Linking professional organisations of health care to patients’ perceptions and experiences of chronic illness. A discussion of health services for type 2 diabetes in Scottish primary care.

Abstract

UK Health policy over the past decade has sought to accelerate established trends of moving services for type 2 diabetes into primary care. This has aimed to make services more accessible and to enable patients to benefit from having their diabetes care incorporated into the “generic and holistic” approach of primary care. However, in 2004 the introduction of a new General Medical Services (nGMS) contract signalled a change in primary care by linking clinical targets to financial rewards on a larger scale than ever before. Diabetes is one of nineteen financially incentivised clinical areas under the nGMS contract (2006). This thesis considers how these health policies may have influenced the organisation and experience of providing and receiving care for type 2 diabetes in Scottish primary care settings. It also aims to bridge two usually separate areas of sociological interest: how health professionals interpret and implement policy, and how patients experience and perceive chronic illness and their health care. A multiple case study approach was employed in order to compare and explore the organisation and experience of type 2 diabetes care associated with three general practices of differing size and location. In each case study a period of non participant observation was undertaken and in-depth interviews conducted with health professionals and their type 2 diabetes patients. Analysis of these data shows that multiple factors influence the way diabetes care is organised and experienced in primary care. I argue that the local context of interpersonal relationships of trust, professional identities and role expectations influence both the organisation of care and the way patients interpret that organisation. Moreover, the meanings patients attribute to the local organisation of diabetes care can inform their perceptions of their condition and influence their desire to be involved in diabetes management.