Fowler Davis Sally, Piercy Hilary, Pearson Sarah, Thomas Ben, Kelly Shona
Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
Centre for Regional, Economic and Social Research, Sheffield Hallam University, Sheffield, UK.
BMJ Open. 2018 Mar 3;8(3):e019084. doi: 10.1136/bmjopen-2017-019084.
To report general practitioners' (GPs') views and experiences of an Enhanced Primary Care programme (EPCP) funded as part of the Prime Minister's Challenge Fund (second wave) for England which aimed to extend patient access to primary care.
Primary care in Sheffield, England.
Semi-structured interviews with a purposive sample of GPs working in 24 practices across the city.
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 access that aimed to reduce emergency department and hospital admissions. 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.
The variation in practice engagement and capacity to manage changes in primary care services warrants a subtle and specialist approach to programme planning. The study makes the case for enhanced planning and organisational development with GPs as stakeholders within individual practices and groups. This would ensure that policy implementation is effective and sustained at local level. A failure to localise implementation may be associated with increased workloading 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 identify the best methods to engage GPs in programme planning and evaluation.
报告作为英国首相挑战基金（第二轮）一部分资助的强化初级保健计划（EPCP）中全科医生（GP）的观点和经验，该计划旨在扩大患者获得初级保健的机会。
英国谢菲尔德的初级保健。
对全市24家诊所工作的全科医生进行有目的抽样的半结构化访谈。
得出四个核心主题：全科医生对EPCP目标的接受度、他们支持综合护理团队的能力、他们管理紧急护理的能力以及一些新的基于社区的计划对加强基于地区的初级保健的价值。全科医生了解与非工作时间就诊相关的政策举措，这些举措旨在减少急诊科就诊和住院人数。由于应对该计划的能力有限，他们选择了与当地患者需求直接相关且不会增加自身工作量的要素。
实践参与度和管理初级保健服务变化的能力存在差异，这就需要在项目规划中采取微妙且专业的方法。该研究表明，应加强以全科医生为个体诊所和团体中利益相关者的规划和组织发展。这将确保政策在地方层面有效且持续实施。未能进行本地化实施可能会导致初级保健工作量增加，而患者和公众却无法持续受益。为使全科医生参与系统转型，需要进一步研究以确定让全科医生参与项目规划和评估的最佳方法。
