The role of the professional representative in the management of the National Health Service

The thesis is about the role of professional representatives in the management of a large organisation - the National Health Service. Members of professions frequently work in organisations the leadership of which must reconcile professional and administrative occupational ideologies if its ability to determine policy and ensure its implementation is not to be frustrated. Co-optation of professional representatives onto management executives is one means of attempting to reconcile such ideological tensions. The success of such co-optation is dependent upon the structure of the professions and the representative systems devised.

Since its inception, the National Health Service has encouraged participation by clinicians in advisory, administrative and managerial capacities. Until 1974 such participation was largely by hospital consultants rather than GPs. One of the chief objectives of the 1974 reorganisation of the NHS was to integrate the three branches of the service and so GPs were made full members of the district management team. The position of GPs within the production and distribution of services was seen to be central and therefore the success of integration depended upon the representative process.

The research reported in this thesis examines the role of the GP team member. Five national surveys were conducted of GP team members, District/Area Medical Committee Secretaries, District/Area Administrators, GPs, and Local Medical Committee Secretaries. Survey findings are used with interview data to examine a number of hypotheses about the representative process, co-optation in a large organisation, and co-optation and the 1974 reorganisation of the NHS.