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

Background: Local Health Care Cooperatives (LHCCs) and Primary Care Groups (PCGs) reflect the continuing importance of a shift towards a 'primary care-led NHS' as a health policy goal in England and Scotland. Yet many commentators have concluded that, to date, the extent of the shift has been limited. To assess the ways in which LHCCs and PCGs might develop in the future, it is necessary to understand the progress made in moving towards a primary care-led NHS and the factors that have either encouraged or hindred its development. 

Aim: To investigate the nature of, the barriers to, and the incentives encouraging the shift towards a primary care-led NHS. Design of study: Qualitative study using semi-structured interviews. 

Setting: Purposive sample of key stakeholders in health authorities, trusts, and primary care in four urban health authorities (two in Scotland and two in England). 

Method: The interviews discussed the commissioning types, the nature and scale of shifts that had occurred, the barriers to and the factors promoting the shift, the mechanisms for discussing and monitoring the shifts that were taking place and the likely impact of LHCCs and PCGs, in relation to three common conditions: inguinal hernia, stroke, and asthma. 

Results: Shifts in activity from secondary to primary care were regarded as small, non-strategic, piecemeal, and not directly underpinned by resource shifts. Barriers identified by responders include the immobility of existing resources, concerns in the primary and secondary care sectors about the appropriateness of the shift, weak incentives supporting the shift, the perspectives of general practitioners involved in commissioning, and the absence of co-operation between key stakeholders. 

Conclusion: The development of a primary care-led NHS needs to resolve a fundamental tension at the heart of the policy: those to whom power was devolved were neither equipped nor minded to engineer the strategic resource shifts necessary to underpin a more primary care-based NHS.