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, global health policy has prioritised primary and integrated care reform to better manage chronic illness, improve health access, and prevent disease. 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. 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 between August and October 2024 with 12 general practice policy or practice leaders identified from publicly available position statements, publications, or innovative programmes 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 facilitators for future reform. RESULTS: The analysis resulted in eight main themes: 1) dynamics of power and autonomy; 2) underinvestment 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; and 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 - General Practice Clinical Unit, University of Queensland, Queensland, Australia c.jackson@uq.edu.au.; Centre for Health System Reform and Integration, University of Queensland, Queensland, Australia.; RAND Europe, Eastbrook, UK.; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
AN - 40796246
BT - BJGP Open
C5 - Healthcare Policy
CP - 1
DA - 04/2026
DO - 10.3399/bjgpo.2025.0065
DP - NLM
ET - 20260427
IS - 1
JF - BJGP Open
LA - eng
N2 - BACKGROUND: Since the Declaration of Alma-Ata in 1978, global health policy has prioritised primary and integrated care reform to better manage chronic illness, improve health access, and prevent disease. 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. 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 between August and October 2024 with 12 general practice policy or practice leaders identified from publicly available position statements, publications, or innovative programmes 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 facilitators for future reform. RESULTS: The analysis resulted in eight main themes: 1) dynamics of power and autonomy; 2) underinvestment 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; and 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 - 2026
SN - 2398-3795
ST - Barriers to and facilitators of coalface primary care reform in England: a qualitative study
T1 - Barriers to and facilitators of coalface primary care reform in England: a qualitative study
T2 - BJGP Open
TI - Barriers to and facilitators of coalface primary care reform in England: a qualitative study
U1 - Healthcare Policy
U3 - 10.3399/bjgpo.2025.0065
VL - 10
VO - 2398-3795
Y1 - 2026
ER -