RESUMEN
BACKGROUND: Recent changes in primary care are encapsulated in a drive for enhanced quality, efficiency and effectiveness of care. A key element of the quality agenda is innovation and evaluation. This paper presents a case study of the processes involved in evaluating practice development in primary care, where commissioned research is concomitant to a service development that also integrated its own evaluation. There was an assumption that an 'outside' evaluation would be complementary to the concurrent 'inside' evaluation. However, there is a paucity of literature that overtly discusses or analyses the specific challenges. AIMS: To surface the tensions involved in combining internal and external evaluation, to allow development of a better understanding of the roles, relationships, perils and value of this approach to maintaining and enhancing quality in primary care. DESIGN: A case study presentation of reflexive analysis of inside and outside evaluator experiences of the evaluation of a practice development. RESULTS: We argue that despite recent methodological developments in practice, methodological, methodical, interpretive and political tensions persist between practice development and evaluation. The key problems fuelling the dissonance experienced by both practitioners and researchers appears to be around the co-existence of differing understandings of the evaluation scope and process among stakeholders. This has the potential to jeopardise the coherence of the concurrent external evaluation of a practice development initiative. A pathway enabling the explicit integration of the views of researchers, service developers, commissioners and ethics and research governance boards is presented. CONCLUSION: This article exposes often underlying and unrecognised areas of consonance and dissonance between the views of researchers and practice developers in a context of concurrent practical and academic evaluations. In some cases there is potential to progress from dissonance to consonance. In others, the differing worlds and agendas mean that dissonance will remain, but its existence needs to be acknowledged and worked with, rather than ignored.
