Deductive coding to areas taken from literature | Inductive codes emerging from interviews | Iterative refining of deductive and inductive codes and themes | Final themes | |
---|---|---|---|---|
Influences on behaviour: | Motivation: | Practitioner motivation: | Influences on behaviour | |
Ownership of change | Support among practices | Patient benefit | Financial reward | |
Motivation (intrinsic and extrinsic) | Financial reward | Patient benefit | ||
Competition with other practices | ||||
Social comparison | ||||
Organisational means | ||||
Relevance: | Opinions: | Attitudes towards the scheme: | ||
Clinical benefit | Clinical value | Don’t agree with localisation | Role of general practice | |
Local population needs | Credibility | Lack of knowledge/interest in evidence | Acceptance/rejection of an externally defined way of working | |
Prevalence | Faith in the evidence | |||
Fairness: | ||||
Distribution of workload | Uneven workload | |||
Scope for gaming | Minimal change | |||
Implications for tackling inequalities | The bigger picture | |||
Failed to address inequalities | ||||
Adjusting role of general practice | ||||
Appropriateness of incentivised targets: | Credibility: | Credibility of the locally negotiated indicators | ||
Robustness of evidence base | Conflict with professional identity | Other guidelines | ||
Costs | Conflict among practice staff | Clinical value | ||
Conflict with patient benefit | Conflict with/supported by prevalence in population | |||
Funding improves credibility | ||||
Acceptability: | Effect on professionals: | Effects of implementing a local scheme: | Exacerbating tensions | |
Compare to national QOF | Just another income stream | Created an uneven workload | Allowed local issues to be addressed | |
Conflicting credibility with NQOF | Caused inequalities | |||
Consequences: | Effect on patients: | Consultation consequences | ||
Effect on practice staff | Adapt consultations | Standardised care | Target became routine practice | |
Effect on consultations: | ||||
Adapt templates as aids | ||||
Effect on patients and patient care | Impact on patient experience | Embedded behaviour | ||
Time pressure | Required minimal change | |||
Conflicting agendas | ||||
Distracting in consultations | ||||
Embedded behaviour | ||||
Standardised care | ||||
Recommendations: | Recommendations: | Experience of engagement | Ownership | |
How it should be introduced | Evolving assessment process | LoQOF champion | Highlight available external support for data extraction and management | |
Local versus national benefits and harms | Extension of NQOF | Patient involvement | Familiarisation period before data collection | |
Conflict with NQOF | Bottom up approach | |||
Bottom up approach | Based at cluster level | |||
Setup time | Outside support | |||
Protected learning time for all staff | ||||
Data support |