Kath Checkland
Dados Biográficos
| ID | 253066 |
|---|---|
| NOME | Kath Checkland |
| PRENOMES | Kath |
| SOBRENOME | Checkland |
| ASSINATURA | CHECKLAND K |
| AFILIAÇÕES | University of Manchester |
| ORCID | 0000-0002-9961-5317 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 43 |
| TOTAL DE CITAÇÕES | 182 |
| TOTAL COMO AUTOR | 43 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 2004 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2026 |
| ÍNDICE H | 9 |
Accountability displacement in health systems integration
Governing complex public services increasingly requires coordination across multiple organisations, yet the collaborative arrangements intended to achieve this create new governance and accountability challenges. In England, the National Health Service (NHS) has pursued successive reforms to better integrate the planning and delivery of health and care. The most recent Health and Care Act 2022 aimed to strengthen horizontal accountability mechani…
Empowerment or responsibilisation
In many well-developed primary care systems patients increasingly receive care from multiple clinicians within networks of providers rather than a single general practice clinician. This makes formal coordination between clinicians and providers necessary and requires informal 'articulation work' from both clinicians and patients to organise coordination of tasks across episodes of care. This is often hidden 'behind the scenes'. We used qualitati…
Employment models for general practitioners in england
BACKGROUND: Recruitment and retention of General Practitioners (GPs) is a global challenge in primary care. Traditionally, GPs in the UK have worked as self-employed partners. However, policy changes in England have allowed for salaried GP positions within primary care partnerships. The effects of these different employment models on recruitment and retention remain unclear. OBJECTIVE: This study investigates the impact of partnership vs. salarie…
Understanding and supporting change in health systems using the strategic action fields framework
Policy-driven change in public service systems is difficult to implement. We focus upon ‘sources of authority’, which figure within the Strategic Action Fields Framework (SAFF) as resources mobilized by socially skilled actors to catalyse and sustain change. Drawing on qualitative case studies evaluating a large-scale policy-driven change in the English NHS, the Vanguard New Care Models programme, we (1) expand the definitions of ‘sources of auth…
Investigating the impact of primary care networks on continuity of care in English general practice
INTRODUCTION: In England, primary care networks (PCNs) offer opportunities to improve access to and sustainability of general practice through collaboration between groups of practices to provide care with a broader range of practitioner roles. However, there are concerns that these changes may undermine continuity of care. Our study investigates what the organisational shift to PCNs means for continuity of care. METHODS: The paper uses thematic …
The hidden work of general practitioners
High quality primary care is a foundational element of effective health services. Internationally, primary care physicians (general practitioners (GPs), family doctors) are experiencing significant workload pressures. How non-patient-facing work contributes to these pressures and what constitutes this work is poorly understood and often unrecognised and undervalued by patients, policy makers, and even clinicians engaged in it. This paper examines…
Unpromising Futures
Over the past few decades, the intensification and reorganisation of work have led to growing precarity, insecurity and uncertainty for employees, affecting even professionals tied to traditionally model employers. Doctors, in particular, have seen substantial changes to their work: having to work harder, longer and more intensely with reductions in expected autonomy, deference and respect. This article focuses on how early-career GPs make sense …
Evaluating primary care networks in low-income and lower middle-income countries
INTRODUCTION: Primary care networks (PCNs) are claimed to be an effective model to organise and deliver primary healthcare through collaborative relationships and effective coordination of primary care activities. Though increasingly implemented in different contexts, there is limited evidence on the effectiveness of PCNs in low-income and lower middle-income countries (LLMICs). OBJECTIVE: Our scoping review aims to understand how PCNs in LLMICs …
‘Real-world’ priority setting for service improvement in English primary care
This article develops an analysis of population-level priority setting informed by Bevir's decentred theory of governance and drawing on a qualitative study of priority setting for service improvement conducted in the complex multi-layered governance context of English primary care. We show how powerful actors, operating at the meso-level, utilize pluralistic and contradictory elements of complex governance networks to discursively construct, leg…
Is bureaucracy being busted in research ethics and governance for health services research in the UK? Experiences and perspectives reported by stakeholders through an online survey
