In the UK, the Department of Health recognizes the importance of research activity to improve patient care, but the amount of research activity relating to primary care is scant. Few have considered managerial and organizational aspects relating to developing research capacity in primary care and none have examined this from the perspective of organizations responsible for managing primary care at a local level. Yet these organizations have a critical role in increasing the amount of appropriate health services research and developing a research culture. A qualitative analysis of focus group workshops was performed to identify issues associated with developing research capacity within a primary care trust (PCT) covering a single local authority borough in England. All staff attached to the PCT were invited to attend facilitator-led focus groups and asked to consider from an individual and organizational perspective: What will enable them to increase the use of and participation in research? What barriers exist? What opportunities exist or could exist to develop this in the PCT? Themes were identified using content analysis based on written records from the focus groups. Issues relating to developing research capacity were grouped into the following categories: What is research? Training; Resources; Managerial; and Organizational issues. Research was not seen as an integral component of the daily or routine work of most people in a health care organization. Managerial and organizational issues were a considerable barrier to developing research capacity. Lack of appreciation and support for research by managers and lack of structures to facilitate research within the organization prevented research capacity being developed. Primary care management organizations need to work with service managers to encourage the incorporation of research activity into the routine work of staff. Greater dialogue is needed between individuals, service managers and academics to ensure that appropriate research is carried out to support the organization in meeting its explicit objectives. More work is needed to understand the perceptions of research from a managers’ perspective and to develop constructive ways to gain their support for a research agenda.

This study investigated adolescent experiences of familial involvement in adolescent peer relations and school attendance. The data were gathered through semi-structured interviews with Finnish adolescents (n = 19; aged 12–16 years). The data were analysed by qualitative content analysis. Positive familial involvement was described as enablement, continual conversations about adolescent activities, actual support and taking an active role in adolescent activities. Negative involvement included negligence, criticism, restrictiveness or coercion. The findings are discussed with reference to previous research, and implications for adolescent and family health promotion are noted.

Against a background of decreasing age at sexual debut, local Brook staff voiced concerns about the increase in clinic attenders under the age of 14 years, who appeared to engage in risky behaviours. This exploratory study, carried out with service providers in a young persons sexual health clinic, aimed to discover what issues staff felt were important to 11–14 year-old girls, in order that a future study be conducted with the young girls themselves. Service providers from two Brook Advisory Centres were interviewed. The interviews were semi-structured and analysed using content analysis. Many of the issues that staff identified as important to young girls mirrored current research findings with older adolescents. These were: alcohol consumption, peer pressure, low self-esteem and confidence, and a lack of knowledge around sexually transmitted infections. However, a new issue to emerge was the high proportion of young girls attending the clinic for the emergency contraceptive pill despite not knowing whether they had had intercourse or not. The study also found that staff perceived the need to understand issues from the perspective of the young girls themselves.

Staff identified a necessity for improved sex education and education around peer pressure and assertiveness, whilst topics for future research which emerged from the study findings included issues of self-esteem, dynamics of peer/media pressure and why young girls feel that they need to have sex.

This article reports on findings from a one-year national evaluation of the Primary School/Primary Care Health Links (PS/PC HL) initiative, commissioned in 2003 by the National Drug Prevention Development Team, on behalf of the Department of Health (DH). The primary aim of the PS/PC HL initiative was to develop links between primary and community health care professionals and primary school children in order to increase the children’s knowledge and understanding of a range of health issues. This involved developing innovative ways in which parents could engage in the health education of their children at primary school level. As part of the evaluation, a questionnaire was sent to parents (n = 69) and children (n = 464) to discover to what extent discussions about health issues, in particular substance misuse, were held at home and what messages children were receiving. In this context, substance misuse includes drugs, alcohol and tobacco. This article also examines children’s attitudes towards smoking and alcohol, and considers how parental influence affects children’s ideas about the acceptability of these substances. The findings indicated that whilst over 65% of parents thought that their children knew a lot about exercise and healthy eating, only 20% thought that their children were well informed about alcohol and drug misuse. Despite 80% of children in our survey reporting that they would prefer to discuss health problems with their parents, substance misuse appeared to be a topic rarely discussed at home. The findings confirm, (i) the need for family and community cohesiveness and (ii) reinforces the need for an increase in parents’ knowledge and motivation in order to (iii) raise their confidence in their conversations with their children about substance misuse. Partnership working between teachers, health professionals and parents would appear to be the ideal in effectively reinforcing health messages to children; however, the authors suggest that the culture of accountability both in the teaching and health professions often hinders this process.

