Table 1.

 Key features and interviewees of the 30 screening interviews and four case study areas

Screening interviews
Semi‐structured telephone interviews with the person responsible for developing respiratory services in 30 PCOs in England and Wales purposively sampled to represent a wide spectrum of attitudes to the reconfiguration of respiratory services	Number of professional interviewees
	19 PCO Managers
	7 Nursing service managers
	3 GpwSIs
Case studies
The case studies studied four Primary Care Organizations (PCOs) with diverse organizational contexts who were developing different models of providing respiratory care to respond to the needs of their local population. PCOs are freestanding statutory NHS bodies with the responsibility for delivering health‐care and health improvements to their local areas. They commission or directly provide a range of community health services, such as district nursing, as part of their functions.34 Under Practice‐Based Commissioning (PBC) arrangements, GP practices are given indicative budgets to commission care for their practice populations.34 A key focus for our ethnographic study was the role of GPs with a Special Interest (GPwSIs)
Team PCO	Number of professional interviewees
Situated in a market town, development was driven by a multidisciplinary team with a ‘diagnosis to death’ vision of respiratory services. Clinical services were led by a GPwSI, working closely with the local respiratory consultant. The appointment of a specialist respiratory nurse was an early focus of the development plan	3 PCO Managers
	1 GpwSI
	1 Respiratory consultant
	1 Community specialist respiratory nurse
Merged PCO	Number of professional interviewees
The existing service was led by a GPwSI working with a respiratory nurse to provide a referral service for local GPs. Following the merger with four neighbouring PCOs, the Merged PCO, who had inherited a major financial deficit, actively rolled out the GPwSI model in order to reduce secondary care costs	6 PCO Managers
	3 GpwSIs
	2 Respiratory consultants
	2 Community specialist respiratory nurses
	2 Practice respiratory nurses
	3 Hospital specialist respiratory nurses
	1 GP PBC lead
	1 Community matron
Commissioning PCO	Number of professional interviewees
The PCO commissioned a nurse‐led community respiratory service, with the primary aim of reducing hospital admissions. The service worked closely with the University teaching hospital and provided proactive care for patients with chronic obstructive pulmonary disease	3 PCO Managers
	2 Respiratory consultants
	1 Senior community specialist respiratory nurse
	1 Paediatric specialist respiratory nurse
	2 GP PBC leads
	1 Hospital Manager
Rural PCO	Number of professional interviewees
The rural location and absence of nearby hospitals resulted in a service based on developing existing primary care resources. The GPs and community nurses were supported by a specialist respiratory nurse who provided education to primary care professionals	4 PCO Managers
	7 GPs
	2 Respiratory consultants
	1 Community specialist respiratory nurse
	1 Practice respiratory nurse
	1 Practice nurse