1. Ruth McDonald ruth.mcdonald@nottingham.ac.uk

2. Acknowledgements SDO, Department of Health, Commonwealth Fund Sudeh Cheraghi-Sohi, Martin Tickle, Martin Roland, Tim Doran, Stephen Campbell, Steve Harrison, Darren Ashcroft, Caroline Sanders, Russell Mannion, Keith Milsom.

3. Methods

4. What do we mean by professional?

5. ‘New’ professionalism? Dynamic context Changes to incentive structures Aligning payment to policy goals GP contract & Practice-based Commissioning (PBC)2004 Pharmacy contract 2005 Dental contract 2006 Policy goals multiple, complex and competing

6. GP contract Self-employed contractors (partnerships) Quality and outcomes framework (QOF) Contract with practice End to OOH Software to facilitate delivery Negotiated, ballot, own data New money, MPIG

7. Impact? Self surveillance Surveillance by others (including non doctors) Hierarchy

8. Impact? Critical of other practices Improvements in other practices Acceptance of public accountability

9. PBC GPs act as commissioners Elites & rank & file New strata Surveillance of self & by others

10. Pharmacy Professional status Business vs. public interest Control over the substance of work ‘Incomplete professionals’ (Denzin & Mettlin 1968) Subordinate to medicine Increasingly ‘corporate’ Divisions/ fragmentation

11. Professional status Conflict with business concerns overstated Knowledge imbues drug with social significance Pharmacists respond to disorder, ‘providing tools for the sick person to respond to the question “What is happening to me? What do the disordered senses of my body mean?”’ (Dingwall and Wilson 1995: 122).

12. Pharmacy contract Contractors 61% multiples (>5 pharmacies) Essential (dispensing) Enhanced (smoking cessation, minor ailments) Advanced

13. MURs Consultation room £28 per MUR Max 400 per annum Copy to GP & patient

14. MUR volumes

15. Professional status Targets for MURs Tick box MURs Home delivery of medicines Delegation to other staff Competitive market

16. Dental contract End to open ended funding End to patient registration UDAs Band 1 - Diagnosis, treatment planning and maintenance 1 UDA Band 2 – Treatment (e.g. fillings, root canal treatment, extractions) 3 UDAs Band 3 - Complex treatment that includes a lab element (e.g. bridges, crowns) 12 UDAs

17. Our findings are consistent with economic theory that suggests that No of extractions vs. year No of root-fillings vs. year

18. Summary a contribution to high levels of attainment of quality targets and a reduction, over time, in the variation in care quality related to deprivation in general medical practice increasing volumes of incentivised activities in community pharmacy a shift towards dental treatments which pay more, relative to effort expended

23. Many thanks