Understanding general practice: a conceptual framework developed from case studies in the UK NHS

Area of Science:

• Organizational studies
• Health services research
• General practice management

Background:

• UK general practice is undergoing significant transformation.
• Traditional research views GPs individually or as a professional group.
• Organizational perspectives are crucial for understanding change impacts.

Purpose of the Study:

• Develop a conceptual framework for general practice organizations using organizational studies literature.
• Empirically test and refine this framework through case studies of practice change.
• Analyze responses to National Service Frameworks (NSFs) and the new General Medical Services (GMS) contract.

Main Methods:

• Iterative, in-depth qualitative case study design.
• Purposeful sampling of five general practices in England.
• Data collection via semi-structured interviews, observation, and document analysis.

Main Results:

• A conceptual framework was developed to explain practice responses to change.
• Key factors influencing change included practice narratives, beliefs about work, managerial roles, and past experiences.
• The framework illuminated reactions to NSFs and the GMS contract.

Conclusions:

• General practices function as small organizations, influencing change responses.
• Change is often bottom-up, driven by perceptions of organizational reality.
• The framework offers questions to explore internal practice dynamics and inform change management.