Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams

Suzanne Grant (Corresponding Author), Adele Ring, Mark Gabbay, Bruce Guthrie, Gary Maclean, Frances S. Mair, Graham C. Watt, David Heaney, Catherine O'Donnell

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


In the UK National Health Service, primary care organisation (PCO) managers have traditionally relied on the soft leadership of general practitioners based on professional self‐regulation rather than direct managerial control. The 2004 general medical services contract (nGMS) represented a significant break from this arrangement by introducing new performance management mechanisms for PCO managers to measure and improve general practice work. This article examines the impact of nGMS on the governance of UK general practice by PCO managers through a qualitative analysis of data from an empirical study in four UK PCOs and eight general practices, drawing on Hood's four‐part governance framework. Two hybrids emerged: (i) PCO managers emphasised a hybrid of oversight, competition (comptrol) and peer‐based mutuality by granting increased support, guidance and autonomy to compliant practices; and (ii) practices emphasised a broad acceptance of increased PCO oversight of clinical work that incorporated a restratified elite of general practice clinical peers at both PCO and practice levels. Given the increased international focus on the quality, safety and efficiency in primary care, a key issue for PCOs and practices will be to achieve an effective, contextually appropriate balance between the counterposing governance mechanisms of peer‐led mutuality and externally led comptrol.
Original languageEnglish
Pages (from-to)30-51
Number of pages22
JournalSociology of Health & Illness
Issue number1
Early online date20 Jan 2015
Publication statusPublished - Jan 2015

Bibliographical note

The authors would like to thank all respondents who generously gave up their time to participate in this study and Michelle McKelvie for administrative support. The study was funded by the NHS Service Delivery and Organisation Programme (project number 08/1618/126). The views and opinions expressed therein are those of the authors alone and do not necessarily reflect those of the National Institute for Health Research Service Delivery and Organisation programme of the Department of Health. SG was funded by a Medical Research Council (MRC) Population Health Scientist Fellowship.


  • general practice
  • primary care
  • performance management
  • soft governance
  • restratification
  • professional autonomy


Dive into the research topics of 'Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams'. Together they form a unique fingerprint.

Cite this