Consultation with those involved in Health Services Research in the UK revealed a picture of overwhelming and increasing bureaucracy, delays, costs and demoralisation related to gaining the approvals necessary to conduct research in the NHS. Suggestions for improvement across all three areas focused on reducing duplication and unnecessary paperwork/form filling and reaching a better balance between risks of harm through research and harms which o…
The Relationship between the Prevalence of the Urgent and Emergency Care Vanguard Participance and Delayed Transfers of Care in English Local Authorities
This paper examines the relationship between the prevalence of the urgent and emergency care vanguard (UEC) at the local authority level and their delayed transfers of care (DTOC) rates in England. We created a novel measure of exposure to UEC vanguards based on the residence of patients who used UEC partner hospitals, and we group it by the level of exposure (high, medium, low, none). We use this measure to estimate the effect of UEC vanguards o…
Skill-mix change and outcomes in primary care
Introduction of new roles to support GPs does not have straightforward effects on quality or patient satisfaction. Problems can arise from the complex adaptation required to adjust practice organisation and from the novelty of these roles to patients. These findings suggest caution over the implementation of policies encouraging more employment of different professionals in primary care
The Problem of Success and Failure in Public-private Innovation Partnerships
Public-Private Innovation Partnerships (PPIPs) are increasingly used as a tool for addressing 'wicked' public sector challenges. 'Innovation' is, however, frequently treated as a 'magic' concept: used unreflexively, taken to be axiomatically 'good', and left undefined within policy programmes. Using McConnell's framework of policy success and failure and a case study of a multi-level PPIP in the English health service (NHS Test Beds), this paper …
Integrated Care in England – what can we Learn from a Decade of National Pilot Programmes
Pilots in all three national programmes made some headway against their objectives but were limited in their impact on unplanned hospital admissions
Ambiguous workarounds in policy piloting in the NHS
Pilot projects are increasingly used as a mechanism to enact organisational change, particularly government policy. Information technology's centrality to organisations often makes it key to the introduction of new processes. However, it can give rise to workarounds as employees circumvent impediments it presents by rejecting its prescribed use. Workarounds tend to be conceptualised dichotomously, as either ‘good’ problem solving, or ‘bad’ subver…
Success” in policy piloting
Research has demonstrated that pilots contain multiple shifting purposes, not all of which relate to simple policy testing or refinement. Judging the success of policy pilots is therefore complex, requiring more than a simple judgment against declared goals. Marsh and McConnell provide a framework against which policy success can be judged, distinguishing program success from process and political success. We adapt Boven's modification of this fr…
Ambiguity and Conflict in Policy Implementation
Policy driven change is challenging, with a significant gap between theory and practice. A key tension in enacting such change is achieving a balance between bottom-up development of local, context-specific approaches, and top-down, centrally determined policy solutions and their mutual sequencing. Ideal type models of the policy-making process envisage a rational ordered approach, driven by evidence and accompanied by ongoing evaluation of outco…
New integrated care models in England associated with small reduction in hospital admissions in longer-term
Closer integration of health and social care services has become a cornerstone policy in many developed countries, but there is still debate over what population and service level is best to target. In England, the 2019 Long Term Plan for the National Health Service included a commitment to spread the integration prototypes piloted under the Vanguard `New Care Models' programme. The programme, running from 2015 to 2018, was one of the largest pil…
Road to Nowhere? A Critical Consideration of the Use of the Metaphor 'Care Pathway' in Health Services Planning, Organisation and Delivery
Metaphors are inescapable in human discourse. Policy researchers have suggested that the use of particular metaphors by those implementing policy changes both influences perceptions of underlying reality and determines what solutions seem possible, and that exploring 'practice languages' is important in understanding how policy is enacted. This paper contributes to the literature exploring the generative nature of metaphors in policy implementati…
Pilots as Projects
The use of policy pilots and other forms of temporary and projectified organisational arrangements has become increasingly widespread over the last two to three decades in public services in the United Kingdom (UK) and elsewhere. Drawing upon a policy ethnography of a pilot programme conducted in the English National Health Service (NHS) we examine the implications of bringing project rationalities to bear upon policy making. Drawing upon the leg…
Beyond the parish pump
Where public health professionals sit in a health system in absolute terms is less important than their ability to develop relationships, negotiate their roles, and provide expert public health influence across that system. A conflation between 'population health' and 'public health' fosters unrealistic expectations of the profession. Public health may be best placed to provide leadership for other stakeholders and professional groups working tow…
