English general practice: once, twice, three times a hybrid

Miller, Robin

doi:10.1071/hc17039

Cited by 4 publications

(4 citation statements)

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“…While the NHS is traditionally thought of as a public entity, primary care organisations "straddle the public-private sector interface" [23]. For example, general practices are usually small businesses owned by GPs, which combine public sector funding (from general taxation), private ownership by GPs and personal profit.…”

Section: Complexity Of the Uk Primary Health Care Systemmentioning

confidence: 99%

Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: a systematic review

et al. 2020

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Background: Normalisation Process Theory (NPT) provides a framework to understand how interventions are implemented, embedded, and integrated in healthcare settings. Previous reviews of published literature have examined the application of NPT across international healthcare and reports its benefits. However, given the distinctive clinical function, organisational arrangements and the increasing management of people with a wide variety of conditions in primary care settings in the United Kingdom, it is important to understand how and why authors utilise and reflect on NPT in such settings to inform and evaluate implementation processes. Methods: A systematic review of peer-reviewed literature using NPT in primary care settings in the United Kingdom (UK) was conducted. Eight electronic databases were searched using replicable methods to identify articles published between January 2012 and April 2018. Data were analysed using a framework approach. Results: Thirty-one articles met the inclusion criteria. Researchers utilised NPT to explore the implementation of interventions, targeting a wide range of health services and conditions, within primary care settings in the UK. NPT was mostly applied qualitatively; however, a small number of researchers have moved towards mixed and quantitative methods. Some variation was observed in the use of NPT constructs and sub-constructs, and whether and how researchers undertook modification to make them more relevant to the implementation process and multiple stakeholder perspectives. Conclusion: NPT provides a flexible framework for the development and evaluation of complex healthcare interventions in UK primary care settings. This review updates the literature on NPT use and indicates that its application is well suited to these environments, particularly in supporting patients with long-term conditions and co-morbidities. We recommend future research explores the receipt of interventions by multiple stakeholders and suggest that authors reflect on justifications for using NPT in their reporting.

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Section: Complexity Of the Uk Primary Health Care Systemmentioning

confidence: 99%

Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: a systematic review

et al. 2020

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“…GPs have a hybrid status that is unusual in the UK NHS as it combines private profit with public sector benefits [12]. This means that GPs are generally not directly managed by government and instead policy makers have to deploy other levers.…”

Section: Introduction and National Contextmentioning

confidence: 99%

Transforming Integration through General Practice: Learning from a UK Primary Care Improvement Programme

Miller

2018

International Journal of Integrated Care

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This article addresses the challenge of how to implement integration within primary care services. It shares learning from a UK based improvement programme which reflected international interest in transferring activities from hospital and community and developing holistic primary care that responds to the needs of the local community. Programme components included additional per capita funding for involved practices, monthly learning sets between pilot leads, and a formative evaluation. Practices had flexibility in how to use the additional funding to meet local needs and were selected through a competitive process. The programme successfully delivered diagnostic and treatment activities previously provided in acute hospital. Some practices also introduces new holistic approaches which were mostly sustained at the end of the twelve month period. The programme demonstrates that transformation of primary care requires a change in the internal paradigms held by clinicians and purchasers, careful design of learning opportunities, responding to multiple levels of motivation, and deployment of relevant change infrastructures and improvement methodologies.

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“…Nationally, the landscape of primary care provision is changing. There are increasing examples of organisations that have enabled practices to work together in different formats, either under umbrella organisations, or as a larger organisation (Pettigrew et al , 2016; Miller, 2017). In the NHS in England, three-quarters of practices are now working collaboratively in larger scale organisations (Pettigrew et al , 2016).…”

Section: Discussionmentioning

confidence: 99%

System wide collaboration? Health and social care leaders’ perspectives on working across boundaries

Shand

Turner

2019

JICA

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Purpose Structural integration is increasingly explored as a means of achieving efficiency gains alongside improved health outcomes. In 2015, three boroughs in London, England began working together to develop an Accountable Care Organisation for the 750,000 population they serve. The purpose of this paper is to understand the experiences of working across organisational and sectoral boundaries for the benefit of the population, including enablers and barriers encountered, the role of financial incentives and perspectives on Accountable Care Organisations. Design/methodology/approach A single site instrumental case study involving 35 semi-structured interviews using a topic guide, with key leaders and decision makers from the site and nationally, between April 2016 and August 2016. Findings There are differences in levels of autonomy and operational priorities between councils and the NHS. Existing financial mechanisms can be used to overcome sectoral boundaries, but require strong leadership to implement. There are challenges associated with primary care participating in integration, including reluctance for small organisations to adopt the risk associated with large scale programmes. Interviewees were aligned on espoused ambitions for the Accountable Care Organisation but not on whether one organisation was needed to deliver these in practice. Research limitations/implications Progressing the integration agenda requires consideration of the context of primary care and the core differences between health and government. Further, research into ACOs is required as they may not be required to deliver the anticipated integration and system outcomes. Understanding if there are specific population groups for whom cross-organisation and cross-sector working could have particular benefits would help to target efforts. Originality/value This paper highlights some of the challenges associated with cross-sector collaboration.

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English general practice: once, twice, three times a hybrid

Cited by 4 publications

References 10 publications

Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: a systematic review

Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: a systematic review

Transforming Integration through General Practice: Learning from a UK Primary Care Improvement Programme

System wide collaboration? Health and social care leaders’ perspectives on working across boundaries

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