Tayside's Primary Care Research and Development Network (TayRen) was awarded £140K per annum for 4 years from 1998 by the Scottish Office Department of Health. The operating model of TayRen is described and the outcomes highlighted. A multiprofessional, multidisciplinary, methodologically rigorous and locally responsive approach has contributed to the outcomes achieved. The network has enabled practitioners to gain research experience by working with more experienced colleagues. The research culture of Tayside has matured since the formation of TayRen as evidenced by the increased number of research practices (six), training fellowships (three), registration for higher degrees (18), grants (£3.9m) and publications (96). In conclusion, TayRen has increased research activity in primary care in Tayside.

As an alternative to the national contract with general practitioners (GPs), Personal Medical Services (PMS) is a way of contracting with GPs for providing primary care, intended to enable individual contracts with practices which are appropriate to the specific needs of their populations. The national plan for the NHS (2000) strongly supports the extension of PMS as a means of improving the quality of primary care. This paper reports two small pilots which found PMS a useful mechanism for achieving desired changes within the practices. In one case, the GPs are now employed by the local community trust and the primary health care team has been expanded, with some clinical functions redistributed among the team. In the other, the primary health care teams of two practices have developed a tool for assessing the health and needs of older people during a home visit. Participants in both pilots expressed satisfaction with the results, although there were some dissenting voices. In both cases, the pilots were unable to demonstrate in detail any improvements in patient care or to quantify the work-load implications of the changes. Perhaps because of their ‘pilot’ status, the initiatives tended to be inward looking, and opportunities for learning across the local health economy have been missed. PMS' value as a driver for improving the quality of primary care is not demonstrated by these two examples.

Current UK health policy guidance locates primary care at the frontiers of health care modernization. New organizational structures have resulted in general practitioner (GP) practices being brought together in Primary Care Groups (PCGs) and Primary Care Trusts (PCTs) each serving a much larger population group than the traditional GP practice. These changes have been accompanied with a need to explore new ways of working and thinking. This paper draws upon the experiences of nurses and GPs participating in an evaluation of workforce planning issues in primary health care. It explores how practitioners working in PCGs across one geographical area were able to gain a better understanding of what these changes, to both the structure and process of practice, might involve. During this developmental process the respondents used ‘the family’ metaphor, as a form of ‘shorthand’ to orientate themselves to the new responsibilities, challenges and opportunities presented by these changes to primary health care. It was in the use of terms and constructs that were familiar to their ‘everyday life’ experiences that made taking the first tentative steps in the change process easier. This paper suggests that using metaphors may be a powerful tool for policy makers, practitioners,managers and for researchers as they seek to communicate a plan for change and in understanding what these changes might mean.

Eating disorders are amongst the most commonly encountered psychiatric disorders experienced by young women. Binge eating disorder (BED) has received some support as a distinct pathology, but is hard to disentangle from other kinds of behaviours. This qualitative study explored awareness and knowledge of BED amongst a group of 18 inner-city general practitioners in NW England. Thematic coding of their accounts suggested a dichotomous tension. (1) Subjects were largely unaware of the existence of BED, and found it difficult to conceptualize its diagnosis and management in primary care. (2) Subjects framed BED as a ‘disorder’ that was firmly within the sphere of patients' personal responsibility, and recognized that psychological distress would be an important causal factor in its aetiology. Subjects were reluctant to consider BED as a diagnosis for obese patients because of the absence of services for onward referral, and because of uncertainties about effective treatment.

The PATCH project was an intersectoral initiative between health, social and education services in Lanarkshire, Scotland which provided support at home from two experienced children's nurses for parents of children with complex disability. The project was funded by the Scottish Executive Health Department Innovations Fund for Children's Services for two years from April 2000. This article reports results of an external independent evaluation of parents' and agency members' perceptions of the PATCH service. Audiorecorded interviews were obtained from members of eight families and eight agencies. Issues related to the two key aspects of support addressed in the project, carer training and partnership working, are presented. The skilled approach to training adopted was successful in creating a network of carers, both lay and professional, which resulted in improved respite and rest for parents. Effective partnership working resulted in improved communication, the development of an innovative child record, effective help in crises and improved service co-ordination. Together, the training and partnership elements of the PATCH service addressed practical, emotional and social dif. culties experienced by families. The freedom to work flexibly and to approach agencies directly and the ability to cut across established organizational structures were significant factors in improving support for families. A number of key aspects of nursing expertise and possible outcome indicators for such a service are presented.

