The role of physician assistant has been established in the US for some time, and has proved a useful and effective adjunct to the medical profession. A similar role is being developed in England by the National Practitioner Programme, and this article reports the early progress of a pilot that is training primary care Medical Care Practitioners (as they are called) (MCPs) in Waltham Forest. Three trainees, all former nurses, are currently undergoing a two year programme of study and placement in general practice. It is anticipated that MCPs will be able to see up to half of the cases at present seen by general practitioners (GPs). The pilot has had to face many challenges. The role has needed to be defined, and its basis in a ‘medical model’ was not originally fully understood; training has had to be devised and provided ‘on the hoof’, before national competency and regulatory frameworks have been developed and agreed; the senior input required from the Primary Care Trust and its higher education provider has been substantially in excess of funding support received. Despite the commitment of pilot participants, a pilot is probably the wrong change management model for the creation of a new health care profession.

Primary care research networks were established in Scotland to encourage research in primary care and build capacity. The aim of this descriptive study was to evaluate the primary care research network in Dumfries and Galloway, a rural area of Scotland, by describing the methods used and the outcomes in terms of research training and completed projects. All primary care professionals working in the region were offered an initial grant to buy time for research training to develop their own research ideas. Those attending the two day research training course were encouraged to submit a protocol for funding and Local Research Ethics Committee approval. Of the 605 and 717 primary care professionals circulated in the first and second years, 23 (4%) and 11 (2%), respectively applied for a research training grant. Of these, eight completed a research project together with a further six who had previous research training. Eleven (79%) of the 14 completed projects were the subject of oral presentations and 11 were submitted for publication in peer-reviewed journals. Only a small minority of professionals working in primary care will want to develop their own research, and this requires support, protected time and long-term mentoring. Building research capacity in primary care involves a number of activities ranging from funding academic units, to giving opportunities for non-academics to undertake research. These distinctions are important for decisions about appropriate funding and support.

The aim of this qualitative study was to examine the experiences and needs of patients and carers affected by one of three common neurological conditions and to explore how primary care can contribute to improvements in care. Data was drawn from five focus groups recruited from various geographical locations in the north of England served by seven primary care trusts and four neurological departments. Researchers in a semi-rural practice recruited 38 participants, 15 of whom were male and 23 were female. Ages ranged from 26 to 74 years. The participants were either patients or carers of people with epilepsy, multiple sclerosis or Parkinson’s disease and were recruited from three settings: primary care (two groups), voluntary groups (two groups) and secondary care (one group). The results showed that neurological care could be patchy, overstretched and insensitive to the individual patients’ needs. Communication between patient and health professional, and between different sectors of the health service is poor and often leads to time wasting and delays in treatment. The impact of these conditions on the patient and their family and their preferences for treatment varies. Specialist nurses are highly valued by patients and their families but the service is overstretched and access is difficult. General practitioners (GPs) are valued for their communication skills and their ability to act as advocate for the patient; however, there are doubts about their knowledge of neurological conditions. Problems of service access were identified. The skills of health professionals in general practice can be used to complement those in secondary care. GPs and nurses are considered a valuable resource that could be used better to improve neurological care, particularly in fostering patient participation in decisions about their care. Practice-based commissioning offers an opportunity to review services to make better use of the time and skills of all professionals involved in the provision of care.

