Introduction and Context
The medical profession is not an easy one to handle. It is composed of eminent men and women who have devoted themselves and dedicated themselves to it, but who do not appear to bring the same collective sagacity to bear upon the profession as they do upon their individual patients. (Bevan, 1946)
This quote, from a speech given by Aneurin Bevan two years before the inception of the National Health Service (NHS), still resonates today. While much has changed across the NHS in that time, General Practice remains as mainly small independent businesses with the majority of their income sourced from their contracted status to the NHS (Baird, Charles, Honeyman, Maguire & Das, 2016). As funding and priorities are set from the Government, through the Department of Health and NHS England (NHSE) (The King’s Fund, 2017), the wicked problem of attempting to develop, or impose, new business models for GP practices remains as fraught with issues – including autonomy, influence and engagement (Pettigrew, Kumpunen, Rosen, Posaner & Mays, 2018) – as for Bevan over 70 years ago.
The NHS has recently released a Long Term Plan (LTP) (NHSE, 2019), setting out an ambitious 10 year strategy that announced a new strategic direction for General Practice. Following its publication the British Medical Association (BMA) and NHSE published, three weeks later, the framework for a new GP contract to achieve these changes (BMA & NHSE, 2019). While there was a persuasive and well-coordinated set of responses to the changes from senior NHS leaders and the UK Government (Elias, 2019; Morris, 2019), reaction from front-line GPs has been mixed (Chand, 2019).
XXXXXXXXXXXXXXXXXXXXXX The importance of this study cannot be underestimated. While it originates from a managerial imperative to undertake this specific piece of work, there are also 194 other Clinical Commissioning Groups (CCGs) across England grappling with the task of how to implement PCNs, which represents the biggest change to GP contracts for 15 years (Bower, 2019).
Research Questions and Objectives
“To examine the support requirements for Primary Medical Care to form strategic alliances (‘Primary Care Networks’), based on the perception of Gloucestershire GP practices”
Within this research aim, three research questions emerge with associated objectives, which form the underpinning reasons for undertaking this study. Specifically these are:
|Q1. What are the principles of strategic planning that need to be considered for GP practices forming alliances as PCNs?
|To undertake an evidenced-based review of strategic planning principles for alliance formation across the range of alliance possibilities – predominantly in the Public Sector where available – that will be required to support the implementation of the LTP for GP practices.
|Q2. What is the perception of Gloucestershire GP practices of the support required to form strategic alliances into the future?
|To evaluate perceptions of GPs – and managerial staff – of the strategic planning impact on them as private businesses in forming strategic alliances, what form these may take, their appetite to do so and what resources and support they need to achieve these alliances.
|Research through qualitative interviews (see ‘Proposed Methodology’)
|Q3. How should GP practices in Gloucestershire be supported for forming alliances?
|To bring together the theory identified in Q1 with the data gathered in Q2 to determine how emerging models in Gloucestershire compare to the theory on strategic alliances and how commissioners (the CCG) and policy makers (NHSE and the UK Government) should respond to support these future models to achieve the ambitions of the LTP.
|Assessed by data gathered during research project
Table 1: Research questions, related objectives and method
Relevant Academic Literature Consulted
The focus of this study is the formation of strategic alliances (PCNs) between the independent businesses of General Practice, as required under the LTP. Ensuring the study is positioned within a theoretical context (Fink, 2005; Booth, Sutton & Papaioannou, 2016), the academic literature consulted to this point has employed a ‘funnel’ approach of considering alliance formation and maturity from a theoretical and conceptual perspective, before narrowing to private and then public sector alliances. This has identified themes in the literature that will help shape the research project and identify where this thesis will contribute to the existing knowledge base.
A model of alliance evolution offered by Johnson, Whittington, Scholes, Angwin & Regnér (2017) will be an important conceptual framework through which to frame this research (Figure 1). Understanding the perceived resources available and required, what commitment there is, at what stage they believe they are now and what they envisage the termination state might be given that alliances are fragile (Panico, 2016), will be of practical relevance in terms of achieving the aim and objectives. Such termination states could include merger, acquisition, joint venture, or even a new government emerging with a new strategic direction that terminates PCNs. Reflection on this model against other theoretical approaches (such as Tallman & Phene, 2006; Huxham & Vangen, 2001; Genefke & McDonald, 2001) and the role of entrepreneurship (Casson & Mol, 2006; Ireland, Hitt & Webb, 2006), will also be considered.
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