This article presents a review of current issues and trends in the use of information technology (IT) by nurses in primary care. Its aim is to raise awareness of the particular problems faced by nurses, and so it is not aimed at the IT expert but at the primary care nurse, researcher or educator who seeks a wider perspective on the issues involved. It is not the purpose of this paper to offer specific solutions to the problems; these will be discussed in further publications. The first section highlights recent policy changes in the area of information technology that are already affecting nurses in primary care. The second section addresses some of the barriers to progress in this area, which should be taken into account if the Government's vision of an IT-rich health service is to be achieved. To draw attention to the fact that nurses in other countries face similar issues to those in the UK, we include a wide selection of international as well as national literature. Finally, the third section suggests how these barriers might be overcome, and identifies emerging trends.

Hospice care is evolving from the traditional in-patient bedded unit into a system of support which is community focused. The cornerstone of this ‘community model’ of palliative care rests on successful collaboration with the primary health care team (PHCT). However, there is evidence that establishing a community service is not straightforward, and acceptance in principle is not always translated into practice. This article presents the findings of an evaluation of one such community palliative care service from the perspective of local general practitioners (GPs) and district nurses (DNs). A combination of interview and survey data is presented. A positive picture emerges. The findings suggest that the task of promoting and integrating the service in the community has been successful. The service was seen by members of the PHCT as helping to provide a choice of care settings and helping patients to remain at home. It was not perceived as having caused extra work or complicated lines of communication. However, it is an area which will require constant attention as other factors come into play.

The publication of the Department of Health's 1993 report Changing Childbirth has prompted major changes in the organization of maternity care, with an emphasis on returning antenatal care to the community. Serum screening for Down's syndrome (triple test) is usually carried out and followed up in secondary care, and work relating to the psychosocial effects of the test has been hospital-based. The aims of this study were to examine the views of women regarding the process and effects of delivering the test as part of routine general practice-based antenatal care, with a view to considering how this care might be most appropriately managed. We sent a questionnaire to all women registered with a fundholding practice who were offered the triple test between 1992 and 1997. The main outcome measures were satisfaction with the way in which the test was offered, what women understood by positive/negative results, why some women declined the test, and satisfaction with obtaining results/follow-up. The response rate was 60.7%. The majority of women were satisfied with the way in which the test was discussed, but there was ambivalence with regard to the procedure for receiving results, including the counselling offered. Confusion over the meaning of the results (particularly negative results) was apparent. The test caused anxiety in many women. The need for continuity of advice and support when women are subsequently referred to secondary care for further tests was highlighted. The majority of women wish the test to be available for all. The conclusion we draw is that no abnormalities have been detected during the study period, raising questions about cost-effectiveness. However, the majority of women view the test as a means of making informed decisions about their pregnancies. Although limited to one practice, the issues associated with a broad range of aspects of care identified through an analysis of the experience both of women declining the test and those accepting it provide important insights into the practicalities of delivering antenatal screening tests in primary care.

Little is understood about the patterns in which frequent attenders consult primary care over time, or about the clinical or behavioural reasons for doing so. The aim of this study was to use a sorting task to identify the important features of patterns of attendance to general practitioners generated by frequent attenders over a period of 44 months. A total of 12 experts performed a sorting task on consulting patterns of the 100 most frequent attenders from one general practice in Leeds. A similarity matrix was constructed which was then subjected to cluster analysis. A range and diversity of patterns was clearly demonstrated within the data. The determining factors of the groupings by the experts included frequency, regularity, bursts of consultations, patterns of consulting after bursts, periods of not consulting, and seasonal or annual trends. The cluster analysis provided six final clusters, the largest of which had no fixed or classifiable pattern of attendance. The other five clusters were ‘regular without bursts’, ‘supernovas’, ‘gap and prolonged burst’, ‘bursts and sporadic attending’ and ‘regular as clockwork’. Distinct patterns of frequent attendance exist, and it seems likely that the clinical and behavioural reasons underpinning such behaviours differ. This work furthers our understanding of the way in which frequent attenders consult, and the results have implications both for general practice and for future research. The methodology described may have applications in other areas of primary care and biomedical research.

Nurses are increasingly being employed instead of doctors in some areas of work. This article examines this phenomenon in relation to a ‘nurse-led’ Personal Medical Services Primary Care Act pilot scheme. As part of an evaluative project, we examined the way in which patients understood and constructed nursing roles in the context of their use of primary care services in a socially deprived area. Whilst professional roles are established to some extent as the result of negotiation between and within professions and with government policymakers, patients' perceptions also affect whether or not changes are accepted, and the extent to which new roles gain legitimacy. Our evaluation took the form of a case study with questionnaires, in-depth interviews and observations. This particular paper is based mainly on data obtained from interviews with patients who had experienced the nurse-led service. The results showed that some patients attributed high status to the nurse by emphasizing that the nurse leading the practice was highly qualified, and other patients reconstructed the role and thought of the nurse as a doctor. This latter interpretation was derived from the patients' descriptions of core activities such as diagnosis and treatment, and other factors such as an absence of uniform. However, the most important factor that affected whether or not patients accepted a ‘nurse-led service’ related to the way in which the service met their needs. This seemed to be more important than perceptions of professional identity. The nurse-led service continued to provide the social support and continuity of care that the patients valued, and which had been provided by their previous general practitioner. The provision of these aspects of care appeared to be more important than whether or not the service was nurse-led or doctor-led. It is important to consider patients' perceptions of policy innovation when establishing new services.