Smokers aged 65 and over have been identified as a priority group for smoking-cessation interventions. However, despite confirmation of the benefits of cessation in later life and compelling evidence that interventions can be effective, studies have shown that members of the primary care team often fail to target this population. If these professionals are to be encouraged to broach the subject of smoking cessation with older people, it is important that barriers to the effective provision of interventions are uncovered. This article reports findings from a qualitative study that sought to do this by exploring the knowledge, attitudes and practice of members of the primary care team in relation to smoking/smoking cessation in later life. A purposive sample of health visitors, district nurses, practice nurses and general practitioners (n = 41) working in the west of Scotland was recruited. Data were collected during face-to-face interviews using a semi-structured interview schedule. The interviews were transcribed and then analysed using content analysis procedures. While the participants were generally convinced of the benefits of cessation many believed that few older people manage to stop smoking successfully. A pessimistic view of the success rate of older smokers appeared to negatively influence practice. In addition, a number of the participants lacked confidence in their own counselling skills and/or had limited awareness of smoking cessation resources and specialist services. These factors also appeared to preclude the provision of effective smoking-cessation interventions. Finally, there was little awareness of the content of the UK Smoking Cessation Guidelines. The findings from this study, and a parallel study that explored the health beliefs of older smokers, have been used to develop smoking cessation training designed specifically for members of the primary care team who have contact with older people who smoke. The efficacy of the training is currently being evaluated.

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.