Responsiveness: perspectives on policy in general practice
thesisposted on 04.12.2017, 10:16 authored by Emma Louise Angell
Meeting the needs of patients in general practice is complex, and responsiveness is seen as a way to meet these needs and preferences. Policies have been published advocating responsiveness, but its meaning is multi‐faceted. Little is known about how initiatives to improve responsiveness to patients interact with the values of the people and organisations trying to implement them. This qualitative study aimed to explore how responsiveness has been espoused in policy and it has been viewed and responded to in practice, with a focus on whether or not it is a useful concept in supporting quality management and improvement in primary care. The research design includes analysis of English national policies about responsiveness in primary care, and interviews with elite policy‐makers, and strategic and frontline staff. Analysis of policies took a thematic and longitudinal approach to investigate how responsiveness emerged as an aspiration in general practice and changed over time. Thematic analysis of interviews examined how the meaning of and response to responsiveness at the macro‐, meso‐ and micro‐levels has changed with the shifting political and social climate. Findings indicate that responsiveness is considered a way to attain goals aligned with the core values of general practice but that there are tensions when balancing the needs of the many and the needs of the few, especially in times of financial austerity. For responsiveness to become successfully enacted, the goals of responsiveness need to be ‘amplified’ such that they become a priority, and these goals need to be aligned with the values of those attempting to prioritise them. Findings suggest that value amplification and values alignment can be helpful when making difficult choices between competing priorities in a context of restricted finances and prolific targets.