There is increasing emphasis on including patients in decision making about treatment. In order to do this, they need to have access to appropriate information about treatment options. The study reported here reports initial work carried out in the development of a decision analysis tool to assist women about treatment for menorrhagia. Women referred to secondary care with a diagnosis of heavy menstrual bleeding were interviewed. Our study shows that women had limited and often inaccurate knowledge of most treatment options. They expressed feelings of diagnostic uncertainty, the need for a ‘label’ for their symptoms and a perception of the failure of the general practitioner (GP) to provide this. The women in our study referred to secondary care with a diagnosis of menorrhagia do not seem to have had their concerns about their menstrual symptoms addressed prior to the referral. In addition, the women in this study do not feel that their GP has communicated a diagnosis to them. Women must be able to feel that they have been diagnosed in order that treatment options can then be properly discussed, and a shared management decision reached. Reasons for the apparent lack of adherence to guidelines are discussed. There is a need for a decision aid for use in primary care to assist women and their doctors in the management of menorrhagia.

Background: Teamwork and collaborative practice are acknowledged as key to strengthening primary health care. This study assessed Canadian family physicians/ general practitioners’ (FPs/GPs) interest and involvement in interdisciplinary collaborative practice. Methods: From nine focus groups conducted with 46 FPs/GPs in the Capital Health region (Edmonton, Alberta) concerning the quality and capacity of services in family practice, the discussions related to collaborative practice and practice teams were extracted and qualitatively analysed. Based on this analysis, one section of a mail survey assessed FPs/GPs levels of interest and current involvement with 11 other types of health professionals. Results: In focus groups, FPs/GPs identified seven categories of issues related to interdisciplinary collaborative practice: quality and capacity of care, quality of work life, affordability, availability/accessibility of other health professionals, team-building processes, responsibility/accountability, and system resources. Survey responses from 300 of 583 FPs/GPs in the region (51%) showed substantial interest in working with other health professionals, but strikingly less frequent current working relationships. Conclusions: The large gap between the interest and willingness of FPs/GPs to collaborate and their current involvement in teamwork must be addressed if collaborative practice is to increase in line with the goals of primary care reform in Canada.

Personal Medical Services (PMS) contracts, introduced in 1997, provide a new financial model for providing general practice. The aim of this study was to measure the costs and consequences of the PMS first wave contracts for sites that aimed to increase the accessibility and the quality of care for vulnerable population groups; to describe the problems encountered in this measurement. A purposive sample of first wave PMS sites targeting vulnerable population groups were selected. A two-stage data collection procedure was used, to obtain micro-level data on the quantity and costs of capital and recurrent funds, and top-down data on costs and apportioning of monies received from central source to broad expenditure categories. The costs data focused on the largest cost components, such as staff and prescribing as well as alternative stakeholders’ contributions. The consequences data measured the accessibility and the quality of care for vulnerable population groups. Five case studies were considered. Sites that were formerly independent general medical practitioner (GP) contractors consolidated their staff with few changes in their staff-skill mix. In all sites the prescribing costs per patient were below the national average in 2000/01. Access was either consolidated or improved over the period and improved quality of care was in evidence through appropriate prescribing patterns. Though the evaluation found that the PMS sites were addressing their main objectives the data collection revealed difficulties in tracking the flows of PMS resources under the current budgetary system. We highlight the limitations of the PMS data monitoring procedures and discuss how these limitations can be overcome so that future National Health Services (NHS) reforms can be appropriately evaluated in the future.

