Table 5 Interview excerpts reflective of the theme ‘Perceived nature of the job and norms of practice’

“I suppose it depends who you, what level you’re viewing it from, so from a GPs perspective, I would say this is bread and butter, so it’s an understanding of pharmacy, poly-pharmacy and individualising therapy.”

GP, Blood pressure targets in hypertension (P67)

“Certainly the blood pressure, blood sugar and cholesterol are so kind of ingrained in general practice, so it would feel like second nature so I’d, you almost kind of go on auto-pilot because it’s very rare that I wouldn’t know what to do…”

GP, Treatment targets in type 2 diabetes (P22)

“…… for whatever reason nurses seem to like guidelines more than doctors, certainly here our nurses will work to templates, if they see a guideline they sort of see it as a rule, and something they’ve got to follow, whereas our doctors won’t work to templates for love nor money, and if they see a guideline they see it as something that 90 percent of the time you ignore but is handy to use now and again…”

Practice Manager, Treatment targets in type 2 diabetes (P30)

“If the GPs want to do different that’s fine, that’s them, but I, as a nurse practitioner, stick to the recommendations, I wouldn’t have a leg, if I gave them out of the recommendations and I ended up in court I wouldn’t have a leg to stand on because I’m a nurse, right, and I would be judged that you’ve gone against regulations you’ve done this and this is the consequence the patient’s lost his life or gone in to heart failure and you’re to blame, you can’t do that, you’re putting your registration on line, you’re opening to be sued if you don’t follow them. GPs can do all sorts out of boxes, but I stick to boxes…”

Nurse Practitioner, Risky prescribing (P5)

“…but there’s always a risk with, when deploying technology such as that, is that patients, people often, doctors certainly just want to get past it cause they’ve already moved on and they’re thinking to something else, or it is totally irrelevant to what’s going on in that consultation, so you know, you’ve got a sick patient who’s got lots of pain and they’re blood pressures notched up as a consequence, and that’s totally irrelevant.”

GP, Blood pressure targets in hypertension (P67)

“…..we will reduce our number of admissions and strokes, and they’re large strokes with atrial fibrillation, so it’s a benefit not only to reduce the number of admissions but to the patient, their quality of life and the long term burden on the NHS when you have a large stroke, with you know, on-going care, not only on their…the patient but their family, and if patients are taking aspirin and that’s carrying a risk of a bleed, then they’ve got risk with minimal difference in benefit there, so we should hopefully be, if we’re treating people effectively, then we should be reducing the number of strokes…..”

GP, Anticoagulation in atrial fibrillation (P52)