Common mental health problems are highly prevalent in primary care, the UK National Service Framework for mental health demanding that effective and accessible services be made available. Although built upon a strong evidence base, traditional psychological therapies are often limited in terms of their applicability and availability. As a consequence innovative self-help programmes are increasingly being advocated as an alternative means of managing mental health illness within primary care. This study reports the results of a three month evaluation of a self-help service provided by a busy UK urban Primary Care Trust. Levels of utilization, effectiveness and stakeholder acceptability were examined through a combination of quantitative and qualitative data. A total of 662 patients were referred to the self-help clinics over a three month period, 67% of whom attended their first appointment. The mean number of sessions per patient was 2.8 (SD = 2.4), with an average total time of 69.6 min (SD = 48.2). Mean Clinical Outcomes in Routine Evaluation (CORE-OM) scores improved significantly between baseline and three month follow-up (P < 0.001), 39% of patients demonstrating a clinically significant improvement. Both selfhelp therapists and referring general practitioners reported moderate to high satisfaction with the self-help treatment model, with the majority of patients perceiving the intervention to be appropriate to their needs. Data demonstrated that, whilst there was a clear need for a simple self-help service to be based in primary care, the ultimate success of this provision necessitates a well developed infrastructure capable of providing sufficient support and information to ensure that it is flexible and responsive to individual needs.

Excessive drinking is a global health problem which is responsible for a wide range of both chronic and acute illness, and which costs the UK National Health Service (NHS) £1.7 billion annually. Current health policy aims to reduce alcohol-related problems by promoting early identification of risk followed by brief intervention to facilitate positive changes in drinking level or patterns of consumption. However, practical and philosophical barriers concerning screening and brief alcohol intervention have so far impeded its uptake in routine primary care. This qualitative study aimed to simultaneously explore and compare health professionals’ and patients’ views on the acceptability and feasibility of screening and brief alcohol intervention in primary care. Focus groups were held with (a) four primary care teams, (b) two general practitioner (GP) and two nurse groups and (c) six patient groups in the north-east of England. A thematic framework approach was used to analyse audio-taped data via transcripts. Both health professionals and patients reported that raising and discussing alcohol-related risk was acceptable in primary care, when combined with other lifestyle issues or linked to relevant health conditions. Targeted rather than universal screening was the most acceptable method of identifying alcohol-related risk and would fit well with existing practice. However, there was uncertainty among health professionals about the effectiveness of brief alcohol interventions and some disagreement with patients concerning who was best placed to deliver them. Health professionals felt that nurses were best placed for such work whilst patients reported that they would initially raise the subject with GPs. There was broad acceptance of brief intervention approaches but a lack of support and specific incentives for this work impeded its delivery in routine practice.

This paper reports on the contribution made by the first cohort of Primary Care Graduate Mental Health Workers (PCGMHW) employed in the Southwest of England. The PCGMHW is one of the new roles envisaged as part of the NHS plan. Aimed at enabling quick access to a range of time-limited therapies, while at the same time engaging in public health strategies to promote mental health in communities, the PCGMHW is at the cutting edge of modernizing primary care mental health. This study demonstrated that PCGMHWs trained in time-limited therapy approaches such as facilitated self-help moved quickly into situations were they were treating people with mild to moderate mental health problems, with evidence of clinical effectiveness. However, the community development aspect of the role was slower to develop, possibly as a reflection of the preference for one to one work in mental health or, alternatively, as an indication of the nebulous nature of public health work. The study identifies a number of key areas for consideration. First is the role of the PCGMHW in signposting people to services or resources. Second, the role of referral protocols in developing service models that profit from the presence of PCGMHWs. Third, the need to develop the role in relation to public health, stigma and social exclusion. However, to achieve this greater clarity over the role is required in Primary Care Trusts and urgent consideration of continuing professional development needs of PCGMHWs.

The objectives of this study were to undertake a needs assessment of mental health services for asylum seekers and refugees in the London Borough of Haringey, to estimate accurate numbers of asylum seekers and refugees who need mental health services, and to understand their perspective on mental health needs and services. The mental health needs of asylum seekers and refugees in Haringey were determined through a needs assessment exercise, using epidemiological and corporate approaches. The representatives of the main asylum seeker communities in Haringey were interviewed to find out what the mental health needs of this group and their community are, and how best to provide services to them. Estimates of number of asylum seekers and refugees in Haringey ranged from 5000 to 35 000, with a current best-guess figure of 31000. The community representatives’ views suggested that the factors affecting mental health of asylum seekers and refugees were not directly under the remit of the National Health Service (NHS). They felt that practical issues like education, employment, and social inclusion should be addressed alongside provision of effective professional help like psychotherapy or pharmacotherapy. They also felt that language and cultural barriers were significant impediments to constructive engagement with mental health services for this group. Mental health needs of asylum seekers/refugees are broad based, with implications for public health, social services, primary care, and mental health services. Approaches to developing services for asylum seekers and refugees should be multidisciplinary, and community driven, addressing language and cultural barriers.

