A subtle governance: 'Soft' medical leadership in English primary care

R. Sheaff, A. Rogers, S. Pickard, M. Marshall, S. Campbell, B. Sibbald, S. Halliwell, M. Roland, William Sheaff

Research output: Contribution to journalArticlepeer-review


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'.
Original languageEnglish
Pages (from-to)408-428
Number of pages20
JournalSociology of Health and Illness
Issue number5
Publication statusPublished - Jul 2003


  • Clinical governance
  • England
  • Networks
  • NHS
  • Primary care
  • Professions
  • Soft bureaucracy


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