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.

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.

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.

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 aim of this qualitative study was to explore the process of care provided by a community-based geriatric assessment and management team (the elderly resource team or ERT) through a critical incident approach. Cases were discussed both with the ERT alone and in combined discussions with referring primary health care teams, using an external facilitator. Data analysis was based on the critical incident technique and a grounded theory approach. Analysis of 11 cases generated a total of 496 events (a mean of 45 events per case). The numbers of positive events and negative events (areas of concern) were approximately equal (236 and 260, respectively). Certain important themes emerged from the data to describe how the elderly resource team managed their patients. Patients were often referred for covert reasons, such as negative emotions in informal and formal carers and inappropriate demands on them. Integrated multidisciplinary assessment by the team generated a realistic appraisal of the situation. With time, the key worker became a trusted professional, leading to recognition of the patient's poor psychological adjustment to their illness, and unexpected breakthroughs in their management, which previous carers had been unable to achieve. Reflection of these concepts back to informal and formal carers was considered to be supportive. Caring for such complex patients also produced negative emotions in the elderly resource team. Internal support for individuals in such teams can be offered via the concept of role transference. Through further analysis using a grounded theory approach, a conceptual model was developed to describe the process of care delivered. This model requires further testing in order to determine whether it is applicable to other multidisciplinary rehabilitation teams.

Policy initiatives increasingly emphasise the importance of breaking down organizational and professional barriers in order to achieve the delivery of effective mental health services. In this context, joint commissioning is seen as providing a way forward, and GPs are now identified as having a key role to play, alongside other professionals and agencies. However, there is evidence that joint commissioning is not yet well established, and a number of barriers to its development have been identified. The study reported here aimed to inform the development of joint commissioning between primary health care and social care in Wales by first mapping progress to date and then exploring the issues involved in more detail through three case studies. After the methods used for each stage have been described, the results are presented and discussed in relation to the problems identified and potential approaches to their resolution.