Improving quality in general practice: qualitative case study of barriers faced by health authorities.
OBJECTIVE
To identify and assess the barriers that health authorities face as they manage quality improvements in general practice in the context of the NHS reforms.


METHODS
Qualitative case study.


METHODS
Three UK health authorities: a rural health authority in the south west, a deprived inner city health authority in the north east, and an affluent suburban health authority in the south east.


METHODS
Senior and junior managers.


METHODS
Structure of strategic and organisational management, and barriers to the leadership and management of quality improvement in general practice.


RESULTS
Seven barriers were identified: absence of an explicit strategic plan for general practice, competing priorities for attention of the health authority, sensitivity of health professionals, lack of information due to poor quality of clinical data, lack of authority to implement change, unclear roles and responsibilities of managers within the organisations, and isolation from other authorities or organisations facing similar challenges.


CONCLUSIONS
The health authorities faced significant barriers that would impede their ability to fulfil their responsibilities in the new NHS and that would reduce their capacity to contribute to quality improvements in general practice.
Institute of General Practice, Postgraduate School of Medicine and Health Sciences, University of Exeter, Exeter EX2 5DW. m.n.marshall@exeter.ac.uk
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D005194:Family Practice / Q000592:standards*; D006801:Humans; D019982:Organizational Case Studies; D011785:Quality Assurance, Health Care; D019035:Rural Health Services / Q000592:standards*; D012959:Socioeconomic Factors; D013222:State Medicine / Q000458:organization & administration / Q000592:standards*; D006113:United Kingdom; D019037:Urban Health Services / Q000592:standards*