title: Factors affecting the shift towards a 'primary care-led' NHS: a qualitative study. National Health Service.
abstract: BACKGROUND
  Local Health Care Cooperatives (LHCCs) and Primary Care Groups (PCGs) reflect the continuing importance of a shift towards a 'primary care-led NHS' as a health policy goal in England and Scotland. Yet many commentators have concluded that, to date, the extent of the shift has been limited. To assess the ways in which LHCCs and PCGs might develop in the future, it is necessary to understand the progress made in moving towards a primary care-led NHS and the factors that have either encouraged or hindered its development.
  
  
  OBJECTIVE
  To investigate the nature of the barriers to, and the incentives encouraging the shift towards a primary care-led NHS.
  
  
  METHODS
  Qualitative study using semi-structured interviews.
  
  
  METHODS
  Purposive sample of key stakeholders in health authorities, trusts, and primary care in four urban health authorities (two in Scotland and two in England).
  
  
  METHODS
  The interviews discussed the commissioning types, the nature and scale of shifts that had occurred, the barriers to and the factors promoting the shift, the mechanisms for discussing and monitoring the shifts that were taking place and the likely impact of LHCCs and PCGs in relation to three common conditions: inguinal hernia, stroke, and asthma.
  
  
  RESULTS
  Shifts in activity from secondary to primary care were regarded as small, non-strategic, piecemeal, and not direct underpinned by resource shifts. Barriers identified by responders include the immobility of existing resources, concerns in the primary and secondary care sectors about the appropriateness of the shift weak incentives supporting the shift, the perspectives of general practioners involved in commissioning and the absence of co-operation between key stakeholders.
  
  
  CONCLUSIONS
  The development of a primary care-led NHS needs to resolve a fundamental tension at the heart of the policy: those to whom power was devolved were neither equipped nor minded to engineer the strategic resource shifts necessary to underpin a more primary care-based NHS.
authors.affiliation: Department of Public Health, University of Glasgow.
authors.forename: Neil
authors.initials: N
authors.lastname: Craig
authors.forename: Sandra
authors.initials: S
authors.lastname: McGregor
authors.forename: Neil
authors.initials: N
authors.lastname: Drummond
authors.forename: Moira
authors.initials: M
authors.lastname: Fischbacher
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
mesh_terms: D001249:Asthma / Q000628:therapy; D001291:Attitude of Health Personnel; D004739:England; D018166:Health Care Reform; D006552:Hernia, Inguinal / Q000628:therapy; D006801:Humans; D007407:Interviews as Topic; D009042:Motivation; D009936:Organizational Innovation; D009937:Organizational Objectives; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D012606:Scotland; D013222:State Medicine / Q000458:organization & administration*; D020521:Stroke / Q000628:therapy; D006113:United Kingdom; D019037:Urban Health Services / Q000458:organization & administration*