Professionals: Back to the Future?

This article examines empirical evidence on the impact of the introduction of a quasi-market in healthcare in the UK on professionals, especially doctors. Data are drawn from two longitudinal studies occurring between 1990 and 1994, of aspects of the changes to the health system. Data collection involved a range of methods, including observation, interviews, questionnaires and archival material. The findings show that a unilateral analysis of the impact of the quasimarket on professionals is inadequate to understand the situation. The responses of the professionals to change have had a major influence on the outcomes. Professionals have not uniformly lost power, some have gained considerably. Explanations of the variance of impact and the substantial power shifts have to take account of a range of contextual factors. The market has not had a major impact on the technical autonomy of the doctors. Consequential structural changes have produced a new category of professional managers who are actively managing their colleagues' performance.