Never events in general practice: a focus group study exploring the views of English and Scottish general practitioners of 'never events'.

Objectives: To examine general practitioner (GP) understanding of the never event (NE) concept in general practice, and to identify potential enablers and barriers to implementation in UK general practice.

Design: Qualitative study using focus groups. The data were analysed thematically and were informed by the normalisation process theory.

Setting: General practice in Northwest England and Southwest Scotland.

Participants: 25 GPs took part in five focus groups. 13 GPs were female and 12 male with an age range of 28-60.

Results: The NE approach of avoiding serious preventable adverse outcomes from healthcare fitted with participants expectations of the delivery of care but the implementation of strategies to prevent the specific NE was considered complex and variable. The main themes identified participants' understandings and perceived limitations of the NE concept; the embedded layers of responsibility to implement NE within practices and the work required for implementation within general practices. Participants' accounts highlighted the differential nature of work in general practice and that the implementation of initiatives to address specific NE should be situated within a learning and systems approach to implementation. Some NEs were considered more relevant and amenable to simple solutions than others which could influence implementation.

Conclusions: The NE concept was considered overall an important approach to help address key primary care patient safety issues. The utility of individual NEs may vary depending on the complexity of the initiatives that would be needed to manage related risks to as low as reasonably practicable.