title: Any qualified provider: a qualitative case study of one community NHS Trust's response.
abstract: OBJECTIVE
  To examine how those managing and providing community-based musculoskeletal (MSK) services have experienced recent policy allowing patients to choose any provider that meets certain quality standards from the National Health Service (NHS), private or voluntary sector.
  
  
  METHODS
  Intrinsic case study combining qualitative analysis of interviews and field notes.
  
  
  METHODS
  An NHS Community Trust (the main providers of community health services in the NHS) in England, 2013-2014.
  
  
  METHODS
  NHS Community Trust employees involved in delivering MSK services, including clinical staff and managerial staff in senior and mid-range positions.
  
  
  RESULTS
  Managers (n=4) and clinicians (n=4) working within MSK services understood and experienced the Any Qualified Provider (AQP) policy as involving: (1) a perceived trade-off between quality and cost in its implementation; (2) deskilling of MSK clinicians and erosion of professional values; and (3) a shift away from interprofessional collaboration and dialogue. These ways of making sense of AQP policy were associated with dissatisfaction with market-based health reforms.
  
  
  CONCLUSIONS
  AQP policy is poorly understood. Clinicians and managers perceive AQP as synonymous with competition and privatisation. From the perspective of clinicians providing MSK services, AQP, and related health policy reforms, tend, paradoxically, to drive down quality standards, supporting reconfiguration of services in which the complex, holistic nature of specialised MSK care may become marginalised by policy concerns about efficiency and cost. Our analysis indicates that the potential of AQP policy to increase quality of care is, at best, equivocal, and that any consideration of how AQP impacts on practice can only be understood by reference to a wider range of health policy reforms.
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.
authors.forename: Jackie
authors.initials: J
authors.lastname: Walumbe
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: Swinglehurst
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Shaw
mesh_terms: D001291:Attitude of Health Personnel; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D003362:Cost-Benefit Analysis; D004739:England; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D009140:Musculoskeletal Diseases / Q000628:therapy*; D020403:Patient Freedom of Choice Laws / Q000191:economics / Q000592:standards; D036301:Qualitative Research; D011787:Quality of Health Care; D013222:State Medicine / Q000331:legislation & jurisprudence*
keywords: QUALITATIVE RESEARCH