As the numbers of cancer survivors grow, community-based primary care physicians are playing a larger role in their care. The goal of this pilot study was to begin to identify the problems and challenges faced by primary care physicians who treat patients with cancer histories. A mail survey was undertaken of 141 community-based primary care physicians in the Southeastern US that addressed physician characteristics, numbers and types of cancer patients treated, problems faced by these patients and challenges physicians face when caring for these patients. These physicians reported that on average 10% of their primary care patients had a history of cancer. The most frequent types of cancers seen by these physicians were skin, breast and prostate cancer, but there was a broad range of other cancers seen in their practices. They reported that patients and family members’ fears and emotional problems were frequently encountered problems. Side-effects of cancer and its treatments and limited access to supportive care services were also reported as frequent problems for the cancer patients they treated. The most challenging aspect of caring for patients with cancer histories they reported was promoting cancer-related risk reduction behaviours. Primary care physicians play a large and important role in the care of cancer survivors. They encounter a number of problems when providing this care, including patient fears and access to supportive care. These findings may be used to guide educational and policy initiatives aimed at improving the care of cancer survivors.

An evaluation of the views of primary health care team members participating in an intervention programme of a Resource for Education, Audit and Teamworking (CREATE) is presented. The pilot CREATE programme comprised of a series of nine educational and team building workshops delivered in protected time to all clinical and administrative staff in seven general practices in one Health Board locality, within a 12-month period. The content of the programme was developed in response to an educational needs assessment undertaken by the CREATE steering group. The purpose of the evaluation study was to identify if the CREATE programme altered participants’ views of teamwork, education and audit, and to ascertain the suitability of the CREATE programme for more extensive implementation in Scotland.

The evaluation study utilized a combination of quantitative and qualitative survey methods. Quantitative questionnaires devised specifically as evaluation tools for the project were manually distributed and collected at the first and last CREATE workshops to all participants present on each occasion. Following the first and last CREATE workshop, key informants from each practice subsequently participated in qualitative, indepth interviews.

The combined results of the quantitative and qualitative analyses reveal that the CREATE project is highly valued by the majority of primary health care team members who participated in the programme, particularly clinical staff but to lesser extent administrative staff. The findings indicate that a relatively simple but inclusive programme delivering appropriate education to primary care teams within protected time is able to overcome barriers to teamwork and has led to staff developing improved quality of health care services. Areas where teamwork and quality improvement were perceived as developing most significantly included: developing objectives, meeting as a practice and communication so people were more involved in discussions and decision-making. As a result of the findings from the pilot, the key elements of CREATE are being replicated elsewhere in Scotland.

The implementation of single assessment for vulnerable older people by 2004 was introduced in the National Health Services (NHS) Plan and the National Service Framework for Older People. The evaluation reported and discussed here is of a single assessment and integrated care process (SAP, ICP) piloted and subsequently introduced into a NorthWest of England Primary Care Trust. The initiative introduced enabled district nurses to undertake social assessments and fulfil the role of care manager for people already on their caseloads whose social needs increased.

The objectives of the evaluation were to explore the impact of the initiative on service users and on district nurses and social workers professional roles compared to the previous system of separate assessments and to examine any barriers to the implementation of single assessment and integrated care.

The perceptions of health and social care professionals and service users were collected via telephone and face-to-face semi-structured interviews (n = 21).

All professionals could identify both actual and potential benefits and disadvantages to service users of single assessment and integrated care planning. The areas important to respondents included a SAP that is, more efficient, without duplication; familiarity with assessor; timeliness of assessment; increased co-ordination and the quality of assessments. Many of these are also discussed in terms of a change in professional roles, mainly that of district nurses. The introduction of the ICP was not as successful as had been anticipated; a number of reasons for this were identified. The requirement to assess clients’ financial circumstances was the main conflict reported for district nurses compared to their traditional role. Issues relating to their lack of knowledge and familiarity of the social care sector were also highlighted. The discussion focuses on how these issues could be addressed namely through education and training, and facilitating integrated working.