Discretion Drift in Primary Care Commissioning in England: Towards a Conceptualisation of Hybrid Accountability Obligations

In the context of welfare delivery, hybrid organisations mix public and ‘new’ market, social, and professional types of mechanisms and rationales. This paper contributes to our understanding of accountability within hybrid organisations by highlighting how accountability obligations can become hybrid, simultaneously formal and informal. Instead of seeing accountability as hybrid only in the sense of the co‐existence of types of organisational mechanisms and structures (i.e., the prevalence of both state and market types), we examine accountability arrangements governing a hybrid model — primary care commissioning in England — and interrogate the relationships between accountability actors and their accountability forums. We conceptualise ‘hybrid accountability obligations’ as a state whereby the nature of obligation underpinning accountability relationships is both formal‐informal and vertical‐horizontal concurrently. The paper concludes by highlighting the consequences of this kind of hybridity accountability, namely how it extended discretion from welfare delivery to the domain of welfare governance.