Improving quality in general practice: qualitative case study of barriers faced by health authorities

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Abstract
Objectives: To identify and assess the barriers that health authorities face as they manage quality improvements in general practice in the context of the NHS reforms. Design: Qualitative case study. Setting: Three UK health authorities: a rural health authority in the south west, a deprived inner city health authority in the north east, and an affluent suburban health authority in the south east. Participants: Senior and junior managers. Main outcome measures: Structure of strategic and organisational management, and barriers to the leadership and management of quality improvement in general practice. Results: Seven barriers were identified: absence of an explicit strategic plan for general practice, competing priorities for attention of the health authority, sensitivity of health professionals, lack of information due to poor quality of clinical data, lack of authority to implement change, unclear roles and responsibilities of managers within the organisations, and isolation from other authorities or organisations facing similar challenges. Conclusions: The health authorities faced significant barriers that would impede their ability to fulfil their responsibilities in the new NHS and that would reduce their capacity to contribute to quality improvements in general practice. Health authorities fail to take a strategic approach to improving quality in general practice Doctors and health authority managers do not work sufficiently closely together to improve the quality of general practice Health authority managers seem to lack the authority and organisational structure to maximise the role in general practice expected of them in the NHS reforms