In the United States (US), Practice-Based Research Networks (PBRNs) are in rapid evolution. As in the United Kingdom (UK), within the last decade there has been widespread recognition that primary care is the ‘undiscovered country’ of health care, and that research in primary care is important and worthy of support.

This paper relates a common problem in community practice. A client chose to share information with a support worker who was unsure of her competence to deal with the disclosure. An innovative and reflective approach to finding evidence for potential benefit or harm is described, together with an interpretation of this evidence, and finally recommendations for clinical practice based on ‘best available evidence’.

This article presents a review of current issues and trends in the use of information technology (IT) by nurses in primary care. Its aim is to raise awareness of the particular problems faced by nurses, and so it is not aimed at the IT expert but at the primary care nurse, researcher or educator who seeks a wider perspective on the issues involved. It is not the purpose of this paper to offer specific solutions to the problems; these will be discussed in further publications. The first section highlights recent policy changes in the area of information technology that are already affecting nurses in primary care. The second section addresses some of the barriers to progress in this area, which should be taken into account if the Government's vision of an IT-rich health service is to be achieved. To draw attention to the fact that nurses in other countries face similar issues to those in the UK, we include a wide selection of international as well as national literature. Finally, the third section suggests how these barriers might be overcome, and identifies emerging trends.

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.

The links between deprivation, poverty and ill health are well known, but many people with significant health problems do not claim welfare benefits to which they are entitled. Accessing advice within primary health care may be one way of tackling this problem. The aim of this development project was to develop and evaluate over a 3-year period a welfare rights advice and information service that would not only complement the work of the primary health care team, but also target those patients who were most in need. The service was developed using an action research approach. Three models were used with different primary health care teams. The evaluation consisted of both qualitative and quantitative elements. The qualitative study used semi-structured one-to-one interviews with 11 patients who consented to be contacted, two Citizens' Advice Bureau workers and 26 primary health care team members from 10 general practices in Gateshead covering a wide range of practices and patients (approximately 73 000) from all socio-economic groups, and additional focus group interviews with three further primary health care teams. Quantitative data were collected by the Citizens' Advice Bureau on 683 patients and benefits received. A welfare rights service with an attached Citizens' Advice Bureau worker was seen as beneficial by the primary health care team. The work of the primary health care team was complemented by the CAB worker's additional expertise. Many patients entitled to benefits who would not otherwise have sought advice from a Citizens' Advice Bureau worker were referred by primary health care team members. It was found that targeting people unable to access the surgery reached those most in need in the project group. For those referred, a cumulative total of £1 641 865 was gained during the lifetime of the project. Many patients were referred and as a result received benefits. Optimum use of the service was achieved by restricting the service to the housebound. The use of a dedicated telephone line appeared to maximize the use of the workers' time, and also made few demands on the time of the primary health care team.

This paper describes how new insight into community nursing know-how or professional artistry was produced through qualitative analysis of 30 transcripts of audio-recorded simulation data. The data were generated by simulated patient assessments of two cases. These simulated assessments were undertaken by a heterogeneous sample of district nurses drawn from a large conurbation in central Scotland in 1995. The existence of multiple sets of rich, dynamic and interactive data about each case provided a sound basis for exploring important and poorly understood aspects of nursing knowledge which are generally regarded as implicit. These aspects of nursing knowledge are particularly challenging for empirical research. The findings described are believed to be of particular interest in their articulation of collaborative approaches to patient assessment. Illustrations from the data are provided, and it is argued that the validity of the findings is enhanced by the unusual nature of the database, as well as the analytical procedures described. The limitations and significance of the findings are also addressed. The empirical analysis is linked to a preliminary discussion of procedural knowledge in nursing practice. The findings are discussed with reference to certain aspects of Foucault's view of power.

Hospice care is evolving from the traditional in-patient bedded unit into a system of support which is community focused. The cornerstone of this ‘community model’ of palliative care rests on successful collaboration with the primary health care team (PHCT). However, there is evidence that establishing a community service is not straightforward, and acceptance in principle is not always translated into practice. This article presents the findings of an evaluation of one such community palliative care service from the perspective of local general practitioners (GPs) and district nurses (DNs). A combination of interview and survey data is presented. A positive picture emerges. The findings suggest that the task of promoting and integrating the service in the community has been successful. The service was seen by members of the PHCT as helping to provide a choice of care settings and helping patients to remain at home. It was not perceived as having caused extra work or complicated lines of communication. However, it is an area which will require constant attention as other factors come into play.

