This study aims to examine the impact of the NHS Reforms on doctors and nurses in two North London hospitals, in relation to both changes to the nature of professional practice, and the effect on quality of care offered by professionals to their patients.\ud
A case study approach is utilised, combining quantitative and qualitative methodologies to explore the consequence of the policy implementation. A survey was carried out to examine the nature and scope of the effects on professional practice, of the NHS Reforms, and to collate examples of improvements and deteriorations in quality of care offered to patients. In-depth interviews were carried out with senior managers in both hospitals and also their purchasing Health Authority, to identify key features of the policy implementation process. In-depth interviews were also carried out with doctors and nurses in both hospitals, working in a range of clinical specialities to explore the experience of professional practice within a changing policy environment. It emerged that there was a shared experience, across both hospitals and professions, of increasing levels of stress, increasing workload and increasing levels of conflict with managers. There is evidence of both improvements and deteriorations in the quality of care offered to patients, but whereas improvements were largely related to the quality element of structure, the deteriorations were closely related to the process element. Analysis of the interview data revealed three distinct responses by professionals to the NHS Reforms, and these related to the differing values and belief systems which were held. Two groups of professionals – the Traditional and the Transformed - have adapted to the changing milieu of the NHS, but the third - the Transitional - have become disenfranchised from the system within which they practice