Liver disease as new work in the context of protocolised primary care - do GPs have a role? A qualitative interview study.

Background: Liver disease is common, but not part of routine chronic disease management in primary care.

Aim: The aim of this study was to explore the challenges of implementing pathways of care for liver disease within existing highly protocolised structures in primary care.

Method: Semi-structured interviews with 20 health professionals working in primary care. Interviews were informed by normalisation process theory (NPT) and boundary theory. Data were subject to thematic analysis.

Results: Three themes were identified relating to chronic disease work; definitions; need and worth, and roles. Participants identified that understanding and value of roles within chronic disease management were pre-defined by targets imposed on them as part of national incentives schemes. Structural boundaries constrained professional autonomy and the potential to influence this area of primary care management, including taking on new work.

Conclusion: The inability to influence care decisions blurs occupational boundaries and goes to the core of what it means to be a professional. Unless liver disease sits within this target-based system, it is unlikely to become part of routine work in primary care.