The majority of people with psychosocial problems confide in relatives or friends rather than their GP or other professional but the advice and information handed out, although well intentioned, may be misinformed. Others consult key personnel within their community who also may be ill-equipped to give constructive help. In a disadvantaged inner city area, it might be expected not only that stress would be prominent in people's lives and affect their health, but also that there would be barriers to seeking professional help. This project investigated whether working in partnership with a community, enabling its members to identify their own support, development and training needs and meeting those needs by adaptation of a recognized basic counselling skills course, was an effective way of helping that community cope with its own psychosocial problems, increasing its transferable skill base. Evaluation was conducted by means of individual interviews and focus groups. Participants perceived that the training that they had undertaken was valuable and that they were now better listeners with increased confidence and more likely to offer appropriate responses to those seeking their help. Several were motivated to undertake further training and others gained confidence to seek further professional help for themselves. Spending time allowing a community to define its own training needs whilst working on familiar territory is a cheap, effective, non-threatening way of putting information, basic counselling and relationship building skills into a disadvantaged urban community without causing dependency but instead encouraging them to seek further training enhancing employability. The skills introduced into that community remain and can be used to the full for themselves and others especially in relation to psychosocial problems. As the project used a well-recognized course and can be adapted to the needs of local people, it is likely to be transferable to other areas.

The recent interest in the issue of domestic abuse has highlighted its adverse impact upon womens' health, together with the need to improve health care responses. Whilst this has implications across health services, the raised awareness of domestic abuse as a health care issue is particularly important for primary care. This is not only due to the nature of primary care contact with women experiencing domestic abuse, but also because the current modernization of primary care, which includes organizational change, enhanced public health, increased partnership working and new forms of service delivery, provides an ideal opportunity to improve the services which are delivered to women experiencing domestic abuse. There are, however, a number of challenges to achieving real changes in practice. These include the complexities of domestic abuse which will always be competing with other clinical priorities, as well as the complexities of primary care which crosses a number of organizational and professional boundaries. Moreover, whilst the recognition that domestic abuse is a health care issue is to be welcomed, concerns relating to the medicalization and professionalization of what is essentially a social problem are highlighted.

The PHASE research programme is an NHS-Executive funded, randomized controlled trial of assisted self-help for common mental disorders, delivered by practice nurses in primary care. The self-help guide – Managing anxiety and depression: a self-help guide published by the Mental Health Foundation – is conceptualized as a ‘health technology’ where the nurse's role is to educate patients how to get the best out of the technology, supervise its safe delivery and monitor its continued use by patients so that they can use it independently with little reliance on nurses or other health professionals. Twenty-three nurses were trained on one of five, 3-day courses to deliver PHASE. As the final task during the training course, nurses were asked to describe what they would say to a patient when delivering PHASE. From these data a qualitative thematic content analysis was used to develop a coding framework which showed that nurses were able to articulate a sophisticated health technology rationale, including relevant psychological models and the principle of an evidence base. This study demonstrates that it is possible to equip primary care nurses with both a highly developed understanding and the knowledge to deliver self-help mental health care. Training nurses using this model moves us away from traditional mental health training courses that have attempted to produce ‘watered down’ versions of specialist practitioners to a more appropriate skills and cultural ‘health technology’ fit for delivering primary mental health care.

A substantial proportion of the symptoms of ill health presented in primary care settings are medically unexplained. Low level physical and mental suboptimal functioning, such as tiredness and nagging psychological discomfort are common features of workload and are rarely amenable to immediate and straightforward treatment and cure. Complementary and alternatives medicines (CAMs), with their frequent focus on overcoming an apparently restrictive mind/body dualism, are being increasingly drawn on to manage such symptoms. reflexology is a CAM that, it is claimed, is able to induce improved physical and mental health and overall well-being. To date, there has been little research which addresses this claim. A single blind trial was conducted to test the effectiveness of reflexology in improving levels of tiredness, overall health and perceived well-being in a sample of 34 patients with chronic irritable bowel syndrome currently under the care of a general practitioner, following diagnosis by a gastroenterologist. Both reflexology and nonreflexology (control) groups were found to produce a moderate improvement in symptoms, but there was no statistically or clinically significant difference in outcome between the groups. Thus, no specific benefit of using reflexology was found. On the basis of this study, there is no evidence for the use of reflexology as a means of enhancing patient well-being in primary care. However, the research was conducted with one quite specific patient group. Considerably more research is needed with a range of patient groups and outcome measures before definitive conclusions can be reached.

