ABSTRACT
Primary care professionals in England have experienced a rapid journey following the evolution of PCTs alongside policies which have sought to develop new and more specialist roles for nurses and doctors. The rise of new local contracts with salaried options of employment has also challenged traditional independence as the NHS system has sought to bring professionals under its wing (Smith and Walshe, 2004). In the process, the involvement of clinicians, particularly GPs, in shaping and leading these new developments has been encouraged. Successive government policies have asserted the role of frontline staff in taking managerial power within a context of working to national standards and accountabilities (Department of Health, 2000, 2001a). However, whilst health professionals were attracted by the prospect of greater local autonomy, the sustainability of professional engagement becomes questionable if they must adhere to nationally-based targets and procedures (Dowling et al, 2003). Moreover, although clinicians are integral to the leadership and management of PCTs, their involvement has often been compromised by a conflict of interest between professional and organizational interests (Croxson et al, 2003).
