Communications in general practice and the domestication of ICT

The NHS is currently being transformed by the implementation of the National Programme for Information Technology (NPfIT). This thesis examines the use of Information Communications Technology (ICT) and its consequences for communications in general practice. While drawing on a range of social scientific approaches to ICT, this research explores the particular utility of the 'domestication' framework advanced by Silverstone and Sorensen. It considers how users in general practice 'tame' and use technology by incorporating its affordances into their work roles and communication practices.Drawing on previous survey work, this research adopts a comparative, ethnographic approach, analyzing patterns of talk and writing in two general practices in London. Empirical work involved analysis of local and national policy documentation and two ethnographic studies that were designed to identify changes in attitudes and behaviours across a defined set of actors over time. Interviews generated preliminary evidence as to how multiple users in general practice communicated by a variety of means, including the problems/concerns they encountered or created in doing so. Observation was used to gather further direct evidence of those problems as they were negotiated and resolved.Although the two cases were both of practices that had been identified in an earlier survey as 'paper-light' which might therefore have been assumed to make effective use of ICT, usage was uneven and sharp differences were noted in the way in which broadly similar technologies were domesticated by specific user groups. Analysis of these differences produced three key findings. Firstly, domestication of ICT in general practice is difficult. To be successfully domesticated, ICTs have to be locally negotiated both horizontally and vertically in order to connect with working practices of the individual users. Secondly, the struggle to 'tame' ICTs is shaped by the extent to which different groups of users perceive ICT as assisting or compromising their roles and responsibilities. This, in turn, increases the diversity between user groups. Thirdly, the research indicated the importance of local context and workplace cultures which facilitate or inhibit the negotiations or 'communications about communications' required to domesticate ICTs.A concluding discussion reflects on the changing relationship between ICTs and communications in general practice and, in particular, the impact of ICT on faceto-face communications. The key contribution of the study lies in offering a theoretically-sophisticated framework in which to examine and explicate detailed patterns of communications in general practice. By addressing both electronic and paper-based communication as well as face-to-face interaction, it provides a basis for future research in this area as NPfIT develops