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The use of standard contracts in the English NHS: a case study analysis

Christina Petsoulas, Pauline Allen, David Hughes, Peter Vincent-Jones, Jennifer Roberts

Social Science & Medicine,, Volume: 73, Issue: 2, Pages: 185 - 92

Swansea University Author: David Hughes

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DOI (Published version): 10.1016/j.socscimed.2011.05.021

Abstract

<p>The use of contracts is vital to market transactions. The introduction of market reforms in health care in the UK and other developed countries twenty years ago meant greater use of contracts. In the UK, health care contracting was widely researched in the 1990s. Yet, despite the changing p...

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Published in: Social Science & Medicine,
Published: Elsevier 2011
Online Access: http://www.sciencedirect.com/science/article/pii/S027795361100298X
URI: https://cronfa.swan.ac.uk/Record/cronfa6726
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spelling 2011-10-01T00:00:00.0000000 v2 6726 2012-01-23 The use of standard contracts in the English NHS: a case study analysis f1fbd458e3c75d8b597c0ac8036f2b88 David Hughes David Hughes true false 2012-01-23 FGMHL <p>The use of contracts is vital to market transactions. The introduction of market reforms in health care in the UK and other developed countries twenty years ago meant greater use of contracts. In the UK, health care contracting was widely researched in the 1990s. Yet, despite the changing policy context, the subject has attracted less interest in recent years. This paper seeks to fill a gap by reporting findings from a study of contracting in the English National Health Service (NHS) after the introduction of the national standard contract in 2007. By using economic and socio-legal theories and two case studies we examine the way in which the new contract was implemented in practice and the extent to which implementation conformed to policy intentions and to our theoretical predictions. Data were collected using non-participant observation of 36 contracting meetings, 24 semi-structured interviews, and analysis of documents. We found that despite efforts to introduce a more detailed ('complete') contract, in practice, purchasers and providers often reverted to a more relational style of contracting. Frequently reliance on the NHS hierarchy proved to be indispensable; in particular, formal dispute resolution was avoided and financial risk was re-allocated in compromises that sometimes ignored contractual provisions. Serious data deficiencies and shortages of skilled personnel still caused major difficulties. We conclude that contracting for health care continues to raise serious problems, which may be exacerbated by the impending transfer of responsibility to groups of general practitioners (GPs) who generally lack experience and expertise in large-scale, secondary care contracting.</p> Journal Article Social Science & Medicine, 73 2 185 92 Elsevier 31 12 2011 2011-12-31 10.1016/j.socscimed.2011.05.021 http://www.sciencedirect.com/science/article/pii/S027795361100298X COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University 2011-10-01T00:00:00.0000000 2012-01-23T12:31:41.9670000 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health Christina Petsoulas 1 Pauline Allen 2 David Hughes 3 Peter Vincent-Jones 4 Jennifer Roberts 5
title The use of standard contracts in the English NHS: a case study analysis
spellingShingle The use of standard contracts in the English NHS: a case study analysis
David Hughes
title_short The use of standard contracts in the English NHS: a case study analysis
title_full The use of standard contracts in the English NHS: a case study analysis
title_fullStr The use of standard contracts in the English NHS: a case study analysis
title_full_unstemmed The use of standard contracts in the English NHS: a case study analysis
title_sort The use of standard contracts in the English NHS: a case study analysis
author_id_str_mv f1fbd458e3c75d8b597c0ac8036f2b88
author_id_fullname_str_mv f1fbd458e3c75d8b597c0ac8036f2b88_***_David Hughes
author David Hughes
author2 Christina Petsoulas
Pauline Allen
David Hughes
Peter Vincent-Jones
Jennifer Roberts
format Journal article
container_title Social Science & Medicine,
container_volume 73
container_issue 2
container_start_page 185
publishDate 2011
institution Swansea University
doi_str_mv 10.1016/j.socscimed.2011.05.021
publisher Elsevier
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
url http://www.sciencedirect.com/science/article/pii/S027795361100298X
document_store_str 0
active_str 0
description <p>The use of contracts is vital to market transactions. The introduction of market reforms in health care in the UK and other developed countries twenty years ago meant greater use of contracts. In the UK, health care contracting was widely researched in the 1990s. Yet, despite the changing policy context, the subject has attracted less interest in recent years. This paper seeks to fill a gap by reporting findings from a study of contracting in the English National Health Service (NHS) after the introduction of the national standard contract in 2007. By using economic and socio-legal theories and two case studies we examine the way in which the new contract was implemented in practice and the extent to which implementation conformed to policy intentions and to our theoretical predictions. Data were collected using non-participant observation of 36 contracting meetings, 24 semi-structured interviews, and analysis of documents. We found that despite efforts to introduce a more detailed ('complete') contract, in practice, purchasers and providers often reverted to a more relational style of contracting. Frequently reliance on the NHS hierarchy proved to be indispensable; in particular, formal dispute resolution was avoided and financial risk was re-allocated in compromises that sometimes ignored contractual provisions. Serious data deficiencies and shortages of skilled personnel still caused major difficulties. We conclude that contracting for health care continues to raise serious problems, which may be exacerbated by the impending transfer of responsibility to groups of general practitioners (GPs) who generally lack experience and expertise in large-scale, secondary care contracting.</p>
published_date 2011-12-31T03:08:17Z
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score 11.03559

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