Professionals: Back to the future?

This article examines empirical evidence on the impact of the introduction of a quasi-market in healthcare in the UK an professionals, especially doct ors. Data are drawn from two longitudinal studies occurring between 1990 an d 1994, of aspects of the changes to the health system. Data collection inv olved a range of methods, including observation, interviews, questionnaires and archival material. The findings show that a unilateral analysis of the impact of the quasi-market on professionals is inadequate to understand th e situation. The responses of the professionals to change have had a major influence on the outcomes. Professionals have not uniformly lost power, som e have gained considerably. Explanations of the variance of impact and the substantial power shifts have to take account of a range of contextual fact ors. The market has not had a major impact on the technical autonomy of the doctors. Consequential structural changes have produced a new category of professional managers who are actively managing their colleagues' performan ce.