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dc.contributor.authorHamilton, Sonya
dc.contributor.authorHuby, Guro
dc.contributor.authorTierney, Alison
dc.contributor.authorPowell, Alison
dc.contributor.authorKielmann, Tara
dc.contributor.authorSheikh, Aziz
dc.contributor.authorPinnock, Hilary
dc.date.accessioned2012-11-16T16:31:03Z
dc.date.available2012-11-16T16:31:03Z
dc.date.issued2008-12-04
dc.identifier.citationHamilton , S , Huby , G , Tierney , A , Powell , A , Kielmann , T , Sheikh , A & Pinnock , H 2008 , ' Mind the gap between policy imperatives and service provision : a qualitative study of the process of respiratory service development in England and Wales ' , BMC Health Services Research , vol. 8 , 248 . https://doi.org/10.1186/1472-6963-8-248en
dc.identifier.issn1472-6963
dc.identifier.otherPURE: 15180153
dc.identifier.otherPURE UUID: 5b30b83d-92b4-48dc-92c4-4ee115add799
dc.identifier.otherWOS: 000263182300001
dc.identifier.otherScopus: 60149083370
dc.identifier.urihttp://hdl.handle.net/10023/3255
dc.descriptionThe research was funded by the National Institute for Health Research Service Delivery and Organisation Programme. SDO/99/2005.en
dc.description.abstractBackground: Healthcare systems globally are reconfiguring to address the needs of people with long-term conditions such as respiratory disease. Primary Care Organisations (PCOs) in England and Wales are charged with the task of developing cost-effective patient-centred local models of care. We aimed to investigate how PCOs in England and Wales are reconfiguring their workforce to develop respiratory services, and the background factors influencing service redesign. Methods: Semi-structured qualitative telephone interviews with the person(s) responsible for driving respiratory service reconfiguration in a purposive sample of 30 PCOs. Interviews were recorded, transcribed, coded and thematically analysed. Results: We interviewed representatives of 30 PCOs with diverse demographic profiles planning a range of models of care. Although the primary driver was consistently identified as the need to respond to a central policy to shift the delivery of care for people with long-term conditions into the community whilst achieving financial balance, the design and implementation of services were subject to a broad range of local, and at times serendipitous, influences. The focus was almost exclusively on the complex needs of patients at the top of the long-term conditions (LTC) pyramid, with the aim of reducing admissions. Whilst some PCOs seemed able to develop innovative care despite uncertainty and financial restrictions, most highlighted many barriers to progress, describing initiatives suddenly shelved for lack of money, progress impeded by reluctant clinicians, plans thwarted by conflicting policies and a PCO workforce demoralised by job insecurity. Conclusion: For many of our interviewees there was a large gap between central policy rhetoric driving workforce change, and the practical reality of implementing change within PCOs when faced with the challenges of limited resources, diverse professional attitudes and an uncertain organisational context. Research should concentrate on understanding these complex dynamics in order to inform the policymakers, commissioners, health service managers and professionals.
dc.format.extent11
dc.language.isoeng
dc.relation.ispartofBMC Health Services Researchen
dc.rights© 2008 Hamilton et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.en
dc.subjectRandomized controlled-trialen
dc.subjectGeneral-Practitionersen
dc.subjectCareen
dc.subjectUKen
dc.subjectOrganizationsen
dc.subjectHealthen
dc.subjectGPen
dc.subjectRA0421 Public health. Hygiene. Preventive Medicineen
dc.subject.lccRA0421en
dc.titleMind the gap between policy imperatives and service provision : a qualitative study of the process of respiratory service development in England and Walesen
dc.typeJournal articleen
dc.description.versionPublisher PDFen
dc.contributor.institutionUniversity of St Andrews. School of Managementen
dc.identifier.doihttps://doi.org/10.1186/1472-6963-8-248
dc.description.statusPeer revieweden


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