UK health policy identifies partnership working as fundamental to tackling health inequalities. Related to this is the development of a multi-disciplinary public health workforce, including an increase in the public health role of primary care nurses. Within this policy context, a primary care trust in the north of England established a community health team (CHT) in September 2005 to improve intra- and inter-agency working for public health. The Clinical Microsystems (CMS) framework informed the process of development, an approach not previously applied to public health.

This paper describes an evaluation of the CHT and presents the key lessons learnt in terms of what worked and did not work in the context of the CMS framework.

Participants were members and wider stakeholders of the CHT from three professional groups: individuals holding relevant strategic posts in the Public Health and Nursing Directorates within the Primary Care Trust, health visitors and school nurses, and voluntary sector staff. Focus group (n = 9 focus groups) and postal questionnaire (n = 21) data were collected at baseline, 6 and 12 months post-implementation. Participants’ views on the implementation of the CHT were explored within the ‘five Ps’ (purpose, population, people, processes and patterns) of the CMS framework.

Six themes emerged from the focus group data that illustrated key issues for the implementation of the CHT: ‘agreeing the focus,’ ‘strong leadership,’ ‘the challenge of communication,’ ‘managing workloads and new ways of working,’ ‘success of the CHT’ and ‘outside influences.’ Communication and heavy workloads were identified as key barriers to the success of the CHT in the questionnaire data. These data highlight the complex and evolving nature of public health partnership working and identify important issues that might usefully be considered in future initiatives of this kind.

This study aimed to explore how the views of patients with coronary heart disease (CHD) could inform the design of an information booklet aimed at providing patients and practitioners with a resource to help influence positive health behavioural outcomes.

Coronary heart disease has major consequences in terms of patient suffering and economic costs, with morbidity and mortality figures in the United Kingdom and the Republic of Ireland among the highest in Europe. Lifestyle behaviours such as smoking, eating an unhealthy diet and a lack of exercise are strongly associated with an increased CHD risk, and practitioners report that health education materials are used in practice to help advise and educate patients about the consequences of their lifestyle.

Opinions of patients with CHD were explored concerning their information needs, particularly lifestyle advice, using a qualitative approach in four general practices. This information was used to design a booklet for a pilot study aimed at promoting healthy lifestyle behaviours and medication adherence among people with CHD. Focus group discussions explored patients’ opinions about the booklet’s ‘fitness for purpose’; semi-structured interviews with practitioners examined their views on the booklet’s usefulness.

In initial focus groups, patients identified gaps in their information provision regarding coping with stress, available local community support and medication purpose. Previously published literature was modified to address these gaps. Patients in the pilot study were satisfied with the re-designed booklet. Practitioners reported that its use in consultations enabled change implementation and facilitated patients’ understanding of connections between lifestyle and health outcomes.

Acknowledging the opinions of CHD patients in producing health information booklets emphasized a patient-centred approach and therefore supported practitioner–patient partnerships for choosing healthy lifestyle choices.

To determine whether a process of care planning for people with diabetes, combining a patient-centred approach by practitioners with measures to promote self-management by patients, improve health outcomes.

Health policy, in many countries, seeks to engage people with long-term conditions in protecting their health. This review was conducted by members of a working group established by the Department of Health and Diabetes, UK to consider the potential for personalized care planning in UK diabetes services.

Review of systematic reviews. The Cochrane Library and Database of Reviews of Effectiveness were searched to identify reviews concerned with components of care planning. Reviews conducted before 1990, and those involving education outside the consultation were excluded. Abstracts were reviewed and data extraction undertaken by reviewers working independently in pairs.

In all, 86 reviews were identified as potentially relevant and 22 included. Patient-focused interventions, such as pre-consultation prompts, enhanced the role patients played in consultations. Personalized approaches using tailored information influenced health behaviour more than uniform approaches. Decision aids and computerized knowledge management improved the process of decision-making. Although effective communication was important, focusing solely on changing practitioner behaviour appeared inadequate. Taken together, there was good evidence that the processes involved in personalized care planning would engage patients more effectively in managing their care, but little robust research on the impact on health outcomes of doing so.

