The Primary Care Deprivation Initiative (PCDI) has been established in a deprived part of inner-city Liverpool in three health centres, in order to improve the capacity of the primary health care teams (PHCTs) to address the health and social care needs of part of the practice populations. Non-professional PCDI support workers, supervised by an experienced nurse, offer advice, support, information and, where necessary, advocacy to patients referred by PHCT members who present with mixed health and social care needs. The aim of the present study was to discover whether the PCDI eases the burden on the PHCT by reducing presentations to health staff of primarily social problems, or whether PCDI clients might make increased demands on the PHCT as a result of the PCDI being available. Routinely collected data on the use of primary care services were compared. Data collected for 12 months before and after accessing the PCDI showed statistically significant reductions in GP consultations and new prescriptions. There was also a definite but statistically non-significant increase in prescribing as a whole. It is concluded that, in the case of patients presenting with undifferentiated heath and social needs, the provision of services to separate and address the latter appears to result in more appropriate use of primary care by patients and more effective prescribing by GPs.

Within a health service that is primary health care led and emphasizes partnership and cross boundary working, the way in which health professionals and others achieve integration becomes increasingly important. This paper highlights some of the professional literature and research evidence on the benefits for nursing and patient care in primary health care when different nursing specialities work within a formal framework of collaboration. This is set against findings from a study on district nursing and their planned or actual participation in integrated self-managing nursing teams. The paper concludes by arguing that although the underlying rationale for integrated nursing teams would seem to have coherence and plausibility, the findings of this study and others indicate that there are issues which need closer attention. These include how competing managerial and medical agendas have influenced the development of integrated nursing teams, and whether existing patterns of self-management by primary care nurses have been overlooked.

NHS policies on research and development are aimed at creating a knowledge base for clinical, managerial and policy decisions. This is largely generated through fixed-term projects and through voluntary collaboration between projects and service providers. In this paper, two such projects are compared. They have some basic similarities but also some conspicuous differences. In the analysis, first the planning and launching of the projects are considered, and then their management. Particular attention is paid to the relationship between the scheduling of the projects (and especially their fixed-term funding) and the process of collaboration with primary care practices.

Asthma is a common chronic condition which places a considerable burden on patients and NHS resources. The relatively high prevalence, together with its innate variability, makes the provision of care by primary teams an essential and recognized part of overall management which is now generally undertaken by enthusiastic asthma-trained nurses. Despite 10 years of such organized care, there is little evidence of its effectiveness, with few data available on who attends and for what reason. We do not know the views of those for whom the clinics were intended, namely the patients. Here we report the results from two qualitative studies, one using in-depth interviews with individual patients and the other using focus groups on a range of different patients. The first study involved 30 adult patients whose pattern of compliance with inhaled medication allowed categorization of individuals into ‘compliers’ and ‘non-compliers’. The results of this study allowed a typology to be developed which categorized patients into ‘distancers/deniers’, ‘accepters’ and ‘pragmatists’. The focus group involved 70 patients (35 patients on two occasions) from a mixture of practices, and varying age and socio-economic groups. Both studies yielded remarkably similar results, and they show that patients, for a variety of reasons, do not regard asthma clinics as being of relevance to them and generally do not attend. Using the typology that was developed, we present reasons for their non-attendance based on the recurring rich quotes from patients. It is clear from these results that if practices run endless clinics, patients will not attend for the reasons given. Further work involving both quantitative and qualitative techniques is needed to explore who attends asthma clinics and why. Patients' views should now be integrated into future service planning, and the current educational role of the asthma clinic should be replaced by one which more closely reflects patients' needs and expectations.

The purpose of this study was to analyse and describe the experiences of adolescents who had been maltreated by their parents in childhood. Child maltreatment was defined as physical, psychological or sexual abuse or neglect caused by parents or other primary caregivers of the child. Data were collected from seven adolescents, aged 14–19 years, who had been maltreated within their family of origin for many years. Interviews employed broad themes pertaining to family life, maltreatment experiences and the family's strengths and problems. The data were analysed by qualitative content analysis. The analysis resulted in a description of the adolescents' experiences of maltreatment and of the consequences of maltreatment as perceived by the young people themselves. The consequences included connections between maltreatment and family life and direct consequences for the adolescents themselves. These results aid our understanding of child maltreatment and its manifestations from the viewpoint of adolescents within the family. An improved understanding of their views should make it possible to develop nursing care of these children and their families as part of multidisciplinary work. The role of nursing is central to this work, because one of the goals of nursing is to improve the well-being of families and individuals. However, further research is still needed to add to our knowledge of child maltreatment from the adolescents' viewpoint.

The concept of burnout among health care professionals involved in AIDS care has been well documented in hospital and hospice settings, but no empirical research has been conducted among practitioners working with AIDS patients in the community setting. This study used a burnout measurement tool, namely the Maslach Burnout Inventory (MBI), to measure the level and components of burnout in a sample of 47 community HIV/AIDS nurse specialists. The study also explored the under-researched relationship between different elements of the MBI. The main finding of the study was a high level of burnout among these practitioners, with over 50% of participants scoring as burnout ‘cases’. There was no link between burnout and caseload and length of time in practice, and female respondents rated marginally higher with regard to the number of burnout cases. There was also a close relationship between the intensity and frequency scales on the MBI. The importance of utilizing both a supportive model of clinical supervision and also the development of less formal peer support systems is suggested as a way forward in addressing burnout prevention in this group of practitioners.