Factors affecting decisions to extend access to primary care- results of a qualitative evaluation of general practitioners views

Objectives: To report general practitioners' (GPs') views and experiences of an Enhanced Primary Care programme (EPCP) funded as part of the UK, Prime Minister's Challenge Fund (second wave) for England which aimed to extend patient access to primary care. Setting: Primary care in Sheffield, England. Participants: Semi-structured interviews with a purposive sample of GPs working in 24 practices across the city. Results: Four core themes were derived: GPs' receptivity to the aims of the EPCP,; their capacity to support integrated care teams,; their capacity to manage urgent care and the value of some new community-based schemes to enhance locality based primary care. GPs were aware of the policy- initiatives associated with out-of-hours (OOH) access to reduce emergency department and hospital admissions, but due to limited capacity to respond to the programme, they selected elements that directly related to local patient demand and did not increase their own workload. Conclusions: The variation in practice engagement and capacity to manage the intended changes in services, warrants a subtle and specialist approach to programme planning, - based on individual practices and groups. The study makes the case for enhanced planning and organisational development with GPs as stakeholders to ensure that policy implementation is effective and sustained at the local level. The risks associated with poor engagement A failure to localise implementation may be associated with increased capacity and work-loading of in primary care without the sustained benefits to patients and the public. To enable GPs to become involved in systems transformation;, further research is needed to build capacity and to identify the best methods to engage GP's them in programme planning and evaluation.