University of Toronto, Toronto, Ontario, Canada.
Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.
Br J Gen Pract. 2017 Nov;67(664):e764-e774. doi: 10.3399/bjgp17X692597. Epub 2017 Sep 11.
Primary care practices are increasingly working in larger groups. In 2009, all 36 primary care practices in the London borough of Tower Hamlets were grouped geographically into eight managed practice networks to improve the quality of care they delivered. Quantitative evaluation has shown improved clinical outcomes.
To provide insight into the process of network implementation, including the aims, facilitating factors, and barriers, from both the clinical and managerial perspectives.
A qualitative study of network implementation in the London borough of Tower Hamlets, which serves a socially disadvantaged and ethnically diverse population.
Nineteen semi-structured interviews were carried out with doctors, nurses, and managers, and were informed by existing literature on integrated care and GP networks. Interviews were recorded and transcribed, and thematic analysis used to analyse emerging themes.
Interviewees agreed that networks improved clinical care and reduced variation in practice performance. Network implementation was facilitated by the balance struck between 'a given structure' and network autonomy to adopt local solutions. Improved use of data, including patient recall and peer performance indicators, were viewed as critical key factors. Targeted investment provided the necessary resources to achieve this. Barriers to implementing networks included differences in practice culture, a reluctance to share data, and increased workload.
Commissioners and providers were positive about the implementation of GP networks as a way to improve the quality of clinical care in Tower Hamlets. The issues that arose may be of relevance to other areas implementing similar quality improvement programmes at scale.
初级保健实践越来越多地以更大的团队形式开展工作。2009 年，伦敦塔哈姆雷特区的所有 36 家初级保健诊所都按照地理位置被分为 8 个管理实践网络，以提高他们提供的医疗服务质量。定量评估显示，临床结果得到了改善。
从临床和管理角度深入了解网络实施的过程，包括目标、促进因素和障碍。
这是一项对伦敦塔哈姆雷特区网络实施情况的定性研究，该地区服务的人群社会地位较低，种族多样化。
对医生、护士和管理人员进行了 19 次半结构化访谈，并参考了关于综合医疗保健和全科医生网络的现有文献。对访谈进行了记录和转录，并采用主题分析方法对新出现的主题进行了分析。
受访者一致认为，网络改善了临床护理，并减少了实践绩效的差异。网络的实施得到了平衡，即“既定结构”和网络自主权之间的平衡，以采用本地解决方案。更好地利用数据，包括患者召回和同行绩效指标，被视为关键的关键因素。有针对性的投资提供了实现这一目标所需的资源。实施网络的障碍包括实践文化的差异、不愿分享数据以及工作量增加。
塔哈姆雷特区的医疗保健委员会和提供者对实施全科医生网络作为改善临床护理质量的一种方式持积极态度。在其他地区大规模实施类似质量改进计划时，可能会出现这些问题。
