The implementation of priority setting. GP gatekeepers between health authorities and health care users.

The Norwegian health care system is increasingly dependent on the general practitioner (GP) gatekeeper function for cost containment and fair and effective resource allocation, and the same development is seen in many other countries with a gatekeeper sys tem. The GP is expected to act as a rationing agent on behalf of society and to adhere to governmental guidelines for prescriptions and referrals. At the same time the power and rights of patients have been strengthened through several organisational and legal reforms encouraging the doctors to share decisions with patient. There is an inherent dilemma in this situation, which emerges in the GP?s everyday role as gatekeeper. This calls for increased understanding of how GPs? allocative decision making tak es place between governmental control and user participation. GPs have traditionally enjoyed extensive professional freedom. However this freedom is being threatened from at least two sides, leading to an ongoing negotiation of professional freedom in eve ryday general practice. Hitherto there has been little debate about the conflicting terms of priority setting (practice guidelines) on the one hand and principles of user participation and patients? rights on the other (shared decision making). This is pr obably linked to a lack of research on how GPs relate to different influences on their decision making. The project will explore the GP?s gatekeeper role in two comparative settings (Norway and UK) to gain an understanding of how GPs balance conside rations of professional autonomy with the demands of governmental control and user participation. To achieve this aim we will conduct focus group interviews with GPs in Norway and the UK. Key issues will be attitude to practice guidelines and user parti cipation. In order to gain a picture of the present knowledge of GP adherence to guidelines in different countries, we will also carry out a systematic review of the qualitative literature on this subject.