The East London and Essex Network of Researchers (ELENoR) funded a project to develop R&D capacity among practice nurses. The ELENoR nurses forum chose the topic, which was ‘Older people’s experiences of primary care’, using qualitative interviews as the main method. The project was designed to enable nurses to participate as much or as little as suited their individual circumstances, and whatever their previous R&D experience. Compulsory training was provided, and ELENoR paid for all the time which was given to the project, travel expenses incurred and so on. This paper reviews the project, drawing on oral and written communications by participants and the personal experience of the authors.

Nine nurses from eight practices carried out 58 interviews, and four collaborated in the analysis. Those participating report a number of outcomes. Their own confidence in their ability to do research has increased; the work enabled them to reflect on their practice and to make changes (e.g., to how they provide health education to those with diabetes; making appropriate referrals to specialist services); and as a result of the participating nurses’ report, her practice team is reviewing particular aspects of how diabetes is managed. Two papers reporting the findings have been submitted for publication, one of which is published, and papers have been presented at national and international conferences.

The project represents a successful small-scale capacity building exercise achieved at a modest cost.

General medical practitioners (GPs) and members of the primary care team have a pivotal role in supporting unpaid carers in their caring role and helping them to maintain their own health and well-being. This paper investigates the difference that caregiving makes to individuals’ access to and use of GP and primary care services. It is based on longitudinal analysis of carers’ contacts with GPs, and a review of the literature including evaluations of measures to improve primary-care-based support for carers. Men increase their consultation rates with GPs when taking on a caring role. In contrast, women who look after someone in the same household and carry heavy caring responsibilities have relatively less contact with GPs than expected. According to the literature, carers report a range of difficulties accessing primary health care. A five-fold typology is described covering barriers arising from: professional responses to the carers’ role; the way services are organized and delivered; language or culturally held beliefs and practices; carer or care recipient characteristics; and unmet information needs. Various measures to improve carers’ access to primary care have been introduced to overcome these barriers, but robust evidence of cost and utility is required to judge their acceptability and effectiveness for both carers and GPs. Although good practice guides, quality standards and evaluation tools are available to help improve primary care support for carers, further investigation of carers’ help-seeking for health care, and the factors involved, is required to underpin the prospects for developing a genuine partnership between unpaid carers and health professionals.

There is increasing concern at the amount and cost of prescribed medicines that are unused or wasted and then have to be disposed of. Previous studies have used health promotion and Dispose Unwanted Medicines Properly campaigns targeted at the patient to describe and quantify the annual cost of waste. The reasons patients return unused drugs to pharmacies have also been explored. The paper focuses on patient explanations for not needing medication; categorized as: over-collection in the past, self-management strategies, changes in medical condition, other changes in patient circumstances, or the repeat medicines policy at the surgery. The aim of the original study was to make a measurable change in prescribed medicines with a reduction in medicines wastage, whilst at the same time achieving improved standards of pharmaceutical care. Information on patient needs and behaviour came from consultation in the pharmacy monitoring forms and interview. The study was based on two medical practices in the West Midlands, UK, comparing an outer city and an inner city population. The participants were general practitioners, pharmacists and 350 repeat prescription patients. Prescriptions were issued for two three-month periods. The outcome was that 23.8% of the prescribed items were not dispensed, at a value of £13.1K, 58% of the medications that would be expected to be regularly supplied were collected. The study suggests that closer professional management at the point of dispensing and an understanding of patient experiences can help reduce the amount of unwanted medication collected by patients.

This paper reports an evaluation of a counselling service that was introduced into 20 general practices within Bradford City Primary Care Trust. Clinical Outcomes in Routine Evaluation (CORE) Assessment and End of Therapy forms were used to record referral and attendance information along with problems identified and demographic information about clients. There was a large disparity in the number of referrals across practices illustrating a range of influences on take-up of the service. Levels of attrition from referral for counselling to commencing were relatively high (188 invitations: 89 took up counselling). A longitudinal evaluation of outcomes was conducted using the CORE outcome measure and the SF-36 Health Survey Questionnaire. Data was collected at the beginning of counselling, at six months and at 12 months follow-up. We found some indication of positive change relating to severity of problems and ability to engage in social activities. However, evaluators should be aware that high attrition rates can create problems in achieving statistical reliability in contexts where overall population numbers are relatively small and/or the time for data collection is relatively short. In light of the recent growth of counselling within primary care, and the need to evaluate these services, the issues encountered in setting up this counselling service, and in seeking to evaluate it, may be instructive to others. Focus groups with counsellors and practice staff explored the benefits and problems in providing the service within practices.

