Attempts to Improve Accountability in Primary Health Care: Evidence from a GP Practice in Scotland

Purpose – The aim of this paper is to examine the effects of government reforms to improve the accountability of primary healthcare providers in Scotland. As a result of the reforms, funding arrangements for GP practices changed and new financing mechanisms were introduced; this paper seeks to investigate the impact of these changes. Design/methodology/approach – The investigation is undertaken using a case study method involving a medical practice in Dundee. Interviews were conducted with staff at the practice and one researcher spent a week on site studying documentation and observing procedures. Findings – The main findings from the case study suggest that as a result of the government reforms, new funding allocation procedures for the practice better resemble a system of financial control rather than demonstrating financial accountability. GPs were more willing to engage in discussions regarding new procedures being introduced to demonstrate clinical accountability; they did not anticipate that practice accreditation or professional revalidation would alter their established practices in any way. Research limitations/implications – The main limitation of this research is that it only relates to one case study in Dundee. In addition, further government reforms in this area mean that follow up case studies are needed to see how subsequent changes have addressed the issues raised in the current research; indeed, some longitudinal studies might investigate how cumulative reforms have impacted upon GPs. Orginality/value – Nevertheless, despite these limitations, this paper does build on previous work in this area and provides a platform on which subsequent work can build.Case study, Health Care, Scotland