Improving quality in general practice: qualitative case study of barriers faced by health authorities

Objectives To identify and assess the barriers that health authorities face as they manage quality improvements in general practice in the context of the NHS reforms. Design Qualitative case study. Setting Three UK health authorities: a rural health authority in the south west, a deprived inner city health authority in the north east, and an affl uent suburban health authority in the south east. Participants Senior and junior managers. Main outcome measures Structure of strategic and organisational management, and barriers to the leadership and management of quality improvement in ge neral practice. Results Seven barriers were identified: absence of an explicit strategic pl an for general practice, competing priorities for attention of the health a uthority, sensitivity of health professionals, lack of information due to p oor quality of clinical data, lack of authority to implement change, unclea r roles and responsibilities of managers within the organisations, and isol ation from other authorities or organisations facing similar challenges. Conclusions The health authorities faced significant barriers that would im pede their ability to fulfil their responsibilities in the new NHS and that would reduce their capacity to contribute to quality improvements in gener al practice.