Focus groups are used increasingly in general practice research, especially where a qualitative method is required to answer exploratory questions. Recently teleconferencing has been used to conduct focus groups in research on rural general practitioners, where distance makes face-to-face focus groups difficult and where anonymity of participants is important. This paper discusses advantages and disadvantages of using teleconferencing as a means of undertaking focus groups and provides examples of research where this has been used. We conclude that focus groups, conducted using teleconferencing, are an appropriate method in research on general practitioners, and can be particularly useful, when conducting research in rural and remote areas, and when anonymity of participants is desirable.

A randomized controlled trial was conducted to assess the efficacy of a computerized therapy programme for depression and anxiety, ‘Beating the Blues’, compared with cognitive-behaviour therapy provided by clinical psychologists and treatment as usual by general practitioners (GPs). The aim of the paper is to describe the study, the problems that were encountered when GPs agreed to recruit participants during consultations and to outline possible solutions to these problems. After three months only five participants had been recruited prompting modification of the study design. After one year only 17 patients had been recruited and the study was discontinued. The GPs indicated that the randomization procedure compromised their traditional role of providing patients with the best possible treatment. This produced role conflict that was resolved by GPs adhering to their care-giving role at the expense of recruiting to the study. GPs also felt that discussion of research took too much time during consultations and was inappropriate given that patients were often somewhat distressed. They also did not see the three treatment arms as equally acceptable, which resulted in GPs failing to recruit patients in case they were randomized to what they considered to be inferior treatments. Competing demands that rendered the study a low priority were also reported. We incorporated suggested solutions to these problems into the study which was rerun and completed after one year with 40 patients having been recruited.

The objective was to explore the feasibility of prospective recruitment of general practice patients to a future trial on the effects of paracetamol on the symptoms of the common cold. In October 2000, recruitment letters were sent by a general practitioner to 276 patients aged between 18 and 75. 65 patients returned signed consent forms. Postal packs were sent to the first 60 of these patients to reply. They contained a daily diary, symptom score questionnaires, an EQ-5D questionnaire, a pack of paracetamol tablets, and detailed instructions. When a cold developed and symptoms reached a specified level, one gram of paracetamol was taken four times daily for two days and questionnaires were completed for four days. Telephone interviews and crosschecking of data were used to identify difficulties in completing the study. The overall recruitment rate was 24% (65/276) with 95% confidence interval 19% to 29%. Recruitment was significantly higher (p < 0.001) amongst patients registered with the main researcher (43% (29/68)) than with other doctors in the practice. The response rate, i.e., those who returned completed study packs, was 77% (46/60). Thirty participants experienced a cold and returned their data during the six months of the study, representing 50% (30/60, 95% Cl 37% to 63%) of participants and 11% (30/276, 95% Cl 7% to 15%) of those initially approached. The mean cumulative four-day symptom score was 34.6, standard deviation 14.7. The EQ-5D health status on day four was 0.89. We conclude that a prospective postal recruitment method in general practice is a potentially useful method of conducting research on the common cold. A better response is obtained when the initial letter is signed by the patient's own doctor.

The study reported here is one part of a wider study, evaluating the role of the nurse practitioner (NP) in primary care This part of the study focussed on the views of the primary health care team (PHCT) regarding their experience of working with two NPs. A project to place Master's prepared nurse practitioners (NP) in general practitioner practices was undertaken with the intention of more fully meeting the needs of practice populations in a deprived inner city area. The roles were supported and funded by the health authority and the placements were intended to be time limited with placement and funding to be reviewed. The project incorporated a planned evaluation of the role and this included a study of consultation patterns, caseload and this particular element, a study of PHCT members' attitudes to and experiences of the role. A purposive sample of 27 staff were interviewed using a partially structured interview format. Each interview lasted around 30 minutes with two researchers undertaking both collection and analysis of the interview data. Subsequently, an additional six staff were also interviewed in an opportunistic manner, at their request. The findings identified two main foci of the NP; as an ‘extra pair of hands’ and as a colleague undertaking a different, valuable and complementary service to existing staff. The pivotal role of the receptionist in the integration of the new role in to the practice and the acceptance of it by patients was clear. General practitioners (GPs) exhibited paradoxical views, particularly with respect to problems of throughput; the NP having longer appointments and therefore usually undertaking fewer consultations than GPs in any session, leading to perceptions of an expensive and perhaps less effective service in terms of its effect on the workload. Within the same interview however, GPs discarded throughput as an effective measure of patient care and highlighted the many benefits of NP consultation. This tension between cost and effectiveness would benefit from more effective analysis and evaluation. The members of the PHCT express many different views, often related to their professional priorities, but all appear to support the NP role enthusiastically, considering it a positive step which benefits the team, patient care and choice.

A variety of nurse practitioner education and training programmes are currently offered. They are designed to prepare experienced nurses to undertake an expanded role and a broader range of activities. Since the introduction of this new nursing role many nurse practitioners are now working in primary care health care teams. This study aimed to investigate how the working patterns of primary care teams have been altered as a result of the introduction of the nurse practitioner into the primary care team, the ways in which nurse practitioners' skills are integrated into the primary care team and other team members' perceptions of this new nursing role. The study was exploratory and a qualitative methodology was chosen. Phase one consisted of three focus groups with three primary care teams including nurse practitioners. Phase two involved audiotaped, semi-structured interviews with nurse practitioners (n = 4) and general practitioners who worked with nurse practitioners (n = 3). The data were subsequently transcribed, reduced and analysed using a theoretical framework appropriate to the research design. Nurse practitioners operated in a variety of ways in primary care. Key clinical activities included triage, physical examination, diagnosis and decisions about the treatment and care of individuals and specific groups of patients. The conditions dealt with by nurse practitioners were generally less complex than those seen by GPs but an element of overlap occurred. The nurse practitioners emphasized the importance of offering patients a choice about whom they prefer to be seen by. Most team members were supportive of the new team member, although some were confused about the role and others were opposed to the introduction of a new specialist nurse post. The findings indicate a need for role clarity, definition and official recognition.

