THE CONTEST FOR CONTROL IN COMMUNITY-HEALTH SERVICES - GENERAL MANAGERS AND PROFESSIONALS DISPUTE DECENTRALIZATION

General Managers (GMs) represent a relatively new cadre in the British National Health Service (NHS) who have become closely aligned with central government policy in recent years. GMs have increasingly been appointed to local levels in the NHS which could potentially lead to a clash with other professional domains. This paper uses the example of a decentralisation policy to trace the contest between GMs and professionals during its implementation. The paper focuses on Community Health Services (CHS) where the negotiated order of the hospital does not apply, where professional interests are more fluid and where organisational boundaries are ill-defined. It concludes that, at the local level, GMs are not simply agents of the centre but actively negotiate with other stakeholders and modify the policy according to local exigencies. The conclusion explores the implications for CHS of locally and centrally inspired policy initiatives and the place of CHS in the emerging mixed economy of welfare.