Discretion or discretions? Delineating professional discretion
The case of English medical practice
Bibliographic Data
| ID | 4599089 |
|---|---|
| Authors | Sudeh Cheraghi‐sohi (0000-0002-2863-0683, University of Manchester), Sudeh Cheraghi-Sohi, Michael Calnan (0000-0002-7239-6898, University of Kent) |
| Year | 2013 |
| Volume | 96 |
| Pages | 52-59 |
| Publication date | 2013-11-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Social Science & Medicine (JOURNAL) |
| Journal identifiers | ISSN: 0277-9536 • E-ISSN: 1873-5347 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.socscimed.2013.07.011 |
| PMID | 24034951 |
| OpenAlex | W1973053730 |
| Language | EN |
| Citations received | 13 |
| References cited | 24 |
There has much debate about the extent to which professional discretion has been challenged by recent organisational changes such as through the new forms of governance associated with the introduction of the principles of the New Public Management (NPM) into health systems and other public sector services. What appears to be missing from these debates is a detailed analysis of the concept of professional discretion itself. This paper attempts to fill this gap by delineating the key concepts of professional discretion evident in the literature and exploring their significance in an empirical study of the influence of the 2004 new general medical services contract (nGMS) and the introduction of the Quality and Outcomes Framework (QOF), a prescriptive pay-for-performance system designed to standardise the quality of care provision in general medical practice in the United Kingdom. The study adopted a longitudinal design using semi-structured interviews with general practitioners (GPs, N = 62) working in the English National Health Service (NHS) between 2007 and 2009. A multi-dimensional conception of discretion was used to explore how GP discretion might have been influenced by contractual changes and in particular, QOF. The findings suggest that through a complex interplay of factors, a post-QOF reduction in GP discretion was identifiable, highlighting different potential sources of constraint such as in the social, organisational and economic dimensions of discretion. The evidence also suggested the emergence of a new form of organisational medical professionalism within general practice characterised by standardisation, bureaucracy and performance management
Bureaucracy · Business · Clinical governance · Constraint (computer-aided design · Corporate governance · Discretion · Health care · Political science · Politics · Public relations · Public service · Quality and Outcomes Framework · Sociology · Engineering · Healthcare Policy and Management · Healthcare Quality and Management · Law · Primary Care and Health Outcomes
How to influence the professional discretion of street-level bureaucrats
Beyond Binaries
The Role of Discretion in the Age of Automation
Police use of discretion in response to domestic violence
Trust matters for doctors? Towards an agenda for research
Deploying telehealth with sheltered housing tenants living with COPD
À force d’en faire, tu sais ce qui est bon »
Street-level quasi-bureaucracy and professional discretion
Defining the health social worker role and function—Struggling between discretion and standardization
Professionals as Knowledge Brokers
Digital transformation of public employment services in the post‐pandemic era. Evidence from Italy as a latecomer country
Off the record
Between diagnostic precision and rapid decision-making
Professionalism Reborn
Identity, Contract and Enterprise in a Primary Care Setting
The New Sociology of the Health Service
Ticking Boxes and Changing the Social World
National Service Frameworks and UK general practitioners
Decline vs. retention of medical power through restratification
Decline vs. retention of medical power through restratification
Co‐optation, Commodification and the Medical Model
Co-Optation, Commodification and the Medical Model
Professional Dominance
Rethinking collegiality
Are new forms of professionalism emerging in medicine? The case of the implementation of Nice guidelines
New Directions in State and International Professional Occupations
Professions and Their Work
A new professionalism? Challenges and opportunities
Market reforms in English primary medical care
The impact of pay-for-performance on professional boundaries in UK general practice
| Unique citing works | 13 |
|---|---|
| Citations per year | 1,18 |
| Citation span | 2015 - 2025 (11) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 13 |