The study objective was to explore the way in which the expert patients programme (EPP) has been implemented by primary care trusts (PCTs) and to identify key barriers and facilitators to the implementation of this initiative in the National Health Service (NHS). The study forms the first part of a process evaluation to record the development of the EPP in the NHS and to identify the patterns of development which impact on NHS organizations and local community partnerships and networks. This preliminary survey consisted of telephone interviews with the key personnel working in primary care sites where EPP was initially piloted. Forty-six PCT leads (74% of those eligible) and 19 EPP trainers were interviewed (68% of those eligible). Secondary sources of data (such as PCT websites and literature promoting the EPP courses) were also examined. The PCTs’ ability to recruit to EPP courses was considered a key marker of early success which in turn related to wider issues concerning EPP’s position in the PCT’s priorities and the degree to which it was seen or made to link with other agendas and goals. A quarter of the sample had good rates of recruitment, the characteristics associated with these sites included: location in urban areas; early access to voluntary tutors; delegation of administrative responsibilities; networking and sharing resources with other PCTs; use of local newspapers to publicize courses; and active support from health professionals. Problems with recruitment were associated with a reliance on a paper-based strategy; poorly developed links to the broader community and health professionals. The evaluation shows that initial success of a lay-led self-care support programme in the NHS depends on commitment at the level of the PCT boards as well as those directly charged with organizing and delivering pilot training courses. Helping key health professionals understand and engage with the principles and benefits of training in self-care for people with long-term health conditions is likely to impact on the success and future of this programme within the NHS.

This paper provides a summary of an exploratory study based on an interpretive approach, aiming to elucidate how professional executive committee members of one primary care trust see their role and the training they need to fulfil their functions. The effective delivery of local and national health priorities in the newly created PCT depends on these members having the knowledge and skills needed to carry out their work. At the time of the study, no one had assessed whether or not the members had the requirements for their role. The study was conducted in 2002 during the first six months of the creation of the PCT. Using questionnaires and semi-structured interviews, the study examined the perceived training needs of the 26 participants. Data analyses were in two stages. Analyses of the questionnaires involved entering the responses into a statistical programme. These were categorized into four areas: intellectual, financial/commissioning, service issues and other issues. Matrices of the responses were developed for the group and for each executive participant. In addition, a further matrix was designed, with a weighting applied, to show the order of importance for each competency. The second stage of data analysis involved content analysis of the verbatim transcripts. Themes identified from the coded analysis include the participants’ views of the direction of the professional executive committee, and concerns about them. The paper shows that the training needs of the committee members are not so easily determined because of lack of clarity of their role, and the part they play in the development of managed clinical networks and in securing co-ordinated and seamless care for the PCT’s patient population. The paper concludes by suggesting that some of the difficulties faced by the executive committee members were not of its own making, but were due to the rapid nature of organizational change in the National Health Service. This project contributes to the knowledge base about executive committee members, group interaction and dynamics, as well as having practical implications for delivering both local and national health targets. Future research could address the extent to which the PEC’s role has been clarified and whether this has been helpful in contributing to the redesign of services.

Attention-deficit hyperactivity disorder (ADHD) is a growing diagnosis in child mental health in the UK and is increasingly being treated with methylphenidate (Ritalin, Equasym, Concerta). There are, however, clinical and public controversies over the diagnosis and ‘labelling’ of ADHD as a disorder, the use of drug treatments, and a relative paucity of guidance on the initial diagnosis and referral of the disorder. General practitioners (GPs) are involved in the assessment, diagnosis and treatment of children with ADHD and in liasing with the other parties involved, such as parents, teachers and specialists. Therefore their understanding of ADHD and its treatment is important. This study explores Wandsworth (South West London) GPs‘ understanding of ADHD as a disorder and their views of its management in order to provide more precise detail about the issues concerning the management of ADHD in primary care by GPs.

Qualitative information was collected by semi-structured interviews (with 13 GPs) and quantitative information by means of questionnaires (93 completed by GPs) in Wandsworth.

Whilst GPs had differing views of the aetiology of ADHD, there was a consensus view about the division of responsibility in the treatment of those diagnosed with ADHD. GPs felt uncomfortable initiating the prescribing of methylphenidate and stressed the importance of ongoing specialist involvement in the management of ADHD. There was also a feeling of inadequacy in terms of the training that GPs had received.

It is suggested that guidance on the initial diagnosis of ADHD is drafted for GPs and that shared care protocols are agreed between primary care and secondary care so that the ongoing division of labour in the management of ADHD is made explicit, ensuring continuity of care.

Public health restructuring in Ontario, Canada occurred in the midst of the rhetoric of ‘primary health care (PHC) reform’. The purpose of this descriptive mailed survey of nurses working in public health nursing in Ontario, Canada was to describe the nature and scope of public health nursing practice, establish a baseline against which to monitor future change, examine nurses’ reports of changes in practice that had occurred in the previous five years, and determine current public health nursing staffing levels. Findings were examined to ascertain whether the changes had moved Ontario closer to PHC. Two sets of questionnaires were mailed in 1999: one to a public health nurse (PHN) in a senior manager position in each of Ontario’s 37 official public health units and one to all PHNs in Ontario.

Response rate was 87% for the managers’ surveys (n = 32) and 77% for PHNs (n = 2242). Reported staffing levels represent an 11% reduction in public health nursing full-time equivalents (FTEs) from 1988 data. Furthermore, between 1993 and 1998, the population:nurse ratio rose 32% from 3710:1 to 4910:1. Many traditional public health nursing services, such as those to individuals, families, and schools, had been reduced or eliminated. Significant regional disparities were revealed. Nurses used a wide variety of individual, community, and population-focused health promotion strategies consistent with principles of PHC in their practice but evidence suggested the continuance of biomedical domination of public health and public health nursing, rather than the shift to a multidisciplinary model that would be more consistent with PHC.

Findings suggest that changes in public health nursing over the last 20 years are incongruent with several tenets of PHC, such as equity, accessibility, social justice, and community participation.