ABSTRACT

This chapter explores decentred theory of governance is used as a lens through which to explore the empirical puzzle posed by the success of successive governments in enrolling General Practitioners (GPs) in ‘clinically led commissioning’. It discusses whether a decentered theory of governance helps to explain the apparent ‘governability’ of GPs in England. The chapter analyses the way governing is operationalised through the interconnected micro-, meso- and macrolevels of primary care organisation. Clinically-led commissioning started in the UK in the early 1990s, with the introduction of the ‘internal market’ and the separation of purchasing of care from its provision. Governance by rules is ubiquitous throughout public and private enterprises. At the micro-level, participation has historically been encouraged via a variety of individual and practice-level incentives. At the macro level, ‘manipulated emergence’ describes an approach used by successive governments to enrol volunteers to enact policy.