The Mant Report supports the need to involve primary care practitioners and their patients in research and development. This paper questions why this key report, that recognized the need for involvement of health care staff in R&D, did not identify the need for practitioner research methods in community practice. Next, it explores what is meant by practitioner-centred research and locates action research within this context. Drawing on ‘critical realism’ and ‘subtle realism’, the arguments for the use of action research in community research and development are explored. Caution is given to adopting extreme perspectives and, in preference to ‘practitioner-centred research’, practice-centred research is advocated. In conclusion, the paper suggests that the world of R&D is changing and that the time is right for influencing the uptake of alternative methods. It is suggested, given that 90% of contacts between the population and the NHS take place in primary care, it is vitally important that community-based practitioners are well versed with these arguments in order to move forward the debate and bring it closer to a vision of research that places practitioners more centrally in the process of research.

This paper aims to address three broad themes. An outline of the current UK primary/community health care research and development (R&D) agenda is presented and it is argued that in addressing this agenda greater diversity of research designs and methods to generate knowledge for policy and practice is needed. It is proposed that philosophical and disciplinary entrenchment, particularly within nursing, has led to over preoccupation with arguments about the epistemological basis of research approaches and methods as an end in itself and the research priorities and questions for health and health care that should drive such debates are often side lined or altogether ignored. The remainder of the paper addresses Meyer's proposition for the need for more participative practitioner-centred research within the context of community/primary health care. It is argued that while action research and other participative research methods have much to offer we need to understand and use the full range of research approaches and methods at our disposal, and where appropriate, develop new ones if we are to tackle the research priorities relevant to a large and diverse community/primary care R&D agenda.

Partnership figures prominently in the rhetoric of contemporary health care. The notion of an ‘active’, ‘informed’ patient in partnership with health care providers has permeated practice and policy globally. Consequently, understandings of partnership have colonized the social space that exists between health care providers and health care recipients. Drawing on Foucault's notion of discourse, this paper explores partnership as a discursive event and interrogates the way understandings about partnership construct how partnership is enacted, including the subject positions of health care professional and patient, which in turn construct understandings about partnership. The paper argues that partnership is more than simply participating in health care. It involves questioning who is offering whom what, and how. The discussion aims to trouble and unsettle taken for granted assumptions about partnership to allow for the possibility that partners can position themselves in the social space that is the site of the partnership in a way that enables the type of professional relationship and outcomes to be negotiated by both partners.

Empowerment has gained prominence in health care as an ideal to underpin practitioner – client/patient relationships. Its advocates see it as preferable to paternalistic or authoritarian models and practices, partly because of the humanistic values that shape it and partly because it is believed to improve efficiency in health care delivery because it makes compliance to treatment regimes and to health promoting advice more likely. However, as Cheek notes in her paper, there are plenty of situations in which it is difficult to find anything approaching empowerment in practice. This paper, which develops Cheek's arguments further, examines some of the historical and philosophical origins of empowerment, traces its trajectory through post-World War II societies into health and welfare values and finally asks whether nurses and other health care workers face significant contradictions if they are to take seriously the call to ‘empower’ their patients.

This paper identifies some of the key questions that researchers should address in relation to community nursing practice in the UK. The paper begins with a brief overview of the nature and impact of change within the UK health service and the way this has impacted on community nursing. It argues that the nature and scale of such change means that it is important to investigate any resultant threats to the safety of patients and clients, to the quality of their care and to the capacity of the service to meet health care needs. However given the difficulties associated with identifying links between the quality of care and policy driven change, the author argues that a more appropriate approach would be to focus on investigating the effectiveness of practice and seeking explanations for variation in practice. The paper makes reference to the complex knowledge base used in community nursing practice and acknowledges the challenges for nurses in internalising messages from the social science disciplines in order to strive to achieve effective practice. Drawing on some current research studies the author then highlights the importance of developing a better understanding of the interpersonal skills used in practice. The author then moves on to consider wider issues of practice including delegation, supervision and teamwork, arguing that insufficient attention has been paid to effectiveness in these domains. In concluding, the author makes the case that questions should be pursued in all these areas with a focus on exploring variation in practice so that a broader more theoretically based understanding of what is effective in practice can be achieved.

As our communities become more and more diverse, those undertaking research into community nursing practice have a responsibility to incorporate a multi-ethnic perspective into their studies. Primary Care NHS Trusts are increasingly powerful institutions in respect to addressing the needs of minority ethnic groups. As with other public bodies, they need to demonstrate that they are promoting race equality in order to comply with the Race Relations (Amendment) Act 2000. Research into the experiences of families affected by sickle cell disorders and thalassaemia are employed to illustrate nursing accountability for the quality of patient and client care.