During recent years, private sector complementary medicine has grown as a significant provider of health care in the UK, and according to many current definitions, this provision may be classified as primary health care. In the context of a relative paucity of dedicated research investigations, and through a combined questionnaire (n = 426) and interview survey (n = 49), this paper provides some base-line evidence on the national sector, considers the previous employment of private therapists, their reasons for practicing, the range of modalities practiced and the positives they gain from this form of caring and business ownership. Although some younger therapists had moved straight from their education into private practice, the most common scenario was for middle-aged persons to enter the sector directly from skilled professional jobs and hence had radically changed their careers. Many were formerly employed in caring-related professions such as nursing, social work and teaching. Often therapists had been disillusioned with particular aspects of their former jobs. However, more frequently, they were simply attracted by the therapies themselves, the conceptual paradigms which underpin them and to the different experiences of business ownership and caring practices. Little is known about private complementary medicine, and it is argued that dedicated studies could build the initial evidence presented here, particularly within the rubric of primary health care research.

The execution and incorporation of research into practice is influenced by the relevance and credibility of the work undertaken. Part of this process can be to identify priority research questions from the service provider perspective. We sought to obtain a multidisciplinary consensus on priority research questions around the broad issue of prescribing in an inner London Primary Care Group locality. Participants were drawn from general practice, primary care nursing and community pharmacy. This paper explores how two formal consensus methods were used to facilitate multidisciplinary participation within the research arena, and the extent to which a convergence of opinion between professional groups was obtained. The use of a structured nominal group interview technique abated professional dominance and generated a diverse array of research questions. An iterative Delphi process secured a wide consensus of opinion regarding the relevance of these questions to practice. The richness of the research questions generated was attributed to the consultation process and the ability of the consensus methods used to capture the multidisciplinary perspective. The practice based research questions identified were diverse and suited to a collaborative research approach.

This qualitative study describes the impact of deploying general practitioners (GPs) as primary care physicians (PCPs) in three Accident and Emergency (A&E) departments in Greater Manchester as part of a Health Action Zone initiative to promote integration of systems of care more responsive to the needs of inner city population groups. The setting was three Accident and Emergency Units in Greater Manchester. Semi-structured interviews with the PCPs and key A & E staff (n = 32) before the PCPs were deployed, then at intervals throughout the project. Interviews were audiotaped and transcribed. Transcripts were analysed using constant comparison to identify emerging themes. Key themes centred on the assumptions and negotiation surrounding the emerging roles of the PCPs (as seen by themselves and other staff), particularly the conflict between operational (day-to-day work with patients) and strategic (forward planning) roles. The PCP appeared to act as a catalyst for the view that patients were not presenting “inappropriately”, rather, the problems presented at A&E might be best dealt with in different parts of the healthcare system, or by different personnel, and it is the service currently available that is inappropriate. By deploying the GP in a new role as PCP, but with the traditional autonomy associated with being a GP, and allowing him/her to develop the role according to local need, the new service evolved to identify and meet the needs of patients more appropriately. The use of the expanded role of the GP may be more successful in achieving ‘joined-up’ services than deploying other professional groups, such as nurses, to fulfil a specific role.

Early retirement has become an important labour market trend for workers in professional occupations. General practitioners (GPs), however, are in short supply, and are being encouraged by the government to stay at work beyond the age of 60. In this study, which followed up a questionnaire survey of all general practitioners over 44 working in the Northern Deanery, 21 GPs took part in semi-structured interviews looking at their plans, reasons for, and feelings about, retirement. Interviews were taped, transcribed, and the text coded using themes from the interview schedule and those derived from the data. Findings are reported using a qualitative distinction between ‘happy’ and ‘unhappy’ doctors and on this basis just over two-fifths of those interviewed were ‘unhappy’, all of whom wanted to take early retirement. The major factor influencing these plans to retire was dissatisfaction with their role and none of this group would be persuaded to change their minds by various incentives such as ‘golden handcuffs’. ‘Happy’ doctors who wanted to stay in practice had found ways of accommodating themselves to change and factors outside of work provided no incentive or ‘pull’. This was not the case for ‘happy’ doctors who wanted to leave: they wanted to pursue hobbies and other interests whilst they were young enough to do so. The paper concludes that change is a major factor producing job dissatisfaction among GPs and that future generations of doctors need to be equipped with the means to cope with it, while governments need to consider the merits of stability and continuity.

Primary care policy and practice in Northern Ireland is unique for two main reasons: unlike elsewhere, Northern Ireland has an integrated health and social services system and the primary care reforms witnessed in many countries have not, as yet, taken place in Northern Ireland. This paper is based on a study in Northern Ireland that aimed to review the role and function of community nursing with reference to new developments in practice, education, research and policy. Service commissioning was one of many areas explored within the study and is the main focus of this paper. The study commenced with focus groups of community nurses (n = 38), general practitioners (GPs) (n = 14) and public representatives (n = 8). This was followed by a two stage Delphi investigation using self-report questionnaires. In addition, data from 34 senior policy makers were collected using semi-structured interviews. The research was primarily carried out in Northern Ireland but involved GPs, community nurses and members of the public from the Republic of Ireland. Findings from all these data sources suggest that there is a perception that community nurses do not have the skills to take a lead role in the commissioning of services, that they require intensive training to take on such roles, and those who do should have equal remuneration with GPs who are involved in service commissioning. Recommendations are offered in the form of action points to guide future practice and policy.