Factors affecting the shift towards a 'primary care-led' NHS: a qualitative study. National Health Service

Area of Science:

• Healthcare policy and management
• Primary care development
• Health services research

Background:

• The policy goal of a primary care-led National Health Service (NHS) in England and Scotland has seen limited progress.
• Local Health Care Cooperatives (LHCCs) and Primary Care Groups (PCGs) are key initiatives within this policy shift.
• Understanding progress and barriers is crucial for future development of primary care-led models.

Purpose of the Study:

• To investigate barriers hindering the shift towards a primary care-led NHS.
• To identify incentives encouraging this healthcare policy shift.
• To explore stakeholder perspectives on primary care transformation.

Main Methods:

• Qualitative study employing semi-structured interviews with key stakeholders.
• Purposive sampling across health authorities, trusts, and primary care in urban settings (England and Scotland).
• Interviews covered commissioning, nature of shifts, barriers, facilitators, monitoring, and impact on specific conditions.

Main Results:

• Shifts in healthcare activity from secondary to primary care were minimal, non-strategic, and lacked resource underpinning.
• Identified barriers include resource immobility, sector-specific concerns, weak incentives, and lack of stakeholder cooperation.
• Stakeholder perspectives revealed challenges in devolving power without adequate capacity for strategic resource shifts.

Conclusions:

• The primary care-led NHS policy faces a core tension: devolved power without the capacity for necessary strategic resource shifts.
• Resolving this tension is essential for successful implementation of a primary care-based NHS.
• Future policy development must address the structural and incentive-related barriers to empower primary care effectively.