The NHS Plan promises that letters about patients will be copied to them as of right. Yet, beyond a few small studies, little is known of the views of clinicians and patients about the process, and few have any experience of it. The aim of this study was to elicit the views of clinicians and patients about the idea of copying general practitioner (GP) referral letters to patients (part one), and to describe the experiences of GPs and patients actually involved in the process (part two). The setting was one health district in the north of England (part one) and three research practices in the same district (part two). A questionnaire survey was used to elicit the views of 214 consultants, 260 GPs and 584 patients (part one), and semi-structured interviews to assess the experience of 11 GPs and 48 patients involved in the process of copying referral letters (part two). The main outcome measures were the perceived and reported benefits and disadvantages of copying referral letters to patients and the practical implications of making this a routine activity. In the first part of the study, replies were received from 148 hospital consultants (70%), 144 GPs (55%) and all the patients in an opportunistic waiting-room sample. Seventy-six of these consultants (55%) but only 49 of the responding GPs (34%) thought that referral letters should be routinely copied to patients. This compares with 499 (85%) of the patients surveyed who were in favour of this in principle. Potential benefits suggested by clinicians included better informed patients and improved communication. There were concerns about making patients anxious and about the difficulty of writing letters that were both comprehensible to patients and informative to colleagues. In the second part of the study, GPs involved in copying letters to patients experienced no major problems in writing letters that patients could understand but which were also fully informative to consultants. There was some increase in administrative workload. A sense of increased openness in the communication process was reported. Patients valued seeing a copy of their referral letter and few admitted to any major problems in understanding its content. In general, they felt better informed about their illness and better prepared for their outpatient appointment −44 patients (91%) thought copying letters should become routine practice. In this study, carried out before the NHS Plan was published, a majority of consultants supported, with some reservations, the idea that patients should receive a copy of their GP referral letter. Surveyed GPs anticipated major difficulties in copying letters to patients, and most were not in favour of this becoming routine practice. Patients and GPs actually involved in copying letters reported important benefits but also identified issues which will need to be addressed before copying letters can be effectively implemented as a routine activity.

This literature review focuses on patient satisfaction with skill mix in primary care. This is an important, rapidly changing, topic as the range of health professionals working alongside GPs increases and the roles of staff change. The review is intended to assist primary care organizations in developing skill mixes that meet patients' preferences and needs.

A number of characteristics that influence the type of services that patients want were discovered. Older people and those from ethnic minorities want a ‘traditional’, GP-led service. Access is important to younger people and those in full-time work. Those from lower socio-economic groups value nurses, but have found the increasingly complex organization of services a problem. There are different levels of knowledge and expectations about health services and information on the skills and knowledge of professionals, what they do and the links between them, needs to be available.

A number of aspects of care are important to patients. Patients liked nurses as they were good communicators, formed good therapeutic relationships, gave information on illnesses and spent more time. The location of services is important and patients liked services provided in the home or community. Continuity of care is key, but has been presented as old fashioned and reorganizations may have reduced continuity; skill mix could be viewed as forming a barrier between doctor and patient, but personal lists and teams where practices are divided into smaller units with shared support may help. The competence of health professionals is clearly vital and patients considered nurses competent, although they had concerns about nurses and pharmacists taking on some new roles.

The literature focuses on patients' views about doctors and nurses, although they also want a wider range of services and professionals available in primary care: occupational therapy, link workers, CAB advisers, pharmacist advice and mental health workers. Despite being satisfied with nurses, some patients still wanted to see a doctor next time or felt that a doctor should be available. GPs can help build awareness and confidence in patients about the roles and contribution of the team.

