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Title:
Primary Care-Led Commissioning in England and Wales: the Changing Complexity of Governance for Quality, 1991-2005

Subject Categories:
Health services and medical care - Health
Management and organisation - Industry and management
Use and provision of specific social services - Social welfare policy and systems

Depositor(s):
Abbott, S., City University. St Bartholomew School of Nursing and Midwifery. Public Health and Primary Care Unit

Principal Investigator(s):
Abbott, S., City University. St Bartholomew School of Nursing and Midwifery. Public Health and Primary Care Unit
Procter, S., City University. St Bartholomew School of Nursing and Midwifery. Public Health and Primary Care Unit

Data Collector(s):
Iacovou, N., Queen Mary, University of London. Institute of Health Sciences Education. Centre for Health Sciences

Sponsor(s):
Economic and Social Research Council

Grant Number:
RES-000-22-1198 (Public Services: Quality, Performance and Delivery programme.)

Other Acknowledgements:
Richard Smith was also responsible for data collection.

Abstract:
This research project explored primary care-led commissioning (PCLC) in the National Health Service (NHS) in England and in Wales, and aimed to set these in the context of NHS changes since 1991. PCLC is understood here to mean the process of arranging the whole range of health care services (acute, community, primary), either by providing services directly or by commissioning them from other providers.

The study had five key objectives:

• to explore the extent to which the complexity and bureaucratic nature of governance processes enable Primary Care Trusts (PCTs) in England and Local Health Boards (LHBs) in Wales to pursue strategic and clinical objectives relating to service quality
• to discover how PCTs/LHBs and the disparate groups within them manage and negotiate the demands of governance mechanisms on organisational capacity
• to assess which governance mechanisms have most (and least) 'bite' and influence on service quality, and why
• to discover whether these governance arrangements permit 'bottom-up' innovation and encourage clinical and managerial commitment to quality
• to interpret the findings in the light of between-country differences (England and Wales) and changes in the NHS since 1991

Coverage:
Time Period Covered: The interview data include respondents' reflections on NHS arrangements from 1991 onwards, but the major focus is the present (2005-2006). Documentary analysis focuses on documents from 2005 only.
Dates of Fieldwork: July 2005-May 2006
Country: England and Wales
Spatial Units: No spatial unit
Observation Units: Individuals; Groups
Kind of Data: Textual data; Individual (micro) level; Semi-structured interview transcripts; Minutes of meetings (includes grid analyses of documents).

Universe Sampled:
Location of Units of Observation:National
Population:Board members of PCTs in England and LHBs in Wales, interviewed during 2005-2006, and associated board meeting minutes/documents.

Methodology:
Time Dimensions: Cross-sectional (one-time) study
Sampling Procedures: One-stage stratified or systematic random sample; Purposive selection/case studies
Number of Units: 48 interview transcripts; 3 meeting minutes documents.
Method of Data Collection: Face-to-face interview; Compilation or synthesis of existing material
Weighting: Not applicable.

Language(s) of Written Materials:
Study Description: English
Study Documentation: English

Access:
Access Conditions: The depositor has specified that registration is required. Available to all registered users. The depositor may be informed about usage.
Availability: ESDS Qualidata, UK Data Archive
Contact: Help desk: qualidata@esds.ac.uk

Date of Release:
First Edition: 6 November 2007

Copyright:
Copyright S.J. Abbott, S. Procter and N. Iacovou

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