The present review identifies effective interventions that are available for clinicians to use in diabetes consultations, but engaging patients requires more than this. Mechanisms to share information and decision-making need further development and evaluation to assess their impact on health outcomes. Narrowly targeted interventions focused on practitioner behaviour appear less effective than whole-system approaches. Personalized care planning offers a mechanism to integrate patient-centred medicine and support for self-management to improve diabetes care.

To compare patterns of population service use and preference in areas with and without one-stop shop services.

A number of strategy documents have recommended adopting a more integrated approach to sexual health service provision. One proposed model of integration is one-stop shops, where services for contraception and sexually transmitted infections are provided under the same roof. Currently, the potential impact of one-stop shop services on patient service use and preference is unclear, particularly at a population level.

Three different models of one-stop shop were studied: a dedicated young persons’ service, a specialist mainstream service, and an enhanced general practice. In each model, the one-stop shop site was matched to two control sites with traditional service provision. Random samples of male and female patients were selected from general practices close to either the one-stop shop or control sites. These patients received a postal survey asking about their use or preference for services for six sexual health needs. One-stop shop and control samples were compared using multivariate logistic regression.

Of the 14 387 patients surveyed, 3101 (21.6%) responded. In the young persons’ model, few significant differences were found in service use or preference between those living in one-stop shop and control site areas. In the specialist services model, women in the one-stop shop area were significantly more likely to cite specialist services for emergency contraception and abortion advice, when compared to those served by non-integrated control services. In the general practice model, respondents in the one-stop shop area were significantly more likely to cite general practice for all six sexual health needs. Overall, general practice was the preferred service provider cited for all sexual health needs, except condoms and pregnancy tests. These findings are discussed in terms of their implications for the provision of integrated sexual health services. In addition, key methodological issues and future research possibilities are identified.

To explore childrens’ and parents’ views and experiences of attending a hospital-based childhood obesity clinic, in order to inform the development of services in primary care.

The prevalence of childhood obesity in the UK is rising. Previous literature identifies the need for long-term, regular follow-up during weight management programmes, and acknowledges the difficulties families face when making lifestyle changes. Primary care has been identified as a possible clinical setting that can meet these needs. However, there is a paucity of evidence to guide the development of such services.

A qualitative interview study was undertaken in a hospital-based childhood obesity clinic in Bristol, England. Short in-depth interviews were held with 21 parents and 11 children attending this clinic. Interviewees were purposefully sampled to ensure interviews were held covering participants of varying age, gender and success in reducing their BMI. The interviews were audiotaped, fully transcribed and analysed thematically.

Families valued the multidisciplinary team approach used in the clinic in terms of the education and support it offered. They enjoyed regular follow-up, reporting that this provided ongoing support and motivation. Families whose children succeeded in BMI reduction appeared more resourceful and tended to embrace ideas for making lifestyle changes. Unsuccessful families, however, found it harder to alter their lifestyle and often met barriers to change. The authors conclude that community obesity clinics will need to provide a multidisciplinary service offering regular support and individualized exercise and dietary advice whilst attempting to address barriers to change.

To explore the factors influencing the completion of the IB113 form for the Department for Work and Pensions (DWP), as an exemplar of how general practitioners (GPs) manage and report patient information to external bodies.

In UK, GPs complete IB113 forms for their patients approaching longer-term sickness absence, who may be exempt from the incapacity benefit linked medical examination. The DWP has expressed concerns about the quality of such reports, and GP organizations have raised objections to completing such forms. The content of returned forms is variable, and may be subject to a number of influences.

Qualitative interviews with purposive sampling of GPs and practice managers (PMs).

Primary Care practices in the North East of England.

GPs and PMs were interviewed using a semi-structured topic guide about completing IB113 forms for the DWP about their patients entering long-term incapacity. The transcribed data were analysed thematically using the framework analysis method.

Whilst the IB113 appears superficially straightforward to complete, our results demonstrate levels of overlapping complexity that add ranges of subjectivity and selectivity onto factual reporting, including practice protocols, the gathering and managing of information, the doctor–patient relationship, and doctor’s personal views on systems.

The recording and reporting of patient related data by GPs is subject to complex influences, which need to be understood and managed to improve the relevance and quality of reports to third parties.