The constipating effect of opioids used in cancer pain is widely acknowledged. Opioids account for about a half of constipation in cancer patients, making constipation one of the most prevalent side effects of cancer analgesia. Scottish Intercollegiate Guidelines Network (SIGN) guideline 44 (7.4.1) states explicitly that the appropriate intervention for opioid-induced constipation is a combination of softening and stimulating prophylactic laxatives. Previous literature suggests such practice is not commonplace, implicating a knock-on negative effect to patients' quality of life and highlighting the need for audit in this area. An audit of bowel management in Fife primary care was carried out comparing laxative prescribing practice before and after the publication of SIGN 44: Control of pain in patients with cancer. The data for the audit included all opioid prescriptions including both cancer and non-cancer patients. It was found that publication of SIGN 44 had no significant effect on adherence to the guideline by general practitioners in Fife, at six-, 12- and 18-months post-publication. Implications for quality of life and improving bowel management are discussed.

Most evidence on the delivery of diabetes services in primary care has focused on the organization of care rather than on the experiences of health care providers. We evaluated staff satisfaction with respect to access, communication, management advice, and understanding of roles. A postal survey of staff at 35 practices from two inner London primary care organizations was linked to profiles of the practice organization of diabetes care. Data were analysed for 124 staff including 81 doctors and 43 nurses. Only 37 (46%) doctors and 20 (47%) nurses were satisfied with the current system of diabetes care. Overall, there were low levels of satisfaction with access to, communication with, or management advice from other members of the diabetes team. Only 29/81 (36%) of doctors understood clearly either their own role or the role of others but 27/43 (63%) of nurses understood their own role and 23 (53%) understood the role of others. Compared with practices with less satisfied staff, practices where staff were more satisfied showed similar organization of diabetes care in terms of the use of a register, recall system, clinical guidelines, availability of equipment, organization of education programmes or use of audit. Staff were generally dissatisfied with diabetes services, but the level of satisfaction was not associated with practice organization for diabetes care. Since a better team climate has been associated with higher quality care, more work should be done to understand influences on staff satisfaction in the delivery of diabetes care in primary settings.

Up to 20% of additional income is being provided to UK general practitioners (GPs) to improve quality of care, through a complex set of quality indicators which relate principally to chronic disease management and organizational aspects of care. Using data from semi-structured interviews with a purposive sample of 20 GPs and responses from 1035 GPs to a questionnaire survey (53% response rate), we describe the initial impact of these incentives. GPs are employing more staff, especially nurses and data entry clerks, and computerizing their clinical records. Patients are more frequently seen in disease-oriented clinics run by nurses. While the health gains associated with the incentives may be realized, GPs predict that there may be unintended consequences, including reduced continuity of care, care fragmentation, neglect of unincentivized conditions, and the risk of damage to their internal motivation.

The aim of this article is to illuminate participants' access, utilization and perceptions of primary health care (PHC) services in two cities in England, including factors that militate against or enhance utilization of PHC services for African Caribbean people residing in England. Hypertension remains a major health issue amongst immigrant and UK born African Caribbean people. Current policy agendas are concerned with a reduction in cardiovascular disease and with addressing social exclusion, ameliorating health inequalities, and ensuring that individuals from black and minority ethnic groups receive fair and equitable access, care and treatment. The research conducted in two English cities investigates the meaning and consequences of hypertension and perceptions of PHC services. The research explored the decision making processes that lead to the presentation of individuals in PHC in England for early diagnosis and treatment. This qualitative study draws heavily on the focused ethnography methodological approach. Multiple methods were employed including two focus groups interviews, 21 semi-structured interviews and five vignette-based interviews. Participants numbered 36 in total. Data were analysed with the aid of Atlas/ti. using established principles for analysing ethnographic data. The findings map out the factors influencing early presentation for diagnosis in PHC and perspectives are gained on the quality of the participant/general practitioner (GP) relationship, as perceived by the participants. Participants' satisfaction and dissatisfaction with PHC services are also evidenced. It is relatively common in English communities of African Caribbean origin to use private PHC services. Motivations for this are evidenced, including historical antecedents. Participants used non-concordance (ie, non-compliance with prescribed medications) and traditional Caribbean herbal remedies as strategies of empowerment.

