Working together: a qualitative study of effective group formation amongst GPs during a cost-driven prescribing initiative.

Abstract

The need to control escalating NHS prescribing costs has become another, for many, contentious factor for GPs to consider when prescribing. Furthermore, despite not having a history of collaboration, GPs now need to work together within Primary Care Trusts. There is little in the medical literature about the development of GP groups. We present data from an evaluation of a cost-driven GP group prescribing initiative which fitted within Tuckman's framework of how groups become established, function and bring about changes to produce outcomes. Our aim was to gain insight into GPs' experiences of working together in a group prescribing initiative. Qualitative semi-structured interviews were conducted face-to-face with 32 GPs from a commissioning group pilot (nine GP practices) in Southern Derbyshire in 1999. The interviews were transcribed and analysed using thematic analysis. Initial reactions to the initiative included feeling anxious and imposed upon. However, reservations about divisive effects on practices and individuals behaving defensively proved largely unfounded. Meeting together enabled participants to discover that their similarities outweighed their differences. Prescribing changes did occur, often facilitated by the support of having group policies. However, for many participants, the most valued outcomes were process orientated: increased interaction between practices and a greater sense of group cohesion. These were regarded by some as providing the basis for further change. The experiences of the GPs reflected Tuckman's sequential model of group development to a large extent. The 'storming' phase was less problematical than anticipated. This model provides a useful framework against which to judge how near a group is to achieving goals.