TY - JOUR
AU - Jackson Am
AU - C. Nicholson
AU - J. Job
AU - J. Sussex
AU - S. Morris
A1 - 
AB - BACKGROUND: Since the Declaration of Alma-Ata in 1978 (1) global health policy has prioritised primary and integrated care reform to better manage chronic illness, improve health access, and prevent disease.(2) Yet internationally primary care, like the health systems it struggles to support, is currently far from strengthened; and is increasingly challenged by chronic underfunding, lack of recognition, and a diminishing and demoralised workforce.(3,4) AIM: To better understand the policy barriers responsible for the current status from the perspective of general practice in England DESIGN & SETTING: Key Informant Interviews with 12 general practice policy or practice leaders identified from publicly-available position statements, publications or innovative programs in UK primary care reform over the past decade METHOD: A qualitative deductive approach using thematic analysis to analyse informant data to understand historical barriers and explore enablers for future reform. RESULTS: The analysis resulted in eight main themes. 1. Dynamics of power and autonomy 2. Under-investment in primary care 3. Aligning policy and implementation 4. Navigating complexity and change 5. Building trust through relationships and leadership 6. The revolving door of policy and leadership 7. Valuing the workforce: A key to morale and retention 8. Strategic communication and media engagement CONCLUSION: Better-targeted funding reform, more effective systems integration building on general practice and community service strengths, and better valuing the complex role of the primary care sector as central to a high-functioning health system, were seen as key to the future. Participants also called for more effective policy input from those skilled in the delivery of care, and the capacity for earned autonomy and flexibility to deliver care relevant to individual community need. Action to address these opportunities is pressing, as finalisation of the 10 Year Health Plan and more-immediate NHS restructure rapidly gathers momentum.
AD - University of Queensland, Health Sciences Building Royal Brisbane Hospital, Herston, Brisbane Qld, Australia c.jackson@uq.edu.au.; Centre for Health System Reform and Integration, Mater Research Institute, The University of Queensland, Health Sciences Building, Herston,Brisbane, Queensland, Australia.; RAND Europe, Eastbrook, Shaftesbury Road, Cambridge, CB2 8BF, United Kingdom.; Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom.
AN - 40796246
BT - BJGP Open
C5 - Healthcare Disparities
DA - Aug 12
DO - 10.3399/bjgpo.2025.0065
DP - NLM
ET - 20250812
JF - BJGP Open
LA - eng
N2 - BACKGROUND: Since the Declaration of Alma-Ata in 1978 (1) global health policy has prioritised primary and integrated care reform to better manage chronic illness, improve health access, and prevent disease.(2) Yet internationally primary care, like the health systems it struggles to support, is currently far from strengthened; and is increasingly challenged by chronic underfunding, lack of recognition, and a diminishing and demoralised workforce.(3,4) AIM: To better understand the policy barriers responsible for the current status from the perspective of general practice in England DESIGN & SETTING: Key Informant Interviews with 12 general practice policy or practice leaders identified from publicly-available position statements, publications or innovative programs in UK primary care reform over the past decade METHOD: A qualitative deductive approach using thematic analysis to analyse informant data to understand historical barriers and explore enablers for future reform. RESULTS: The analysis resulted in eight main themes. 1. Dynamics of power and autonomy 2. Under-investment in primary care 3. Aligning policy and implementation 4. Navigating complexity and change 5. Building trust through relationships and leadership 6. The revolving door of policy and leadership 7. Valuing the workforce: A key to morale and retention 8. Strategic communication and media engagement CONCLUSION: Better-targeted funding reform, more effective systems integration building on general practice and community service strengths, and better valuing the complex role of the primary care sector as central to a high-functioning health system, were seen as key to the future. Participants also called for more effective policy input from those skilled in the delivery of care, and the capacity for earned autonomy and flexibility to deliver care relevant to individual community need. Action to address these opportunities is pressing, as finalisation of the 10 Year Health Plan and more-immediate NHS restructure rapidly gathers momentum.
PY - 2025
SN - 2398-3795
ST - Enablers and barriers to coalface primary care reform in England: a qualitative study
T1 - Enablers and barriers to coalface primary care reform in England: a qualitative study
T2 - BJGP Open
TI - Enablers and barriers to coalface primary care reform in England: a qualitative study
U1 - Healthcare Disparities
U3 - 10.3399/bjgpo.2025.0065
VO - 2398-3795
Y1 - 2025
ER -