Adding the past to the policy mix
Historical perspectives can be embedded into policy initiatives through a process of ‘past-proofing’—ensuring new policies take the study of the past into consideration. We describe how this was done in a project looking at patient access to general practice in the NHS. We argue that current preoccupations with timeliness which have led to the marginalisation of other dimensions of access are connected to a broader process of neo-liberal reform s…
Discretion drift in primary care commissioning in England
In the context of welfare delivery, hybrid organizations mix public and ‘new’ market, social, and professional types of mechanisms and rationales. This article contributes to our understanding of accountability within hybrid organizations by highlighting how accountability obligations can become hybrid, simultaneously formal and informal. Instead of seeing accountability as hybrid only in the sense of the coexistence of types of organizational me…
Being Autonomous and Having Space in which to Act
The optimal balance between central governmental authority and the degree of autonomy of local public bodies is an enduring issue in public policy. The UK National Health Service is no exception, with NHS history, in part at least, a history of repeated cycles of centralisation and decentralisation of decision-making power. Most recently, a significant reorganisation of the NHS in 2012-13 was built around the creation of new and supposedly more a…
Local histories and local sensemaking
Biomedicine, holism and general medical practice
In 2004 a new contract was introduced for General Practitioners in the UK, which introduced a significant element of ‘pay‐for‐performance’, including both clinical and organisational targets. The introduction of this contract has caused interest across the world, particularly amongst those responsible for commissioning primary care services. It can be argued that the clinical targets in the contract (known as the Quality and Outcomes Framework, Q…
The policy work of piloting
National Service Frameworks and UK general practitioners
This paper argues that the past decade has seen significant changes in the nature of medical work in general practice in the UK. Increasing pressure to use normative clinical guidelines and the move towards explicit quantitative measures of performance together have the potential to alter the way in which health care is delivered to patients. Whilst it is possible to view these developments from the well‐established sociological perspectives of d…
The spatial politics of place and health policy
Rethinking collegiality
Ticking Boxes and Changing the Social World
The new General Medical Services contract was introduced into general practice in the UK in 2004, and it links pay to performance far more than in the past. As a result, accurate data collection about patients and the care that they receive is now not only important for good patient care but also to prove that targets are being met. The use of electronic records and information technology has thus become much more sophisticated. This article repo…
Local histories and local sensemaking
Central policies that are only loosely specified might be expected to result in local variations in interpretation and implementation, and practice-based commissioning in the English National Health Service (NHS) is no exception. We show how local ‘sensemaking’ in relation to this policy has been influenced by local histories and by conceptual schemata derived from earlier reorganisations of the NHS. Changes to organisational formalities do not n…
The impact of pay-for-performance on professional boundaries in UK general practice
The 2004 new General Medical Services (nGMS) contract exemplifies trends across the public services towards increased definition, measurement and regulation of professional work, with general practice income now largely dependent on the quality of care provided across a range of clinical and organisational indicators known collectively as the 'Quality and Outcomes Framework' (QOF). This paper reports an ethnographically based study of the impact …
Commissioning in the English National Health Service
The English NHS is currently organised around a split between the 'commissioning' and the 'providing' of health care. There has been considerable critical comment about commissioning, focusing upon perceived inadequacies of the regulatory structure and a perceived lack of competence of the managers concerned. In this paper, we use empirical data from two detailed studies of commissioning to propose a third explanation of the difficulties that hav…
Joining it up? Health and Wellbeing Boards in English Local Governance
Statutory responsibility for health care and social care has long been separated between National Health Service (NHS) bodies and local government authorities. Repeated policy attempts to promote service integration through collaboration between such authorities have achieved little. The latest of such policy interventions are the Health and Wellbeing Boards (HWBs) established by the 2012 Health and Social Care Act (HSCA) alongside a range of oth…
Like a Circle in a Spiral, Like a Wheel within a Wheel
