The impact of pay-for-performance on professional boundaries in UK general practice: an ethnographic study

摘要: 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 quality care provided a range clinical organisational indicators known collectively as 'Quality Outcomes Framework' (QOF). This paper reports an ethnographically based study impact financial incentives contained within it boundaries in UK practice. distribution administrative work has changed significantly there been concentration authority, QOF decision making monitoring being led by internal team managerial staff who make major practice-level decisions about QOF, monitor progress against targets, intervene to resolve areas or at risk missing targets. practitioners nurses, however, appear have accommodated these changes re-creating long established narratives hierarchies. is concerned arrangements existing