the BMA in the National Health Service. Available at: http://www.bma.org.uk/about_bma/what_the_BMA_does/TUroleoftheBMANHS.jsp (accessed 10 February 2010).

BMA (2007b) A Rational Way Forward for the NHS in England. Available at: http://www.bma.org.uk/healthcare_policy/nhs_system_reform/rationalwayforward.jsp (accessed 3 February 2010).

BMA (2008) Towards a Model of Healthcare Delivery. Available at: http://www.bma.org.uk/healthcare_policy/nhs_system_reform/healthcare2008.jsp (accessed 3 February 2010).

BMA (2009a) BMA Campaign Wins Overwhelming Support. Available at: http://www.bma.org.uk/whats_on/annual_representative_meeting/arm09_monday/arm09bmanewsmonday03.jsp (accessed 3 February 2010).

BMA (2009b) General Practitioners Committee Annual Report 2009. Available at: http://www.bma.org.uk/about_bma/annual_reports/gpcannreport09.jsp (accessed 3 February 2010).

BMA (2010a) Chairman of the General Practitioners Committee Letter to all GPs in England. Available at: http://www.pulsetoday.co.uk/Journals/Medical/Pulse/2010_August_11/attachments/GPCwhitepaperletter.pdf (accessed 30 November 2010).

BMA (2010b) Equity and Excellence: Liberating the NHS; BMA Response. Available at: http://www.bma.org.uk/healthcare_policy/nhs_white_paper/whitepaperbmabriefingpaper.jsp (accessed 14 December 2010).

10.

BMA (2010c) Shaping Change: BMA’s Position on Future Development of the Proposed NHS Reforms. Available at: http://www.bma.org.uk/images/whitepaperbmabriefingdec2010_tcm41-202540.pdf (accessed 14 December 2010).

11.

Borkan

Eaton

Novillo-Ortiz

Rivero Corte

Jadad

(2010) Renewing primary care: Lessons learned from the Spanish health care system. Health Affairs 2(3): 1432–1441.

12.

Circle News (2010) More than 200 GP Surgeries Now Run by Private Companies. Available at: http://www.circlehealth.co.uk/2010-july (accessed 14 February 2011).

13.

Commonwealth Fund (2010) International Profiles of Health Care Systems. Available at: http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jun/International-Profiles-of-Health-Care-Systems.aspx (accessed 16 February 2011).

14.

Day

(2006) UK government accused of privatising the NHS. British Medical Journal 333(7558): 61.

15.

Department of Health (2000) The NHS Plan: A Plan for Investment, a Plan for Reform. London: Stationery Office.

16.

Department of Health (2008) Equitable Access to Primary Medical Care Services (EAPMC) programme. Available at: http://www.dh.gov.uk/en/Procurementandproposals/Procurement/ProcurementatPCTs/DH_080719 (accessed 5 July 2009).

17.

Department of Health (2010a) Equity and Excellence: Liberating the NHS. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117794.pdf (accessed 23 July 2010).

18.

Department of Health (2010b) Liberating the NHS: Commissioning for Patients. Available at: http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_117587 (accessed 23 July 2010).

19.

Ellis

(1979) The BMA as a trade union. British Medical Journal 284(6176): 1498–1499.

20.

Ellis

(1982) The BMA’s trade union structure – four years on. British Medical Journal 285(6334): 71–72.

21.

Ellis

(1984) Impact of the Trade Union Act 1984 on the BMA. British Medical Journal 289(6458): 1637–1638.

22.

Freeman

Frisina

(2010) Health care systems and the problems of classification. Journal of Comparative Policy Analysis 12(1–2): 163–178.

23.

Genschel

(1997) The dynamics of inertia: Institutional persistence and change in telecommunications and health care. Governance 10(1): 43–66.

24.

Gosden

Sibbald

Williams

Petchey

Leese

(2003) Paying doctors by salary: A controlled study of general practitioner behaviour in England. Health Policy 64(3): 415–423.

25.

Greer

(2008) Choosing paths in European Union health services policy: A political analysis of a critical juncture. Journal of European Social Policy 18(3): 219–231.

26.

Hassenteufel

Palier

(2007) Towards neo-Bismarckian health care states? Comparing health insurance reforms in Bismarckian welfare systems. Social Policy and Administration 41(6): 574–596.

27.

Heins

Pollock

Price

(2009) The commercialisation of GP services: A survey of APMS contracts and new GP ownership. British Journal of General Practice 59(567): 750–753.

28.

Hudson

Hwang

G-J

Kühner

(2008) Between ideas, interests and institutions: Analysing third way welfare reform programmes in Germany and the UK. Journal of Social Policy 37(2): 207–230.

29.

Kmietowicz

(2006) Doctors say no to more privatisation of NHS in England. British Medical Journal 333(7558): 61.

30.

Lane

J-E

(2000) New Public Management. London: Routledge.

31.

Leibfried

(2005) Social Policy: Left to the Judges and the Markets? In: Wallace

Wallace

Pollack

(eds) Policy-making in the European Union. 5th ed. Oxford: Oxford University Press, 243–278.

32.

Leu

Rutten

FFH

Brouwer

Matter

Rütschi

(2009) The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets. New York: Commonwealth Fund Publication 1220.

33.

NAO (National Audit Office) (2008) NHS Pay Modernisation: New Contracts for General Practice Services in England. London: The Stationery Office, HC 307 2007-2008.

34.

O’Dowd

(2006) BMA joins health unions in bid to change Labour policy. British Medical Journal 333(7571): 718.

35.

Pollock

(2004) NHS plc. London: Verso.

36.

Pollock

Price

Viebrock

Miller

Watt

(2007) The market in primary care. British Medical Journal 335(7618): 475–477.

37.

Review Body on Doctors’ and Dentists’ Remuneration (DDRB) (2009) Thirty-Eighth Report 2009. Cm 7579. London: Stationery Office.

38.

Schmidt

Gerber

Stock

(2009) What can we learn from German health incentive systems? British Medical Journal 339(3504): 725–728.

39.

Schoen

Helms

Folsom

(2009a) Harnessing Health Care Markets for the Public Interest: insights for US Health Reform from the German and Dutch Multipayer Systems. New York: Commonwealth Fund.

40.

Schoen

Osborn

Doty

Squires

Peugh

Applebaum

(2009b) A survey of primary care physicians in eleven countries, 2009: Perspectives on care, costs and experience. Health Affairs 28(6): 1171–1183.

41.

Sindberg Martinsen

(2005) Towards an internal health market with the European Court. West European Politics 28(5): 1035–1056.

42.

Sindberg Martinsen

(2007) EU for the Patients: Developments, Impacts, Challenges. Stockholm: SIEPS.

43.

Smith

(2003) The failures of two contracts. British Medical Journal 326(7399): 1097–1098.

44.

Wilsford

(1994) Path dependency, or why history makes it difficult but not impossible to reform health care systems in a big way. Journal of Public Policy 14(3): 285–309.

The role of wage bargaining partners in public sector reform: The case of primary care contracts

Abstract

Keywords

Get full access to this article

References