Since the beginning of the 1990s the public healthcare system in England has been subject to reforms. This has resulted in a structurally hybrid system of public service with elements of the market. Utilizing a theory of new institutionalism, this article explores National Health Service (NHS) managers’ views on competition and cooperation as mechanisms for commissioning health services. We interrogate the extent of institutional change in the NHS by examining managers’ understanding of the formal rules, normative positions and frameworks for action under the regime of the Health and Social Care Act 2012. Interviews with managers showed an overall preference for cooperative approaches, but also evidence of marketization in the normative outlook and actions. This suggests that hybridity in the NHS has already spread from structure and rules to other institutional pillars. The study showed that managers were adept at navigating the complex policy environment despite its inherent contradictions.
- How are CCGs managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis
- Inside the mindset of NHS managers
- Commissioning through competition and cooperation in the English NHS under the Health and Social Care Act 2012: evidence from a qualitative study of four clinical commissioning groups
- PRUComm Research Review 2017
- Commissioning for health improvement following the 2012 health and social care reforms in England: what has changed?
- Review of the Quality and Outcomes Framework in England
- Improving GP recruitment and retention needs a long-term strategy
- Alliance contracting, prime contracting and outcome based contracting: What can the NHS learn from elsewhere? A literature review
- PRUComm Research Review August 2016
- Public Health and Obesity in England – the New Infrastructure Examined