The inclusion of health and social care as part of Greater Manchester devolution took many by surprise. Health and social care practitioners and managers have been working together in differing ways across the conurbation for many years. The formalisation of this working in a set of new organisational structures brings both opportunities and challenges. The Health and Social Care Act 2012 created new organisations within the English National Heal…
Interrogating Institutional Change
Since the beginning of the 1990s the public healthcare system in England has been subject to reforms. This has resulted in a structurally hybrid system of public service with elements of the market. Utilizing a theory of new institutionalism, this article explores National Health Service ( NHS ) managers' views on competition and cooperation as mechanisms for commissioning health services. We interrogate the extent of institutional change in the …
Success” in policy piloting
Research has demonstrated that pilots contain multiple shifting purposes, not all of which relate to simple policy testing or refinement. Judging the success of policy pilots is therefore complex, requiring more than a simple judgment against declared goals. Marsh and McConnell provide a framework against which policy success can be judged, distinguishing program success from process and political success. We adapt Boven's modification of this fr…
Ambiguity and Conflict in Policy Implementation
Policy driven change is challenging, with a significant gap between theory and practice. A key tension in enacting such change is achieving a balance between bottom-up development of local, context-specific approaches, and top-down, centrally determined policy solutions and their mutual sequencing. Ideal type models of the policy-making process envisage a rational ordered approach, driven by evidence and accompanied by ongoing evaluation of outco…
The Devolution Project in Greater Manchester
Embracing the future is second nature in the North West and Greater Manchester in particular is no stranger to innovation and change—as long ago as the 1600s residents were adopting vegetarianism a
Structural Interests' in Health Care
Alford's theory of structural interests has been used as a framework within which to analyse health systems across the world. However, authors have often been uncritical in their acceptance of Alford's original analytic categories. In this article we use data from a detailed qualitative study of the introduction of Practice Based Commissioning in the UK NHS to interrogate Alford's work more critically. Disrupting Alford's original categories of '…
Road to Nowhere? A Critical Consideration of the Use of the Metaphor 'Care Pathway' in Health Services Planning, Organisation and Delivery
Metaphors are inescapable in human discourse. Policy researchers have suggested that the use of particular metaphors by those implementing policy changes both influences perceptions of underlying reality and determines what solutions seem possible, and that exploring 'practice languages' is important in understanding how policy is enacted. This paper contributes to the literature exploring the generative nature of metaphors in policy implementati…
Ambiguous workarounds in policy piloting in the NHS
Pilot projects are increasingly used as a mechanism to enact organisational change, particularly government policy. Information technology's centrality to organisations often makes it key to the introduction of new processes. However, it can give rise to workarounds as employees circumvent impediments it presents by rejecting its prescribed use. Workarounds tend to be conceptualised dichotomously, as either ‘good’ problem solving, or ‘bad’ subver…
Discretion drift in primary care commissioning in England
In the context of welfare delivery, hybrid organizations mix public and ‘new’ market, social, and professional types of mechanisms and rationales. This article contributes to our understanding of accountability within hybrid organizations by highlighting how accountability obligations can become hybrid, simultaneously formal and informal. Instead of seeing accountability as hybrid only in the sense of the coexistence of types of organizational me…
The hidden work of general practitioners
High quality primary care is a foundational element of effective health services. Internationally, primary care physicians (general practitioners (GPs), family doctors) are experiencing significant workload pressures. How non-patient-facing work contributes to these pressures and what constitutes this work is poorly understood and often unrecognised and undervalued by patients, policy makers, and even clinicians engaged in it. This paper examines…
Unpromising Futures
Over the past few decades, the intensification and reorganisation of work have led to growing precarity, insecurity and uncertainty for employees, affecting even professionals tied to traditionally model employers. Doctors, in particular, have seen substantial changes to their work: having to work harder, longer and more intensely with reductions in expected autonomy, deference and respect. This article focuses on how early-career GPs make sense …
Skill-mix change and outcomes in primary care
Introduction of new roles to support GPs does not have straightforward effects on quality or patient satisfaction. Problems can arise from the complex adaptation required to adjust practice organisation and from the novelty of these roles to patients. These findings suggest caution over the implementation of policies encouraging more employment of different professionals in primary care
