School of Government

Abstract In many countries governments are recruiting the medical profession into a more active, transparent regulation of clinical practice. Consequently the medical profession adapts the ways it regulates itself and its relationship to health system managers changes. This paper uses empirical research in English Primary Care Groups (PCGs) and Primary Care Trusts (PCTs) to assess the value of Courpasson's concept of soft bureaucracy as a conceptualisation of these changes. Clinical governance in PCGs and PCTs displays important parallels with governance in soft bureaucracies, but the concept of soft bureaucracy requires modification to make it more applicable to general practice. In English primary care, governance over rank-and-file doctors is exercised by local professional leaders rather than general managers, harnessing their colleagues’ perception of threats to professional autonomy and self-regulation rather than fears of competition as the means of ‘soft coercion’.

A suitable correlation can be made to represent the simulated distillation of heavy oils starting from thennoaravimetric measurements. This method is applicable to hydrocarbons having an initial boiling point equal or greater than 200°C.The simulated thermogravimetric distillation fit was obtained from experiments with the standard compounds obtained from ASTM D-2887-83 (Boiling range distribution of petroleum fractions by gas chromatography). This method is simple, fast and without problems when applied to heavy feedstocksThe data were used in the determination of average boiling temperatures of products from thermal cracking and thermal hydrocracking. It was also possible to quantify coke yieldsAverage relative molecular masses of products from the above processes correlated well with the average boiling point temperatures. It indicates that, with respect to the hydrocarbon types, thermal cracking is not selective in comparison with thermal hydrocrackingThe equation applied to find the average boiling temperature is following: T = (1/al) (Ttg-a2). T is the boiling temperature, al and a2 are the correction factors, Ttg is the thermogravimetric temperature.

In many countries health policy and health system reforms are giving primary health care (PHC) a more prominent role in the health system. As a result, policy towards PHC is becoming more contested and is posing bigger and more contradictory demands of PHC (e.g. that PHC should at once be more accessible and of higher quality and cheaper). International and professional bodies have responded to the debates about what the role of PHC should be partly by promulgating redefinitions of ‘primary health care’. However, such definitions tend simply to assert a policy standpoint of their own, thereby begging the policy questions noted above. This paper tests some better-known current definitions of ‘primary health care’ against various criteria of validity, including the requirement not to prejudge the aforementioned policy debates. It then constructs a fresh definition from the materials which survive that test and from a general theory of the function of health care. The resulting definition is: Primary health care: goods or services which individuals obtain for maintaining their personal functioning or preventing pain; which they can access directly and receive in settings which allow them to continue their other normal activities of daily life at home and (when applicable) at work. Whilst its present conclusions relate specifically to PHC, the paper’s method for generating and testing definitions applies to health services research generally.