RT Journal Article
SR Electronic
T1 Building managed primary care practice networks to deliver better clinical care: a qualitative semi-structured interview study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e764
OP e774
DO 10.3399/bjgp17X692597
VO 67
IS 664
A1 Jasmine Pawa
A1 John Robson
A1 Sally Hull
YR 2017
UL http://bjgp.org/content/67/664/e764.abstract
AB Background Primary care practices are increasingly working in larger groups. In 2009, all 36 primary care practices in the London borough of Tower Hamlets were grouped geographically into eight managed practice networks to improve the quality of care they delivered. Quantitative evaluation has shown improved clinical outcomes.Aim To provide insight into the process of network implementation, including the aims, facilitating factors, and barriers, from both the clinical and managerial perspectives.Design and setting A qualitative study of network implementation in the London borough of Tower Hamlets, which serves a socially disadvantaged and ethnically diverse population.Method Nineteen semi-structured interviews were carried out with doctors, nurses, and managers, and were informed by existing literature on integrated care and GP networks. Interviews were recorded and transcribed, and thematic analysis used to analyse emerging themes.Results Interviewees agreed that networks improved clinical care and reduced variation in practice performance. Network implementation was facilitated by the balance struck between ‘a given structure’ and network autonomy to adopt local solutions. Improved use of data, including patient recall and peer performance indicators, were viewed as critical key factors. Targeted investment provided the necessary resources to achieve this. Barriers to implementing networks included differences in practice culture, a reluctance to share data, and increased workload.Conclusion Commissioners and providers were positive about the implementation of GP networks as a way to improve the quality of clinical care in Tower Hamlets. The issues that arose may be of relevance to other areas implementing similar quality improvement programmes at scale.