Exploring the impact of clinical governance on the professional autonomy of general practitioners in a primary care trust in the North West of England.

Employing a single-site exploratory case study research methodology, this study seeks to
paint a rich and detailed picture of managerial and professional perspectives of the impact
of clinical governance on the professional autonomy and self-regulation of general
practitioners (GPs) in a Primary Care Trust (referred to as the Utopian PCT), in the North
West of England. The study defines clinical governance in the context of general practice;
identifies the requirements for and barriers to its implementation; explores the role of GP
Medical Advisers to the PCT and determines whether clinical governance is contributing to
the deprofessionalisation (Haug 1973; 1975; 1977; 1988), proletarianisation (McKinlay and
Arches 1985; McKinlay and Stoeckle 1988; McKinlay and Stoeckle 2002; Coburn 1992;
Coburn et al 1997) or restratification of general practice (Fried son 1975; 1983; 1984; 1985;
1986).
There are a small number of existing studies examining the impact of clinical governance
on the professional autonomy and self-regulation ofGPs (SheafTet a12002; 2003; 2004;
Locock et at 2004). This study focuses on the whole process of clinical governance whilst
others focus on the implementation of National Service Frameworks. This is the only study
employing a single-site exploratory case study methodology seeking to 'particularise'
rather than to 'generalise' and to paint a rich and detailed picture of the 'human-side' of the
Utopian peT and the associated general practices. Whilst never intending to be
generalisable, the results of the study add to the growing body of evidence that the
restratification of general practice has begun in England through GP Professional
Representatives (referred to as GP Medical Advisers at Utopian PCT), employed in hybrid advisory/supervisory roles within PCTs. My study also supports Sheaff et aI's
(2004) findings, suggesting that in the case of general practice, restratification does not
divide the profession into separate occupational groups (Fried son 1984). Instead,
knowledge management, supervision and general practice are different aspects of the same
role (Sheaff et a12004; Courpasson 2000). The study demonstrates that despite the
structural constraints imposed by clinical governance on general practice GPs are by no
means helpless victims of government policy. Where possible they use clinical governance
to their own advantage and to the advantage of their patients. They unenthusiastically
implement those aspects of clinical governance they dislike but cannot avoid. The GPs
participating in the study objected to what they perceived to be the managerial interference
embodied in clinical governance and continued to adhere to a professional rather than a
'neo-bureaucratic' culture. The study suggests that in the future the new General Medical
Services Contract (2004) will be influential in reinforcing the implementation of clinical
governance in general practice.