Discretion drift in primary care commissioning in England: Towards a conceptualization of hybrid accountability obligations

Abstract

In the context of welfare delivery, hybrid organizations mix public and ‘new’ market, social, and professional types of mechanisms and rationales. This article contributes to our understanding of accountability within hybrid organizations by highlighting how accountability obligations can become hybrid, simultaneously formal and informal. Instead of seeing accountability as hybrid only in the sense of the coexistence of types of organizational 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 conceptualize ‘hybrid accountability obligations’ as a state whereby the nature of obligation underpinning accountability relationships is both formal-informal and vertical-horizontal concurrently. The article concludes by highlighting the consequences of this kind of hybridity, namely how it extended discretion from welfare delivery to the domain of welfare governance.