title: Joining them up: the challenges of organisational change in the professional politic of general practice.
abstract: Primary health care in the UK is currently centred around independent contractor organisations (general practices). Although the development of these organisations is considered necessary to improve the quality of health care, no structures exist to support the systematic development necessary to attain this goal. Part of the failure to change clinical processes has been the requirement that general practitioners attend passive educational events for continuing professional development, without reference to organisational or local health priorities. A feasibility study to integrate professional and practice development planning sought to overcome this mismatch. NHS Staff College Wales, as a facilitating organisation in this study, developed a model to assist practices to identify, prioritise and implement developments, interlinked with individuals' professional development. The paper summarises the experiences of facilitators supporting this integrated approach, using Senge's model of the challenges to the successful implementation of change. The role of facilitation in negotiating these challenges is also explored. The paper concludes that the approach is effective in the integration of professional and practice development and offers a useful framework to progress the quality improvement agenda.
authors.affiliation: Primary Care Development Team, NHS Staff College Wales, Hensol Castle, Pontyclun, Mid Glamorgan CF72 8YS, UK. Aburtonwood@staffcollegewales.org.uk
authors.forename: A M
authors.initials: AM
authors.lastname: Burtonwood
authors.forename: P J
authors.initials: PJ
authors.lastname: Hocking
authors.forename: G
authors.initials: G
authors.lastname: Elwyn
mesh_terms: D003299:Cooperative Behavior; D005194:Family Practice / Q000458:organization & administration*; D017146:Models, Organizational; D009936:Organizational Innovation; D013222:State Medicine / Q000458:organization & administration; D006113:United Kingdom