Outline of My PhD


The impact of NHS Direct on primary care services in the United Kingdom has been the subject of on-going debate. The main purpose of this research is to investigate the changing inter-relationship between NHS Direct and Primary care during the decade from the inception of NHS Direct to the present. The primary purpose of the research is to develop a commentary on the dynamic and systemic nature of such innovations and hence to inform future initiatives within the public sector.

The key objectives of the research, are to investigate, by using NHS Direct as a case study, the changing relationship between a system innovation and the wider context, in this case the healthcare system..

The investigation will take place within a systemic framework .i.e. the investigation will focus on different aspects of NHS Direct and the changing relationship between NHS Direct and Primary Care over a period of 10 years. The study is in two parts: The first phase, undertaken in 2000/1 involved interviewing representatives of four Primary Care Groups and the development of systemic models of the differing perspectives of the various.

Phase 2 seeks to capture current perspectives in what are now merged Primary Care Trusts. In this part of the study, a series of interviews with key stakeholders will be used to capture the various perspectives of Primary Care professionals on the impact of NHS Direct 10 years after it became fully operational.

Finally the project will endeavour to develop a commentary that informs decision making and management processes related to the introduction of systems within the public sector.

What is the purpose of the research?

This project, which is being undertaken as part of my PhD studies, will look at NHS Direct, over a period of 10 years, and its impact on two primary care organizations within the NHS.

NHS Direct was set up in 1998 and by 2000 it became nationwide. It is the world’s largest provider of telephone and online healthcare advice receiving 3.5 million calls in 2001 (NAO 2002). The reported impact of the service on the related organizations within the NHS, such as General Practitioners and the Emergency Services, is mixed. There is evidence that NHS Direct has stemmed the upward trend in calls by patients to out-of-hours GP centres but not to the emergency services (NAO 2002). The wider picture from the medical press and reports from GPs is more mixed despite a favourable report in 2002 (NAO 2002).

This research will look at how the inter-relationship between NHS Direct and Primary Care, in particular, has changed and evolved in the context of wider environmental changes within the NHS.

The fieldwork is in two phases. Phase 1 undertaken in 2000/1, at the inception of NHS Direct, involved four Primary Care Groups: Bury North and Bury South and Trafford North and Trafford South, all in the North West of England. Organisational changes in the NHS have resulted in the merger of these 4 primary care groups into two Primary Care Trusts. Phase 2 of the fieldwork will begin in September. It examines how the inter-relationship between NHS Direct and these two Primary Care Trusts has changed since its inception and how this has been influenced and accommodated by the Trust Boards.

By examining the co-evolution of NHS Direct and Primary Care I aim to provide a commentary on innovation and change which will inform decision making and management processes within the public sector.

The study aims are to:
• design a systemic framework to explore the nature of PCTs and
• use the framework for investigation of response to change in particular responses to the introduction of NHS Direct and
• it’s current adoption within PCTs


3 Responses to Outline of My PhD

  1. Howard Clark says:

    Hello Ariana

    Read through your PhD outline. Have you read John Seddon’s Systems Thinking in the Public Sector? (also Freedom from Command and Control).

    John’s books will be particularly enlightening.

    As an aside, reflecting upon the subject of NHS direct, the number/volume of calls that NHS direct receives has no bearing/or relationship to the achievement of purpose.

    Are you going to understand the types of demand coming into NHS direct? Now that would be a very interesting study indeed!

  2. Ariana Yakas says:

    Thanks for your very useful comment Howard. I have not seen John Seddon’s book though as you can see from my blog I follow the website. I will have a look at it and I am sure it will complement Jake Chapman’s ‘System Failure’ which is also about the public sector.

    On the matter of whether ‘ the number of calls has no bearing on the achievement of purpose’ – I suppose that will depend on whose perspective or even worldview you apporach this. But definitely an element to keep in mind together with your comment on the types of demand.

    Once again thanks!

  3. Pingback: 2010 in review | My PhD Diary

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