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Perceived aids and barriers to clinical effectiveness in the work of primary care organisations in England: a qualitative study

Kevork Hopayian, Ian Harvey, Amanda Howe, Gillian Horrocks

Aims: To understand the aids and barriers to the progress of clinical effectiveness within primary care organisations (PCOs). Design: A qualitative study based on interview data from a two-stage survey employing postal questionnaires and telephone interviews. Key informants in PCOs were nominated by their chief executives. Data collection started on 1 October 2000 and ended on 4 April 2002. Setting: PCOs in England. Results: Barriers to clinical effectiveness as perceived by the participants were mostly non-specific: under-funding, excessive central guidance, and constant reorganisation. Specific barriers included negative attitudes to clinical effectiveness and a limited understanding of its nature. Leadership and the building of personal relationships were cited as aids. Involvement by public health doctors was seen as an aid by some, though some participants would have welcomed more involvement. Conclusions: Two options for PCOs in enhancing clinical effectiveness are suggested by these results. They could promote training to improve knowledge and understanding of clinical effectiveness within their organisations. Key figures in PCOs could raise the profile of clinical effectiveness through leadership and example.