A meso-level approach to quality improvement: a qualitative rapid evaluation of the role of integrated care boards in improving access to general practice in England

Background Commissioning and funding agencies have an increasing role in translating and implementing national policies to improve primary care access, whilst being sensitive to the needs of local contexts. Integrated Care Boards (ICBs) are meso-level commissioning organisations that sit in between national bodies and general practices in the National Health Service (NHS) in England. Aim In this study we examine the role of ICBs in facilitating improvements in access to general practice. Design & setting Qualitative rapid evaluation in three English NHS districts (ICB areas) focused on the role of the ICB in supporting access-focused improvements to primary care services. Method The study included semi-structured interviews ( n =32) with ICB and general practice staff and two focus groups with members of patient representative groups ( n =14). We used Braun and Clarke’s (2006) six phases of data engagement for data analysis. Our analysis was informed by Bate et al’s (2008) framework of six challenges in organising for quality. Site workshops ( n =3) with general practice staff supported refinement of findings as part of member validation. Results ICBs were found to perform three key roles in facilitating and implementing access-related quality improvement: 1) translational work to contextualise national funding priorities and objectives to the local level; 2) relational work to build trustbased relationships with practices and system stakeholders including local government, at-scale primary care providers, and patient groups; and 3) developmental work to establish infrastructure to support quality improvement, including knowledge-sharing and data analytics capacity. Conclusion Commissioners play a critical role in bridging national and local contexts to support quality improvement in primary care. The capacity and capability of ICBs to carry out this role are however limited by ongoing organisational restructuring initiated by national policy makers and by constrained resources.