Why do some practices innovate: A qualitative study of the views of primary care professionals
De Lusignan S., Shaw A., Wells S., Rowlands G.
Background: The Personal Medical Services (PMS) contract is an innovation which allows general practices to provide locally sensitive, quality-based primary care, unlike the traditional contract based on a complex formula of fees. Aim: To determine from the primary care professionals in 33 second-wave PMS practices their perceptions of the factors associated with both positive outcomes and also with slow progress. Design: A qualitative study, adopting an iterative thematic approach. Method: Semi-structured interviews were conducted with one practice nurse, practice manager and general practitioner from each practice. Interview transcripts were analysed for emerging themes using QSR N-VIVO software. Results: Analysis of the interviews revealed a general enthusiasm for PMS by the primary care professionals. They felt that critical success factors included the provision of additional clinical staff, and a cohesive, communicative team with a visionary leader and good management systems. The perceived barriers to progress were inadequate premises and the difficulty in recruiting and retaining staff. Conclusion: PMS provides a framework for quality orientated, locally sensitive care. In the best practices it allows the development of services that cross the health and social care divide. © 2005 Radcliffe Publishing.