Analysing Structural Interests in Primary Care Groups

Alford's theory of structural interests in health care has been used as a heuristic device both in the USA and the UK. Despite concerns about its heuristic power it provides a lucid analytical framework and is helpful in exposing the structural interests that underpin political processes in health systems. To date its application in the UK has been primarily in relation to an NHS dominated by health authorities and hospital providers. Recent reforms in the UK have created a new context dominated by primary care organizations. In this paper we identify the key players in English primary care groups as they relate to Alford's structural interest groups: the professional monopolizers, corporate rationalizers and community. The paper outlines the context of the involvement of the key groups and then analyses the relationships between them. In doing so it raises concerns about the structure and purpose of primary care groups and the probability that key tensions between general practitioners who adopt a corporate rationalizer role and those who retain a professional monopolizer role will be damaging to the progress and development of PCGs. Our analysis also highlights the continuing weakness of the community as an interest group despite the emphasis on involving patients and the public. Importantly, we would suggest that the professional monopolizers among GPs will retain a powerful voice, countering the new corporate rationalizers and continuing to claim that they represent the community's interests.