Paediatric chronic fatigue syndrome or myalgic encephalopathy (CFS/ME) is relatively common and disabling. Current guidance recommends referral to specialist services, although some general practitioners believe the label of CFS/ME is harmful and many are not confident about diagnosing CFS/ME.

Explore whether or not adolescents and their mothers value referral to a specialist service for young people with CFS/ME.

A qualitative study nested within a feasibility study of interventions for CFS/ME [Specialist Medical Intervention and Lightning Evaluation (SMILE)]. In-depth interviews were undertaken with 13 mothers and 12 adolescents participating in the SMILE study. Transcripts were systematically assigned codes using the qualitative data organisation package NVivo and analysed thematically using techniques of constant comparison.

Gaining access to the specialist service was difficult and took a long time. Mothers felt that they needed to be proactive and persistent, partly because of a lack of knowledge in primary and secondary care. Having gained access, mothers felt the CFS/ME service was useful because it recognised and acknowledged their child's condition and opened channels of dialogue between health-care professionals and education providers. Adolescents reported that specialist medical care resulted in better symptom management, although some adolescents did not like the fact that the treatment approach limited activity.

Adolescents and their mothers value receiving a diagnosis from a specialist service and making progress in managing CFS/ME. General practitioners should support adolescents with CFS/ME in accessing CFS/ME specialist services, consistent with current guidance.

This study aims to explore the possible reasons for the lower levels of diagnosis of chronic fatigue syndrome/myalgic encephalitis (CFS/ME) in the black and minority ethnic (BME) population, and the implications for management.

Population studies suggest CFS/ME is more common in people from BME communities compared with the White British population. However, the diagnosis is made less frequently in BME groups.

Semi-structured qualitative interviews were conducted with 35 key stakeholders in NW England. Interviews were analysed using open explorative thematic coding.

There are barriers at every stage to the diagnosis and management of CFS/ME in people from BME groups. This begins with a lack of awareness of CFS/ME among BME respondents. Religious beliefs and the expectation of roles in the family and community mean that some people in BME groups may choose to manage their symptoms outside primary care using alternative therapies, prayer or spiritual healing. When accessing primary care, all participants recognised the possible influence of language barriers in reducing the likelihood of a diagnosis of CFS/ME. Stereotypical beliefs, including labels such as ‘lazy’ or ‘work shy’ were also believed to act as a barrier to diagnosis. Patients highlighted the importance of an on-going relationship with the general practitioner (GP), but perceived a high turnover of GPs in inner city practices, which undermined the holistic approach necessary to achieve a diagnosis.

Training is required for health professionals to challenge inaccurate assumptions about CFS/ME in BME groups. The focus on the individual in UK primary care may not be appropriate for this group due to the role played by the family and community in how symptoms can be presented and managed. Culturally sensitive, educational resources for patients are also needed to explain symptoms and legitimise consultation.

The aim was to explore adults’ experiences of their family members’ use of interpreters in health-care encounters.

Language barriers are a major hindrance for migrants to receive appropriate healthcare. In a foreign country, family members often need support in care of migrant patients. No previous studies focusing on adult family members’ experiences of the use of interpreters in healthcare have been found.

A purposive sample of 10 adult family members with experiences of the use of interpreters in health-care encounters. Data were collected between May and September 2009 by focus-group interviews and analysed with qualitative analysis according to a method described for focus groups.

Three categories emerged from the analysis: (1) Experiences of the use of professional interpreters, (2) Experiences of being used as an interpreter and (3) Experiences of what needs to be improved when using interpreters. The main findings showed no agreement in family members’ experiences; interpretation should be individually and situationally adapted. However, when family members acted as interpreters, their role was to give both practical and emotional support, and this led to both positive and negative emotions. Use of simple language, better collaboration in the health-care organization and developing the interpreters’ professional attitude could improve the use of professional interpreters. The type of interpreter, mode of interpretation and patient's preferences should be considered in the interpretation situation. In order to achieve high-quality healthcare, health-care professionals need to organize a good interpretation situation case-by-case, choose the appropriate interpreters with the patient in focus and cooperate with members of the patient's social network.

The aim of this study was to describe the views of health-care personnel about video consultation (VC) prior to implementation in primary health care in rural areas.

For people living in rural areas, it is often a long distance to specialist care, and VC could be an opportunity for increased access to care. Therefore, this study was to investigate what views primary health-care personnel had on VC as a working method in the distance between primary and specialist care. The development of technology in society and the introduction of technology in health care mean that the working methods must be adapted to a new approach. It is therefore important that in the initial phase of the introduction of new working methods to capture the personnel views regarding this.

Focus group (FG) discussions with health-care personnel from five primary health-care centres in northern Sweden. The transcribed FG discussions were analysed with qualitative content analysis.