This study was designed to test the hypothesis that a behavioural programme was used preventatively to try to reduce crying and improve night sleeping in 1- to 12-week old infants compared with educational support or existing services. The objectives were to develop strategies which can be used to inform, help and support parents of new babies. The study was a three-group prospective randomized controlled trial in West Berkshire and South Oxfordshire, making a comparison between a behavioural policy, an educational intervention and existing services. The participants were 610 mothers giving birth to term healthy infants at the Royal Berkshire Hospital, Reading between March and November 1997. The main outcome measures were interruption-free nights i.e., the number of nights each week when parents reported that their baby slept for a minimum of 5 hours; babies' fuss/crying patterns; and mothers' general well-being and approach to parenthood. There were no significant differences between the groups in the amount of fuss/crying, which gradually reduced during the 12 weeks. At 12 weeks of age, more mothers in the behavioural group reported their babies to have had seven interruption-free nights (61%), compared with the educational (53%) and the control groups (50%). This was significant at the P < 0.05 level. The educational and control groups did not significantly differ at any age. At 6 and 12 weeks, mothers allocated to the behavioural policy were more structured in their approach to parenting and rated it more highly for convenience. At 9 months, their babies were more likely to have a regular bedtime routine. Where mothers followed a behavioural programme, 10% more babies slept for a minimum of 5 hours at night without disturbing their parents at 12 weeks of age. This improved sleeping pattern persisted up to 9 months of age. Mothers in this group also reported a greater feeling of control and increased confidence in their ability to cope. The more widespread adoption of a behavioural approach to the management of early infant sleeping should be considered.

The government has stated its commitment to provide equality of access to health care for all and has emphasized the need to take account of users' views. The aim of this review was to search for evidence of adolescents' perceived needs for and access to primary health care services and to evaluate and report on the evidence found. Methods used were systematic searching of data bases and direct contacting of health and related organizations. The main finding was that a substantial minority of teenagers has health-related problems which are not met by current services. The main barriers to accessing primary health care were a perceived lack of confidentiality, embarrassment and unsympathetic staff. Reported access to a school health nurse varied widely (between 5% and 83%). The conclusions were that the barriers to accessing services as identified by teenagers are amenable to staff training, and that taking account of users' views could act as a stimulus for such training.

Interest in the role of the nurse practitioner in primary care, as first point of contact for patients with acute illnesses, is well established. Recent studies in the UK have examined the role in the context of a variety of acute presentations and have addressed issues of competence, safety and patient satisfaction. The management of acute presentations involves responsibility for making a diagnosis and, frequently, for recommending medication either on prescription or to be purchased from the pharmacy. As the nurse practitioner role develops in primary care there is a need for evidence of the effective management of specific acute presentations. Protocols have been advocated as a key to the successful introduction of the nurse practitioner role but the legality of their use, particularly in relation to prescribing, remains unclear. The aim of this study was to compare, in one general practice, the management of acute urinary symptoms by nurse practitioners with that of GPs in the context of a protocol. The study was undertaken in two parts: a retrospective analysis of a sample of the records of female patients followed by a patient satisfaction survey. The retrospective analysis examined the use of the protocol in guiding the decision-making of both groups of practitioners and evaluated the outcome for the patient. The outcome indicator used in this part of the study was the need for a repeat consultation within 14 days due to non-resolution of symptoms. The retrospective analysis of records was supplemented by a patient satisfaction survey. In comparison with the GPs, the nurse practitioners' records were more complete, the prescribing rate was lower, the use of laboratory resources was similar and there was no difference in the number of patients who needed to be seen again. In the patient satisfaction study higher levels of patient satisfaction were achieved by the nurse practitioners.