The NHS constitution requires that clinicians provide high-quality care that is safe and effective. However, the 2014 National Review of Asthma Deaths report made it plainly clear that patients with asthma were dying preventable deaths and in some cases the failure of healthcare professionals to implement clinical practice guidelines was to blame. Chapter 1 explores the theoretical roots of implementation science in healthcare; chapter 2 a review of the existing literature related to guideline use by clinicians within asthma medicine. Chapter 3 describes our downstream analysis of the use of two national asthma guidelines to understand and to provide an explanation of how healthcare professionals within primary care in a single locality chose and implement these documents. In chapter 4 we present our findings : clinician behaviour was determined not just by familiarity with guidelines and clinical workload, but by
each individual’s perceived position in a wider social network of clinicians and distinct clinician groups. Furthermore, we found that disempowerment of key staff, an apathy towards improvement or financial worries were strong determinants of behaviour. By exploring attitudes and behaviour in rich detail across this case study area, this research paves the way for rational interventions to improve guideline implementation in this area in the future.