DECLINING PROFESSIONAL DOMINANCE - TRENDS IN THE PROLETARIANIZATION OF PRIMARY-CARE IN NEW-ZEALAND

This paper explores the relevance of the proletarianisation thesis to the emergence of new forms of managed primary care in New Zealand. Thi s concern is of particular interest because the primary care sector ha s persisted virtually unchanged, since the birth of the welfare state in 1938, despite numerous past slate attempts at reform. Since 1993 co llective action on the part of general practitioners has resulted in t he formation of Independent Practice Associations (IPAs). In terms of Light's (1993) idea of countervailing trends to proletarianisation, IP A development represents a pre-emptive strategy designed to prevent th e introduction of the kind of managerialism imposed on the secondary s ector where some loss of autonomy has been sustained by health care pr ofessionals. At the macro-level, therefore, there has been little chan ge in GP autonomy although at the micro-scale there has been some loss of freedom as the development of IPAs ironically has meant that the d egree of control by GPs over the content of their work has changed. Th e results suggest that the notion of the profession acting as a counte rvailing force has been borne out. Furthermore, the proposition inhere nt in modern organisation-environment relations literature, that organ isations not only adapt to their environment but may actively seek to change it receives some support. (C) 1998 Elsevier Science Ltd. All ri ghts reserved.