title: A stakeholder analysis of developments at the primary and secondary care interface.
abstract: BACKGROUND
  The interface between primary and secondary care has become a major focus of health policy debate, but the differing perspectives of stakeholders on recent developments in policy and practice have seldom been researched.
  
  
  OBJECTIVE
  To examine stakeholder perspectives on the extent of developments at the primary and secondary care interface, and the barriers and opportunities for future development.
  
  
  METHODS
  This qualitative study was based on semi-structured interviews with a purposive sample of 27 primary and secondary care stakeholders in Southampton and South West Hampshire in 1994. Respondents were asked to identify developments in seven areas: direct access, consultant outreach, shifted services, substituted services, shared care, workload shifts and communication.
  
  
  RESULTS
  Key issues were identified relating to the cultures of primary and secondary care, communication and work-load. Most respondents described an important shift in power from consultants to GPs. Although respondents identified several useful developments at the interface, including improvements in communication and increased direct access facilities, there were relatively few reports of shifts in resources and services to primary care. Respondents identified important continuing barriers to change, including the attitudes of consultants and the individualistic culture of GPs.
  
  
  CONCLUSIONS
  Policies to "shift the balance' and to further "a primary care-led NHS (National Health Service)' need to address the cultural and political factors which respondents identified as barriers to primary care development.
authors.affiliation: Institute for Health Policy Studies, University of Southampton.
authors.forename: D
authors.initials: D
authors.lastname: Evans
mesh_terms: D001291:Attitude of Health Personnel; D005194:Family Practice; D018166:Health Care Reform; D018578:Hospital-Physician Relations; D006801:Humans; D013222:State Medicine; D006113:United Kingdom