Shaw, SE; (2006) "Out of utopia" the (re)production of primary care research policy. Doctoral thesis , UCL (University College London).

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Abstract

This thesis challenges conventional approaches to policy analysis associated with a rational model of decision-making and shows how a discursive approach can add essential insights to contemporary policy debates. I investigate primary care research policymaking as a socially accepted set of practices, asking: what are the historical, social and ideological origins of primary care research in England? Which discourses have dominated the debate, and why? What are the tensions between discourses relating to primary care research policy and any potential means for coping with these? I draw on the theoretical and methodological approach of discourse analysis and use Parker's (1992, 2002) framework for distinguishing discourses to inform the selection and analysis of 29 policy documents (from 1971 to 2005) and 16 historical and contemporary policy stakeholders for in-depth interview. Identification of discourses is aided through importing relevant theory applying focused questions exploring the use of rhetorical devices incorporating contextual information to appreciate how and why discourses are shaped and comparing and contrasting policy language. This is brought together into a descriptive and theoretically situated account through the methodological process of writing. Findings show how primary care research policies have shaped and been shaped by prevailing discourses. Political emphasis on a primary care-led NHS in the 1990's led to increased political recognition and favourable changes in the research budget. However, the Utopian era that followed fell into decline as primary care research no longer aligned with scientific, economic and global discourses emphasising microscopic 'discovery' exploitation of information large-scale consumption and the contribution of highly technological activities to 'UK pic'. Unable to compete on these terms, primary care research has been repositioned as a strategic resource and population laboratory for epidemiological research. In addition to illuminating the emergent nature of policymaking, this work provides a useful framework for analysis of national policy.

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