The aim of this study was to describe the extent and variations in administration of depot antipsychotic medication within primary care in the North Thames Region, by means of a cross-sectional survey of a sample of general practices in the North Thames Region. Outcome measures were the number of patients receiving depot at the general practice, the professionals administering depot in that general practice, and the perceived need by these professionals for further training. Depot antipsychotic medication was administered in 55 practices (79.7% of the respondents). Practice nurses gave depot antipsychotics in 41 (59.4%) of the respondents, general practitioners in 27 (39.1%) of the respondents and community psychiatric nurses (CPNs) in 31 (44.9%) of the respondents in the practices studied. It was found that the majority of GP practices within the North Thames Region administer depot antipsychotic medication, and the GPs and practice nurses share a significant proportion of this administration. Practice nurses need specific training for this task, with access to regular refresher courses to ensure good practice.

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.

Primary care groups (PCGs) and primary care trusts (PCTs) are the way forward for primary care in the UK. These groups of general practitioners (GPs) and community nurses, organized along geographical lines, will need to forge relationships with other organizations and key players to a much greater extent than has been necessary hitherto. Currently PCGs most closely resemble the total purchasing pilots (TPPs), which have been the subject of a national evaluation. This paper reports on the evidence collected by interviewing key stakeholders – lead GPs, health authority (HA) leads, project managers and social services representatives – about how relationships developed in TPPs and how this might be relevant to PCGs and PCTs. The importance of good relationships with HAs was recognized by the TPPs, and the HAs were seen as having an important strategic role. Relationships with social services were slow to start for historical reasons, and had not progressed particularly far by the end of the study. Similarly, involving patients and the wider public in TPPs was problematic, and there was a lack of guidance about the most appropriate ways of proceeding. The evidence suggests that progress will be slow and the problems encountered by TPPs are likely to become apparent as PCGs develop, and with the transition to trust status. There is much for the primary care groups and trusts to learn from the TPPs.

The publication of the Department of Health's 1993 report Changing Childbirth has prompted major changes in the organization of maternity care, with an emphasis on returning antenatal care to the community. Serum screening for Down's syndrome (triple test) is usually carried out and followed up in secondary care, and work relating to the psychosocial effects of the test has been hospital-based. The aims of this study were to examine the views of women regarding the process and effects of delivering the test as part of routine general practice-based antenatal care, with a view to considering how this care might be most appropriately managed. We sent a questionnaire to all women registered with a fundholding practice who were offered the triple test between 1992 and 1997. The main outcome measures were satisfaction with the way in which the test was offered, what women understood by positive/negative results, why some women declined the test, and satisfaction with obtaining results/follow-up. The response rate was 60.7%. The majority of women were satisfied with the way in which the test was discussed, but there was ambivalence with regard to the procedure for receiving results, including the counselling offered. Confusion over the meaning of the results (particularly negative results) was apparent. The test caused anxiety in many women. The need for continuity of advice and support when women are subsequently referred to secondary care for further tests was highlighted. The majority of women wish the test to be available for all. The conclusion we draw is that no abnormalities have been detected during the study period, raising questions about cost-effectiveness. However, the majority of women view the test as a means of making informed decisions about their pregnancies. Although limited to one practice, the issues associated with a broad range of aspects of care identified through an analysis of the experience both of women declining the test and those accepting it provide important insights into the practicalities of delivering antenatal screening tests in primary care.

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.

To clarify how nursing practice influences programme outcomes, the purpose of the research reported here was to examine the relationship that exists between client factors, system characteristics, provider actions and client outcomes in a postpartum programme. The programme is a community-based service primarily delivered by public health nurses in a large urban city in Western Canada. Relationships between structure, process and outcome dimensions in the programme were examined from both an explicit programme theory (normative programme) grounded in primary health care principles and philosophy, and an implicit programme condition (implemented programme) reflecting actual programme delivery. Elements of the McGill model of nursing were used as the basis from which to develop the normative programme theory that guided the research. One finding from this descriptive study was that nursing practice in the programme is still very much rooted in a ‘traditional’ model of health service delivery. There was little evidence of practice consistent with generally accepted health promotion standards.