+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Discretion or discretions? Delineating professional discretion: the case of English medical practice

Discretion or discretions? Delineating professional discretion: the case of English medical practice

Social Science and Medicine 96: 52-59

There has much debate about the extent to which professional discretion has been challenged by recent organisational changes such as through the new forms of governance associated with the introduction of the principles of the New Public Management (NPM) into health systems and other public sector services. What appears to be missing from these debates is a detailed analysis of the concept of professional discretion itself. This paper attempts to fill this gap by delineating the key concepts of professional discretion evident in the literature and exploring their significance in an empirical study of the influence of the 2004 new general medical services contract (nGMS) and the introduction of the Quality and Outcomes Framework (QOF), a prescriptive pay-for-performance system designed to standardise the quality of care provision in general medical practice in the United Kingdom. The study adopted a longitudinal design using semi-structured interviews with general practitioners (GPs, N = 62) working in the English National Health Service (NHS) between 2007 and 2009. A multi-dimensional conception of discretion was used to explore how GP discretion might have been influenced by contractual changes and in particular, QOF. The findings suggest that through a complex interplay of factors, a post-QOF reduction in GP discretion was identifiable, highlighting different potential sources of constraint such as in the social, organisational and economic dimensions of discretion. The evidence also suggested the emergence of a new form of organisational medical professionalism within general practice characterised by standardisation, bureaucracy and performance management.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 052646356

Download citation: RISBibTeXText

PMID: 24034951

DOI: 10.1016/j.socscimed.2013.07.011

Related references

Professional discretion concerning medical histories of deceased. Deutsche Medizinische Wochenschrift 93(39): 1868-1869, 1968

Discretion in Context: A Moderated Mediation Model of the Relationship between Discretion and Turnover Intentions. Industrial Relations: A Journal of Economy and Society 51(1): 106-128, 2012

Specialist discretion for managing specialty pharmaceuticals: the ethics argument for discretion. American Journal of Managed Care 10(8 Suppl): S240, 2004

Employees of the confidential medical service and professional discretion. Deutsche Medizinische Wochenschrift 94(27): 1423-1424, 1969

Professional discretion of an opinion commission regarding medical competence. Deutsche Medizinische Wochenschrift 131(31-32): 1754-1755, 2006

Employer requested medical examinations, professional disclosure and discretion. Deutsche Medizinische Wochenschrift 95(22): 1242, 1970

"Speech is silver, but silence is gold": the Kinski case and professional discretion. Psychiatrische Praxis 36(1): 2-3, 2009

Probation and Parole Officers' Compliance With Case Management Tools: Professional Discretion and Override. International Journal of Offender Therapy and Comparative Criminology 62(14): 4565-4584, 2018

The duty and the right of professional discretion of the physician. On problems of legal evaluation of medical problems. Munchener Medizinische Wochenschrift 109(7): 365-376, 1967

Professional discretion of physicians. Das Deutsche Gesundheitswesen 12(13): 385-397, 1957

The professional secret and discretion. Revista de Odontologia Da Unesp 1(2): 179-183, 1970

Professional discretion on autopsy findings. Deutsche Medizinische Wochenschrift 94(26): 1381-1382, 1969

Professional discretion and open postcards. Deutsche Medizinische Wochenschrift 94(24): 1299-1300, 1969

Professional discretion and traffic safety. Deutsche Medizinische Wochenschrift 94(1): 47-48, 1969

The issue of professional discretion for pathologists. Beitrage Zur Pathologie 160(1): 93-96, 1977