Drinkwater, J orcid.org/0000-0003-1034-0781, Salmon, P, Langer, S et al. (4 more authors) (2013) Operationalising unscheduled care policy: a qualitative study of healthcare professionals’ perspectives. British Journal of General Practice, 63 (608). e192-e199. ISSN 0960-1643
Abstract
Background: UK health policy aims to reduce the use of unscheduled care, by increasing proactive and preventative management of patients with long-term conditions in primary care.
Aim: The study explored healthcare professionals’ understanding of why patients with long-term conditions use unscheduled care, and the healthcare professionals’ understanding of their role in relation to reducing the use of unscheduled care.
Design and setting: Qualitative study interviewing different types of healthcare professionals providing primary care or unscheduled care services in northwest England.
Method: Semi-structured interviews were conducted with 29 healthcare professionals (six GPs; five out-of-hours GPs; four emergency department doctors; two practice nurses; three specialist nurses; two district nurses; seven active case managers). Data were analysed using framework analysis.
Results: Healthcare professionals viewed the use of unscheduled care as a necessary component of care for patients with long-term conditions. Those whose roles involved working to targets to reduce the use of unscheduled care described a tension between this and delivering optimum patient care. Three approaches to reducing unscheduled care were described: optimising the system; negotiating the system; and optimising the patient.
Conclusion: Current policy to reduce the use of unscheduled care does not take account of the perceptions of the healthcare professionals who are expected to implement them. Lipsky’s theory of street-level bureaucrats provides a framework to understand how healthcare professionals respond to imposed policies. Healthcare professionals did not see the use of unscheduled care as a problem and there was limited commitment to the policy targets. Therefore, policy should aim for whole-system change rather than reliance on individual healthcare professionals to make changes in their practice.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Keywords: | general practice; healthcare systems; out-of-hours medical care; policy; primary health care |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Psychiatry and Behavioural Sciences (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 08 Apr 2019 15:12 |
Last Modified: | 08 Apr 2019 15:12 |
Status: | Published |
Publisher: | Royal College of General Practitioners |
Identification Number: | 10.3399/bjgp13X664243 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:116143 |