National Service Frameworks and UK general practitioners
This paper argues that the past decade has seen significant changes in the nature of medical work in general practice in the UK. Increasing pressure to use normative clinical guidelines and the move towards explicit quantitative measures of performance together have the potential to alter the way in which health care is delivered to patients. Whilst it is possible to view these developments from the well‐established sociological perspectives of d…
Ticking Boxes and Changing the Social World
The new General Medical Services contract was introduced into general practice in the UK in 2004, and it links pay to performance far more than in the past. As a result, accurate data collection about patients and the care that they receive is now not only important for good patient care but also to prove that targets are being met. The use of electronic records and information technology has thus become much more sophisticated. This article repo…
Identity, Contract and Enterprise in a Primary Care Setting
This paper examines the responses of primary health care clinicians (doctors and nurses) to an invitation to enterprise contained in a new contract which offers financial rewards for meeting targets. We suggest that far from being swept along by a hegemonic enterprise discourse or having `no choice but to comply' (Cohen and Musson, 2000: 45), the engagement of our study participants in enterprising behaviours can be understood in terms of a more …
Biomedicine, holism and general medical practice
In 2004 a new contract was introduced for General Practitioners in the UK, which introduced a significant element of ‘pay‐for‐performance’, including both clinical and organisational targets. The introduction of this contract has caused interest across the world, particularly amongst those responsible for commissioning primary care services. It can be argued that the clinical targets in the contract (known as the Quality and Outcomes Framework, Q…
Rethinking collegiality
The impact of pay-for-performance on professional boundaries in UK general practice
The 2004 new General Medical Services (nGMS) contract exemplifies trends across the public services towards increased definition, measurement and regulation of professional work, with general practice income now largely dependent on the quality of care provided across a range of clinical and organisational indicators known collectively as the 'Quality and Outcomes Framework' (QOF). This paper reports an ethnographically based study of the impact …
Structural Interests' in Health Care
Alford's theory of structural interests has been used as a framework within which to analyse health systems across the world. However, authors have often been uncritical in their acceptance of Alford's original analytic categories. In this article we use data from a detailed qualitative study of the introduction of Practice Based Commissioning in the UK NHS to interrogate Alford's work more critically. Disrupting Alford's original categories of '…
Local histories and local sensemaking
Central policies that are only loosely specified might be expected to result in local variations in interpretation and implementation, and practice-based commissioning in the English National Health Service (NHS) is no exception. We show how local ‘sensemaking’ in relation to this policy has been influenced by local histories and by conceptual schemata derived from earlier reorganisations of the NHS. Changes to organisational formalities do not n…
Commissioning in the English National Health Service
The English NHS is currently organised around a split between the 'commissioning' and the 'providing' of health care. There has been considerable critical comment about commissioning, focusing upon perceived inadequacies of the regulatory structure and a perceived lack of competence of the managers concerned. In this paper, we use empirical data from two detailed studies of commissioning to propose a third explanation of the difficulties that hav…
Changing the Ties That Bind? The Emerging Roles and Identities of General Practitioners and Managers in the New Clinical Commissioning Groups in the English NHS
The English National Health Service (NHS) is undergoing significant reorganization following the 2012 Health and Social Care Act. Key to these changes is the shift of responsibility for commissioning services from Primary Care Trusts (PCTs) to general practitioners (GPs) working together in Clinical Commissioning Groups (CCGs). This article is based on an empirical study that examined the development of emerging CCGs in eight case studies across …
Joining it up? Health and Wellbeing Boards in English Local Governance
Statutory responsibility for health care and social care has long been separated between National Health Service (NHS) bodies and local government authorities. Repeated policy attempts to promote service integration through collaboration between such authorities have achieved little. The latest of such policy interventions are the Health and Wellbeing Boards (HWBs) established by the 2012 Health and Social Care Act (HSCA) alongside a range of oth…
Like a Circle in a Spiral, Like a Wheel within a Wheel
