The National Service Framework for Coronary Heart Disease provides indicators and criteria, which can guide improvement activity in primary care, but this guidance will need to be complemented by local initiatives to promote change. The need forchange strategies to be tailored to the problems and settings they are meant to address is only now clearly understood.E¡ective evidence-based implementation will require a correct diagnosis of underlying barriers to change, an understanding of the e¡ectiveness and appropriateness of alternativechange strategies and a judicious selection fromthe available options. In this paper we show howlocal investigations of barriers to change might beused to generate change proposals for implementationby primary care organisations. Although thechange proposals we developed were complex, thepolicy context in primary care is favourable forengaging practitioners and patients and for deliveringchange. It is our hope that local investigationswill be used alongside the research literature on theimplementation of change, to develop change proposalsthat are grounded in evidence and tailored toparticular settings.
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