An increasing number of general practitioners (GPs) are personally practising complementary and alternative medicine (CAM) to treat their NHS patients. While research on CAM is beginning to emerge we still know very little about CAM practice in primary care. Researchers have largely concentrated upon exploring CAM consumption and broad orthodox CAM provision. A small body of work has begun to examine CAM practice from the GP therapist's perspective and this work has highlighted the constraints and difficulties associated with CAM integration in general practice. Despite such limitations, direct integration continues apace and this raises the question: what clinical and practice benefits are GPs possibly gaining from CAM integration? This is an area that still lacks focused research attention and this paper, exploring the positive gains of integration as perceived by GP therapists, provides a first stage towards filling this research gap. A study, based upon 25 in-depth interviews with GPs practising CAM, was undertaken to explore GP therapists' understandings and experiences of their complementary practice. This paper presents one area of findings produced from the analysis of the GPs' accounts. Analysis reveals that GP therapists identify a number of positive clinical gains associated with their direct integrative practice. These are: filling gaps and successfully treating conditions for which conventional medicine proves ineffective; providing safer techniques in medical cases where the practitioner suspects or anticipates potential side-effects from conventional treatments; and helping maintain job satisfaction and relieve boredom for the practitioner. These findings are discussed within the context of contemporary CAM provision and consumption and recent circumstances affecting general practice. Set within this context, the findings provide an important addition to our current understanding of the increasingly close relationship between CAM and general practice. In conclusion, it is argued that the positive gains experienced by GPs practising CAM should not be ignored by those considering the future provision and practice of CAM within the general practice environment.

Primary care groups and trusts (PCG/Ts) are key to the successful implementation of the NHS information strategy, Information for Health. This study describes the current levels of IM&T within PCG/Ts and their constituent general practices and examines the ability of PCG/Ts to support the delivery of national targets. Results are derived from the National Tracker Survey of Primary Care Groups and Trusts, which uses a stratified sample of 72 (15%) of PCG/Ts.

The findings indicate that although PCG/Ts are beginning to identify their priorities and work on the huge development agenda in primary care, they may have difficulties meeting both local and national targets. PCG/Ts need additional, appropriately skilled staff and better information to support the planning process. They also need access to high quality data from a range of sources to support their key functions. The quality of data currently available to PCG/Ts is generally perceived by IM&T leads as being poor and is seriously hindering progress. The paper concludes that there is a gap between the vision described in the national information strategy and the ability of local organizations to deliver targets. If the national strategy is to be implemented successfully it may need to be adapted in the light of the findings presented.

The need to improve the skills of primary care workers in the management of mild-to-moderate mental health problems in children and adolescents is widely recognized. One model for providing such skills is the use of specialist psychiatric nurses as interface workers in a consultation–liaison role. This aims to provide training and expert advice to facilitate the detection, assessment and management of child and adolescent mental health problems. The objective of this study is to assess the impact of a pilot scheme which placed three consultation–liaison interface workers, for 15% of their time, in primary care. This study involved a qualitative assessment of health professionals' experiences of the new system, using constant comparison analysis of the transcribed texts of five focus groups. The setting was within the participating surgeries and at the secondary care centre. The participants comprised ten secondary care workers, ten GPs, seven health visitors and three school nurses. The main outcome measure was the views of the health care professionals of the interface worker service. The results showed that primary care staff reported strong, positive effects on confidence, morale and patient care, although a few possible problems were perceived in terms of carers' understanding of brief intervention. Prior to the introduction of the new system, they felt they had little to offer children and adolescents with mental health problems, but now they had a service to offer. The interface workers had particularly enhanced their treatment skills/options. However, the secondary care workers felt that there had been little effect on their workload although only four out of 54 practices feeding into them had had interface workers appointed. Although they recognized the potential benefits for mild to moderate cases in primary care, they were also concerned that scarce resources might be being directed towards lower priority cases. This pilot study concluded that this was an efficient, effective service offering a quick response to patients, equipping primary care workers with treatment skills and having a positive effect on the numbers of referrals to secondary care. Further, more extensive quantitative work is needed to find out if these conclusions are really justified.

There is evidence to suggest that GPs experience significant difficulties associated with lack of support from, and communication with, hospital and other specialists in palliative care. The establishment of cancer and palliative care facilitator schemes by Macmillan Cancer Relief reflects these current concerns very clearly. This paper presents some of the findings from the first phase of an evaluation of one such GP facilitator scheme in the Welsh county of Powys. It examines the perceptions and expectations of GP facilitator post-holders during the first year of the facilitator scheme, based upon data gathered from qualitive interviews conducted on three separate occasions. The picture that emerges from the first year of this facilitator project is broadly a positive one. Facilitators have tailored their roles to fit in with and augment the practices with which they deal. Attitudes vary, but their goals of facilitation and education appear similar. Themain challenges facing post-holders is that of being aware of the possible existence of professional rivalries whilst developing their role in ways which do not encroach upon the territories of long-established colleagues.