Development of PCGs sets

The body of theory that describes interest groups and their actions reflect the changes the groups have undergone. Key element of this theory includes how and why interest groups form and why they persist. Interest groups have evolved rapidly from close-knit alliances into diverse, large, and powerful players in federal (and state) policy making. Many groups occupy somewhat narrow “niches” in policy, but they also participate in coalitions that allow them to pull their efforts to effect or deflect broad policy change.

Interest groups provide information and campaign support to elected officials and use several strategies to influence policy, including direct lobbying, grassroots organizing, campaign contributions through PACs, and participation in coalitions. Though interest groups spend most of their time attempting to influence congress, they also recognize the importance of lobbying the executive branch. Interest groups also use the court, often as the final avenue for action when other means fall short.

Interest groups play an important role in both electing members of Congress favourable to their cause and working with these members to enact the policies that the members desire (and stop the policies they oppose). In sum, the role of interest groups in defining and shaping health care policy is pivotal. Next to congress, interest groups may well be the most important actors in healthy policy. Interest groups consist of individuals who have organized themselves around a shared interest and seek to influence public policy.

Interest groups include organizations as diverse as the Federation of Behavioural, Psychological, and Cognitive Science and the Association of State and Territorial Health Officials, as broad as the American Public Health Association and as narrow as the American Society of Gastrointestinal Endoscopy. They also include corporations and institutional interests such as hospitals, medical schools, HMOs, and schools of public health (Weissert, & Weissert, 2006) Political parties on public health policy. The election of the labour government by May 1997 appeared to herald a change in emphasis for health-care policy.

Within weeks of the election, the government had appointed the UK’s Minister for Public Health and announced the end of the internal market with a shift towards more collaborative arrangements for health care commissioning and provision. Livings centre to be funded from the lottery and are also evident in the proposals for HAZs. The development of HAZs represents one element of the government’s intention to provide ‘joined up solutions’ to complex problems, a desire to move away from compartmentalize which characterises health a social care issues.

Collaboration between health and local authorities is also highlighted as essential to the broader promotion of public health and proposals for HIPs (cited DoH, 1997) emphasize the important role of local authorities. Direct involvement in the development of HIPs is seen as a key task for local authorities and will be underpinned by a new statutory duty to ‘improve the economic, social and environmental well being of their areas’ (cited DoH, 1998b) and the Green Paper envisages an important role for local authorities in tackling public health issues through housing, transport, education and social policies.

Therefore the proposals contained in the Green Paper support a wider public health approach and implicitly acknowledge the primary care function of other front line agencies and their importance in improving health. However responsibility for the coordination of the public health strategy will remain with the directors of public health at regional and health authority level. Health authorities are still dominated by the medical model, raising concerns that the ever-present need to increase the provision of medical services may override the longer term strategic need to develop collaborative strategies.

Another concern is that there appear to be few links between the White Paper on NHS and the Green Paper on public health. So, while the rhetoric of collaboration and partnership may be present in both NHS and public health policy, the mechanisms for implementation of policy do not appear to be through and through. The new NHS also represents a further extension of managerialism within the UK health service with the incorporation of primary care more firmly within the NHS.

The development of PCGs sets out an agenda for incorporating primary care within the NHS hierarchy and presents a real challenge to the independent nature of general practice. The organization of commissioning is likely to lead to greater managerial scrutiny of and accountability for primary care. Yet at the same time, the White Paper promote the development of clinical governance and support the increased involvement of clinician and others, such as nurses, in service planning and commissioning.

This support for clinical involvement is a key theme of the White Paper and appears to encourage professional involvement in decision making which may be at odds with increasing managerial control. At one level, this emphasis on professional involvement is to be welcomed as there is a shift away from a specific focus on doctors to an increased nursing role in decision making, particularly in PCGs.

However, there is a clear preference for doctors to be lead clinicians in both commissioning and clinical governance as nurses have less presentation on PCG boards. However, it is not clear that clinical skills are necessarily the most appropriate skills for commissioning and there is a tension between whether nurses in managerial roles would be more suitable nursing representatives than those with only clinical experience (Craig & Lindsay, 2000).