Eating disorders are a crippling and disabling condition. If they become chronic, the emotional, physical and social effects are substantial. The death rate is the highest of all psychiatric illnesses so the need to find prevention strategies is urgent. This research project has three aims, primary prevention of an eating disorder for the child, helping the mother recover and developing a protocol for a group to be used in primary care. Children of mothers with an eating disorder, are a proven ‘at risk’ group, because children model and internalize their experiences. This project was carried out in a community setting, targeting mothers with an eating disorder who had children under the age of 13. It was argued that if these mothers can be encouraged to change the dysfunctional behaviour they may be passing on to their children, an attempt can be made to break the cycle. This qualitative research pilot project utilized semi-structured interviews before and after 11 weeks of group therapy, with three- and six-month follow-ups. Although the sample was small, the results showed that a group allowed these mothers a safe space for reflection, enabling them to become aware of their behaviour. As a result the mothers implemented changes in response to their children's needs, encouraging healthier development. The pilot was a precursor for a larger study to be carried out and developed within the primary care network.

The focus of this paper is on health inequalities at a local level and the implications for community-based practice. This paper describes the development of a small multiagency project supporting families in a disadvantaged urban neighbourhood within the UK. A baseline assessment enabled primary and secondary data to be collected to inform project development and identify priorities for action. Findings revealed the scale of health need and helped focus the direction of the project. Several issues affecting implementation were identified, including the importance of good liaison between services and adopting a community development approach. This paper discusses the wider implications for the planning, delivery and evaluation of community-based initiatives addressing health inequalities. Despite the scale of need, there appears to be good potential for practitioners working in disadvantaged neighbourhoods to achieve some positive changes. Key points of learning are identified.

There is a policy drive in the UK National Health Services (NHS) towards public involvement in service, education and research, with a number of national initiatives such as INVOLVE that have championed effective user input on research and development (R&D). The requisites of research governance include a balance of professional and public input, and the structures for this now exist at primary care level. There is a need for examples of how such policies can be implemented in Primary Care Trusts, and this article aims to show in detail the way in which a systematic approach to user involvement in R&D has been implemented. The PPIRes (Public and Patient Involvement in Research) project, whose progress over two years from 2003 to 2005 is reported, has been funded by NHS R&D monies allocated through a research consortium in Norfolk, and has been hosted in an NHS – academic partnership between Norwich Primary Care Trust and the Institute of Health at the University of East Anglia. The profile of volunteers, recommendations for good practice in public involvement, and the ‘facilitators and challenges’ to the programme are described.

International and UK National Health Service policy has focused attention on the need to develop research capacity in primary care, with the emphasis on collaboration between professional groups and across organizations including health and social care, and the academic context. The results of a survey of research activity, interest and skills in a health and social care community, in Northern England, are reported. The survey targeted primary care trust (PCT) staff, general practice staff and social services staff seconded to the PCT, and a response rate of 31% was achieved. Twelve per cent of respondents were involved in research, with research active professionals typically involved in between one and three projects. PCT staff reported a significantly higher level of research activity, research skills and research interest than general practice or social care staff. The holding of a master's degree was associated with a greater desire to lead or collaborate in research. All three groups expressed a preference for practice-based research training and other forms of research support were identified, including protected time, apprenticeship, mentoring and funding advice. The results of this survey have been valuable in terms of research governance, forming research strategy, and impact on capacity via training and support for the health and social care community within a newly formed research alliance between a district general hospital, a PCT and social services, including an academic advisory group. The paper concludes that a holistic approach to research capacity building should inform changing policy and research funding in the UK.

Trent Focus, a Research and Development Support Unit, have introduced the ‘Designated Research Team’ (DRT) approach to building research capacity. This approach funds protected time to develop research ideas and skills for a team with limited research experience. This paper uses the example of a successful team of podiatry researchers to illustrate the approach to, and outcomes of, a DRT. It draws on documentary analysis of meeting notes and annual reports, and team members' views collected during a recorded reflective session of the team at the end of the funding period. The DRT were successful in achieving agreed outcomes, including completing the project, submitting and publishing in peer reviewed journals, and presenting at conferences. They were also able to attract further funding, and engage with international collaborations and research activity. The unique contribution of this paper is that it focuses on facilitating factors to building research capacity based on a practice example. These include: enabling protected time, effective managerial support, applied and timely research training at relevant levels to expertise, immediate access to supervision and mentorship, a critical mass of research expertise within the team, and an encouraging workplace environment. Importantly, research undertaken was seen as a means to improve practice and the status of the professional group. ‘Accessible’ academic support including outreach work and attitudes of the team members and supervisors towards teaching and learning were important. Process factors enabling success include the use of project management techniques, clear delegation of tasks, effective lines of communication and accountability, and high levels of social capital and commitment between team members. The paper highlights ways forward to using these facilitating factors to build further research capacity, and to use this approach to highlight other areas of research capacity outcome measures.