Aims To investigate the impact of organisational change on the delivery of health services in remote and rural Scotland using, as an example, changes in the organisation of out of hours primary care, and to identify the attributes of successful innovation in remote and rural health provision. Methods The thesis comprised a thematic literature review; in depth interviews with key stakeholders, and case studies based in remote communities. Results The literature review identified recurring attributes of successful innovation. Interviews with remote and rural GPs showed that working out of hours had been, or still was, an integral part of life as a GP. Most agreed there had been an impact on family life. Advantages and challenges of remote and rural working were identified; many GPs could not envisage a better way of delivering services. This was contested by managers. There were divergent views of the 2004 GMS contract. The GPs who opted out of 24 hour responsibility experienced a transformational change in working life. All in all, there was a lack of understanding, and trust, between organisations. NHS 24 and Scottish Ambulance Service were criticised. There had been little change in out of hours service delivery since 2005, and the present configuration was seen as expensive and unsustainable. Despite these acknowledged difficulties, the view was that difficult decisions had been avoided, and a long-term solution that fits the area was required. The case studies added detail and contextual understanding of delivery of services. This could vary even within a practice area. Service delivery on islands was different, with a stronger tie between community and practice, governed by transport logistics, and difficult to understand from an outside perspective. Conclusions. The delivery of out of hours services in remote and rural Scotland has been a difficult and contested issue. Context can have different impacts, even within a very small area. Failure to innovate was associated with lack of collaboration, lack of strategy, lack of understanding of local context, and avoidance of difficult decisions. The organisational change literature demonstrated that receptive contexts for change were not present.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:619172 |
| Date | January 2013 |
| Creators | Heaney, David |
| Publisher | University of Aberdeen |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=211425 |
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