This paper describes how a health needs assessment of a specified community was conducted using action research. The study involved local people and a multiagency steering group, within a primary health care setting. Community development approaches were applied because of the potential it has to address some of the fundamental issues that lead to poor health. A multimethod approach was used to gather data using quantitative and qualitative approaches. Six focus groups, with varying sections of the community, were used to elicit community perceptions of their health needs. Data triangulation was used in order to identify differences and similarities in each of the methods. The outcomes identified disparities in health needs between the areas assesseddue to differences in socio-economic variances. One area experienced a greater level of deprivation using the Jarman index. The most common forms of ill health in the community were heart disease, cerebrovascular disease, asthma and diabetes. The assessment identified a need for more health promotional work to be carried out by health care professionals, i.e., annual health checks. A number of outcomes confirmed the existence of well-known difficulties in accessing health care, such as difficulties with physical distance to secondary care services, as well as the length of the waiting time at the outpatient departments. It was also apparent that there was a poor understanding of primary health care services and the role and function of the varying health care professionals, particularly amongst the ethnic minority population. The assessment highlighted a number of issues, including obvious benefits, which may accrue from this process for primary care groups and primary care trusts in identifying the health needs of their local populations and subsequent development of the health improvement programmes with the health authority. The discussion raises issues concerning the impact that these changes have on collaboration between varying professional groups and users of services in the planning and delivery of services in order to reduce inequality in health.

The government intends to invest heavily in intermediate care services by the year 2004. The term ‘intermediate care’ de. es precise definition, but is said to include a number of community-based services, including those provided by district nurses. Enhanced district nursing may be one solution to providing care for many elderly patients who are thought to be inappropriately admitted to acute hospitals. The feasibility of this option has yet to be tested, but district nursing enjoys public confidence and is well placed within the primary care framework to ensure continuity of care. This paper describes a national postal survey of district nursing provision within all community trusts in England conducted in 1998 to explore a picture of the structural and organizational factors which impinge on the delivery of intermediate care by district nurses. The Handbook of Community Nursing was used to identify those with designated responsibility for district nursing within trusts. A response rate of 83% (n = 148) was attained. The majority of responding trusts reported a lack of resources to deliver more intensive levels of care. When trusts were ranked according to their performance on six key variables thought to be related to the delivery of intermediate care only two achieved the maximum score. Over half of the trusts scored 3 or less. The findings from this survey indicate a curious neglect of the district nursing service and suggest that considerable investment is needed if district nurses are to deliver an intermediate level of care.

It is anecdotally reported that general practitioners (GPs) consider much of their time is wasted by patients consulting with minor ailments. The management of minor ailments and the need to reduce pressure on GPs has been a recent focus of government health policy. However, knowledge of the lay and professional interpretations of the term ‘minor ailment’ is sparse. This study determined GPs' and patients' views of consultations perceived by patients to be forminor ailments. A face-to-face, structured interview was conducted with all consenting patients immediately prior to their consultation with two GPs, over a total of 20 surgery sessions, in England. The GP view of consultations perceived by patients to be for minor ailments was obtained. A total of 240 patients (96.4%) participated in the study. Almost 40% of interviewees (93/240) indicated that they were consulting about a minor ailment. In many cases the GPs gave a contrasting view of these consultations, with approximately half judged not to be minor ailments. Whilst there was agreement that the remaining consultations were for minor conditions, sometimes a mismatch existed in the perception of whether the consultation was necessary. In almost 30% of cases (n = 27) the GPs viewed that the patient could have managed their condition alone. Policy-makers and GPsmaintain thatminor ailments account for a substantial proportion of GP workload. However, in this study over 50% of patients had underestimated their ‘minor’ condition. Furthermore, two subgroups of minor ailment consultation were identified; those that could and those that could not be managed by the patient alone. Minor ailment consultations would therefore appear to be far more complex than trivial, inappropriate or unnecessary consultations that waste the time of GPs.