Getting the Job Done: How Managers in General Practice mediate internal and external influences in constructing their identities as managers

From the early 1990s there has been a process of increasing managerialisation in general practice. This new emphasis on management precipitated the creation of two groups of managers, the promoted ex-receptionist and the manager
coming into general practice from outside, usually with prior management experience in the private sector. These groups were used in the research investigation as the ideal-types of internal and external managers respectively.
The thesis looks beneath the purely descriptive collection of data, both quantitative and qualitative, to explore the origins of the phenomenon of practice management in its socio-economic and political context. It looks at the facility of labour process theory, neo-liberalism and New Public Management as explanatory frameworks for what is happening in general practice and the existence of the two ideal-types. The research investigation consisted of a
quantitative questionnaire containing questions about the practice, the functions undertaken by the manager and personal demographic information to throw light on the rising importance of Practice Managers and practice management. The survey was followed up with and complemented by a series of semi-structured interviews with both internal and external managers. The data shows that there is clearly an intensification of the application of managerialism into general practice directed from the centre, with Practice Managers as both agents and conduits of that process. It also shows that the terrain of manager, but particularly Practice Manager, is heavily contested between the two ideal-types of internal and external manager, with each trying to appropriate it for themselves. However, the research also demonstrates areas of similarity and overlap between the two groups that potentially illustrates the way forward for the development of management of general practice in the future.

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