The inclusion of health and social care as part of Greater Manchester devolution took many by surprise. Health and social care practitioners and managers have been working together in differing ways across the conurbation for many years. The formalisation of this working in a set of new organisational structures brings both opportunities and challenges. The Health and Social Care Act 2012 created new organisations within the English National Heal…
The Devolution Project in Greater Manchester
Embracing the future is second nature in the North West and Greater Manchester in particular is no stranger to innovation and change—as long ago as the 1600s residents were adopting vegetarianism a
Effectiveness of multidisciplinary team case management
Introduction: In the UK’s NHS, as in many health systems, the primary method of integrating care at the service delivery level appears to rely on case management of ‘high-risk’ individuals in primary care.1 We aimed to evaluate a multidisciplinary team (MDT) case management intervention across a number of health system outcomes using a robust quasi-experimental study design, modelling effects at both the individual- (to capture direct effects of …
Interrogating Institutional Change
Since the beginning of the 1990s the public healthcare system in England has been subject to reforms. This has resulted in a structurally hybrid system of public service with elements of the market. Utilizing a theory of new institutionalism, this article explores National Health Service ( NHS ) managers' views on competition and cooperation as mechanisms for commissioning health services. We interrogate the extent of institutional change in the …
Local histories and local sensemaking
Making Sense of Inequalities
This research explored how newly forming clinical commissioning groups (CCGs) were beginning to think about their new ‘duty’ to tackle health inequalities (HIs), as outlined in UK health policy. The concept of ‘sensemaking’ (Weick 1995) was used to illustrate the influences on CCGs’ interpretations of the policy. Three CCGs in the North of England were recruited, and qualitative methods, including interviews, observations and document analysis, w…
The spatial politics of place and health policy
The policy work of piloting
Beyond the parish pump
Where public health professionals sit in a health system in absolute terms is less important than their ability to develop relationships, negotiate their roles, and provide expert public health influence across that system. A conflation between 'population health' and 'public health' fosters unrealistic expectations of the profession. Public health may be best placed to provide leadership for other stakeholders and professional groups working tow…
Adding the past to the policy mix
Historical perspectives can be embedded into policy initiatives through a process of ‘past-proofing’—ensuring new policies take the study of the past into consideration. We describe how this was done in a project looking at patient access to general practice in the NHS. We argue that current preoccupations with timeliness which have led to the marginalisation of other dimensions of access are connected to a broader process of neo-liberal reform s…
Discretion drift in primary care commissioning in England
In the context of welfare delivery, hybrid organizations mix public and ‘new’ market, social, and professional types of mechanisms and rationales. This article contributes to our understanding of accountability within hybrid organizations by highlighting how accountability obligations can become hybrid, simultaneously formal and informal. Instead of seeing accountability as hybrid only in the sense of the coexistence of types of organizational me…
Being Autonomous and Having Space in which to Act
The optimal balance between central governmental authority and the degree of autonomy of local public bodies is an enduring issue in public policy. The UK National Health Service is no exception, with NHS history, in part at least, a history of repeated cycles of centralisation and decentralisation of decision-making power. Most recently, a significant reorganisation of the NHS in 2012-13 was built around the creation of new and supposedly more a…
Pilots as Projects
The use of policy pilots and other forms of temporary and projectified organisational arrangements has become increasingly widespread over the last two to three decades in public services in the United Kingdom (UK) and elsewhere. Drawing upon a policy ethnography of a pilot programme conducted in the English National Health Service (NHS) we examine the implications of bringing project rationalities to bear upon policy making. Drawing upon the leg…
New integrated care models in England associated with small reduction in hospital admissions in longer-term
Closer integration of health and social care services has become a cornerstone policy in many developed countries, but there is still debate over what population and service level is best to target. In England, the 2019 Long Term Plan for the National Health Service included a commitment to spread the integration prototypes piloted under the Vanguard `New Care Models' programme. The programme, running from 2015 to 2018, was one of the largest pil…
Political science (37 obras) · Public relations (32 obras) · Sociology (23 obras) · Law (22 obras) · Business (20 obras) · Medicine (20 obras) · Health care (18 obras) · Psychology (18 obras) · Primary Care and Health Outcomes (17 obras) · Public Administration (17 obras)