The analysis revealed four main categories: a patient-centred VC; the importance of evaluating costs and resources; new technology in daily work; technology gives new possibilities in future health care.

This paper explores cultural and professional dynamics of HIV general practice nursing in Australia. It highlights specific contributions that HIV general practice nurses make to HIV medicine and considers how nurses’ clinical practice has been shaped by past experiences of the AIDS crisis and subsequent developments in HIV medicine.

In international contexts, nurses in HIV medicine commonly work as part of shared-care teams. In recent years, HIV general practice nursing has become a prioritised area for primary health care in Australia.

Data for this analysis were drawn from 45 in-depth, semi-structured interviews conducted with nurses and general practitioners (GPs) who provide HIV care in general practice, and key informants who work in policy, advocacy or education and training of the HIV general practice workforce.

Viewed through a socio-ecological framework of social capital, descriptive content analysis highlights a unique and strong HIV health professional identity, which emerged out of the adverse conditions experienced by nurses, GPs and allied health professionals during the 1980s AIDS crisis. Participants reported that today, HIV general practice nursing includes information provision, HIV treatment side-effect management, teaching patients methods to increase adherence to HIV treatments and capacity building with allied health professionals. Participants reported that HIV general practice nurses can reduce the clinical burden on GPs, ameliorate patients’ exposure to HIV health care-related stigma and discrimination and facilitate the emergence of a comprehensive and personalised model of shared primary health care based on trust and rapport, which is desired by people with HIV. This study's findings support the future expansion of the role of HIV general practice nurses in Australia and internationally. General practice nursing will become increasingly important in the scaling up of HIV testing and in caring for increasing numbers of people living with HIV.

To review the effectiveness of physical activity interventions for adults aged 50 and above, delivered through general practice.

Physical activity has beneficial effects on the common disorders of later life. General practice is a potentially important setting for promotion of physical activity among older adults, but the effectiveness of such interventions is presently unknown.

Studies published between January 1998 and July 2011 were identified from electronic databases. We searched for studies of tailored physical activity interventions to older adults through general practice. The search and selection process was not restricted to any outcome measures but only included studies comparing two or more groups prospectively. Two reviewers screened the studies and obtained full texts of eligible studies. Included studies were assessed for their methodological quality and public health impact.

Altogether, 4170 studies met the initial search criteria but only six were included in the review, with a total of 1522 participants. The interventions ranged from six weeks to six months. One study showed a statistically significant increase in physical activity in the intervention compared with the control group (P ⩽ 0.007). Four studies measured quality of life using the SF-36, of which three reported inconsistent results. This review shows some evidence of the effectiveness of physical activity promotion for older adults through general practice, but not enough to warrant widespread commissioning and implementation. Large-scale developmental projects with long follow-up (beyond two years), objective measures of physical activity and comprehensive documentation of resource use, should now be conducted.

The aim of the study was to establish the scale and cost of ineffectively made consultations by self-referring patients across three North Wales primary care practices for ‘day-to-day’ conditions.

Little evidence exists of the scale of ineffectively made day-to-day help-seeking by self-referral patients. Examination of this issue is compromised by the use of traditional language to describe help-seeking, which is subjective and of limited use. There is little understanding about help-seeking for day-to-day conditions. Most research on help-seeking behaviour has considered help-seeking for specific services; specific cohorts; or specific conditions, rather than help-seeking for day-to-day conditions.

A survey of all routine consultations made at four general practices in North Wales over a one-week period was conducted. Using objective definitional parameters classifying routine consultations as either effectively or ineffectively made, we measured the scale of ineffective help-seeking. General practitioners categorised consultations as either effective or ineffective. Ineffectively made consultations were categorised as follows: potentially avoidable; made with the wrong healthcare professional; or made at the wrong time.

A total of 22 GPs made 1217 routine consultations for day-to-day symptoms, of which 24% were ineffectively made. Fifteen percent of consultations were potentially avoidable. Potentially avoidable consultations alone may be costing the NHS £87.85 million annually. The ineffective use of limited and scarce healthcare resources should be examined. Patient outcome may be potentially compromised directly by poor help-seeking decisions but also by ineffective use of resources.

The aim of our study was to develop a survey for family physicians to better understand family physicians' beliefs, level of knowledge and sense of accountability regarding their support of informal (ie, unpaid) caregivers of older adults.

Seniors with dementia can be supported to ‘age in place’. However, this requires assistance from family and friends, who are often seniors themselves and may have health issues of their own. Although family physicians are well positioned to assist older adult caregivers, there is a paucity of data regarding this role.

After a literature review, we created a questionnaire to examine these issues. It was reviewed by experts and, after revision, was appraised by health planners/decision makers and pre-tested with family physicians. A final questionnaire was created using this feedback.

The next important step would be to administer the questionnaire to Canadian family physicians using appropriate survey methodology.