The aim of the study was to investigate the experiences of professionals who treat asylum seekers and refugees, as well as those responsible for the planning, management and delivery of mental health services to this group in Haringey; and to identify and address key areas of difficulty to assist development of appropriate mental health services for this group in Haringey. Individual face to face interviews were conducted with the service providers using a semi-structured interview schedule. The results were triangulated with another study done in general practices in Haringey. Fourteen service providers – health professionals, service managers and commissioners who were involved in responding to the mental health needs of asylum seekers and refugees in Haringey. Findings from a previous study were used for primary care professionals’ views. The main issues faced by providers in dealing with mental health needs of asylum seekers and refugees were: increased demands placed on the time and resources of already stretched mental health services, language and cultural barriers, the difficulties in working through interpreters in delivering therapy, and the need for longer consultation time. Asylum seekers and refugees were felt to seek health professionals’ help with matters that were outside the professionals’ remit. Some providers were unsure of the appropriateness of the western model of treating mental illness for this group. Development of better information on these particular groups locally, and the use of appropriately trained health professionals from the asylum seeker and refugee community to both inform and provide mental health services, would be appropriate responses. A model of service provision addressing the wider influences on the mental health of this group is proposed, that would address the concerns raised by providers and users.

Increasingly, attention is shifting away from a focus on postnatal depression to the recognition that depression may be a recurrent experience in many women’s lives with the perinatal period constituting a time of particular vulnerability. This article reports on a study undertaken in one primary care trust which explored mothers’ and practitioners’ experience and awareness of antenatal depression and considered the service response offered by midwives and health visitors. The mothers who participated in focus groups felt ill prepared for the possibility that depression could occur during pregnancy. They identified social and role expectations as well as professional attitudes and service delivery models as barriers to disclosing feelings of depression during this period. The midwives and community nurses surveyed placed rather less emphasis than mothers on the value of continuity of care in pregnancy in promoting disclosure of mental health problems. Community midwives appeared less confident than health visitors in detecting and responding to antenatal depression but both groups of professionals had little knowledge of relevant community services. Co-ordination between midwives and health visitors appeared limited and contact with mental health services was lower than might have been anticipated; the general practitioner (GP) was still seen as the key resource in cases of antenatal depression. However, many of the mothers participating in the study found GPs unresponsive to expressions of negative feelings in pregnancy. The article considers approaches for increasing awareness and detection of antenatal depression and improving co-ordination between services.

Jurisdictions around the world have articulated the need for the development of an integrated health care system with an increased emphasis on primary health care that incorporates the principles/practices of health promotion. Over the past century, the medical model has been the default model of care in many countries, and yet treatment alone is unlikely to have marked effects on health inequities or health status. This article presents and discusses three fundamental dimensions (strategies, processes and outcomes) of health promotion in primary health care (HP in PHC) settings. We argue that the three dimensions are founded on the values and structures of health promotion (Frankish et al., 2006). Our work is based on a comprehensive literature review, validation by key informants and a national survey of Canadian primary health care settings. We suggest that the strategies (types of interventions), processes (client and community centred care), and desired health promotion outcomes (intended or unintended results) need to be better articulated and understood. Identification and discussion of the domains of HP in PHC settings is a crucial first step. It is a step toward the subsequent identification of related indicators and measures of health promotion that can be used for planning, implementation and evaluation of important health promotion initiatives.