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Background: Little is known about how health professionals translate national government health policy directives into action. This paper examines that process using the so-called Well Men's Services (WMS) policy initiative as a 'real world' case study. The WMS were launched by the Scottish Government to address men's health inequalities. Our analysis aimed to develop a deeper understanding of policy implementation as it naturally occurred, used an analytical framework that was developed to reflect the 'rational planning' principles health professionals are commonly encouraged to use for implementation purposes. Methods and materials: A mixed-methods qualitative enquiry using a data archive generated during the WMS policy evaluation was used to critically analyze (post hoc) the perspectives of national policy makers, and local health and social care professionals about the: (a) 'policy problem', (b) interventions intended to address the problem, and (c) anticipated policy outcomes. Results and conclusions: This analysis revealed four key themes: (1) ambiguity regarding the policy problem and means of intervention; (2) behavioral framing of the policy problem and intervention; (3) uncertainty about the policy evidence base and outcomes, and; (4) a focus on intervention as outcome. This study found that mechanistic planning heuristics (as a means of supporting implementation) fails to grapple with the indeterminate nature of population health problems. A new approach to planning and implementing public health interventions is required that recognises the complex and political nature of health problems; the inevitability of imperfect and contested evidence regarding intervention, and, future associated uncertainties.

INTRODUCTION: General Practitioners with Special Interests (GPwSIs) have a potentially important role in delivery care for people with long-term respiratory diseases. The development of a GPwSI service within a Primary Care Trust (PCT) involves a process of 'transitional change' which impacts on all stakeholders, who may embrace or resist change. AIMS AND OBJECTIVES: The objective of the current study is to explore the attitudes and views of stakeholders to the provision of a respiratory GPwSI service within the six PCTs in Leicester, UK. SUBJECTS AND METHODS: Using a qualitative design, GPs, nurses, secondary care doctors, nurse specialists, physiotherapists, a healthcare manager and patients with respiratory disease took part in focus groups and interviews. RESULTS: The 25 participants expressed diverse opinions about the challenge of integrating specialist services with generalist care and the specific contribution that GPs might make to the care of people with chronic respiratory disease. A range of potential roles for a respiratory GPwSI, working as part of a multi-disciplinary team, were suggested, and a number of practical issues were highlighted. For the role to succeed, the GPwSI needs to have the trust of their primary and secondary care colleagues as well as the patients, to be a credible practitioner, and to be politically astute potentially enabling them to act as a champion supporting the transition process within the local health service. CONCLUSIONS: The introduction of a respiratory GPwSI service represents a challenge to traditional roles which, whilst broadly acceptable, raised a number of important issues for the stakeholders in our study. These perspectives need to be taken into account if workforce change is to be implemented successfully. Conflict of interest and funding GPIAG funded.