What people know and how people feel about type 2 diabetes will affect demand for early identification of the disease at an asymptomatic stage. This paper reports on the selected findings from a broader study of the attitudes and perceptions of GPs, nurses and patients about screening for type 2 diabetes. Purposive sampling was used to identify several practices across north-east England, and data were collected via semi-structured interviews with GPs, nurses and patients from these practices. Interview transcripts were analysed by drawing on the principles of grounded theory, with the aid of NUD*IST software. This paper focuses upon the perceived seriousness of this condition, and the implications such perceptions may have in practice. Results indicate a marked variation in perceptions of seriousness between health practitioners and patients. This diversity can be explored via three overlapping frameworks identified during the study: medical, political and personal. A medical framework suggests that individuals' perceptions are guided by a medical model. This links the seriousness of type 2 diabetes with concepts of prevention and cure, a need for individual lifestyle change, bias towards younger patients and anticipated use of medication. In short, diabetes is perceived to be more serious as it becomes more medicalized. A political framework views seriousness in terms of national incentives and priorities, a recognized need for a centralized push for early detection and financial inducements. Diabetes detection is not generally thought to be attractive politically compared with systematic cancer screening. A personal framework suggests that perceptions of seriousness are determined by individual attitudes, knowledge and experiences of diabetes. The findings offer important insights into how perceptions of the seriousness of type 2 diabetes may influence detection and management of this disease in primary care.

In the context of widespread discussion about a crisis in GP recruitment and retention we review available evidence and comment on underlying policy dynamics. There have been a number of attempts to improve recruitment and retention, and examples of salaried schemes and personal medical service pilots are discussed. The results of a postal survey to health authorities requesting information on existing salaried schemes are reported. Forty health authorities responded to the survey, of which 30 had developed a scheme. These schemes had been established to address recruitment and retention issues, provide higher professional training for GPs, provide care to specific groups of patients, to support underperforming practices, and to help practices develop their range of services and address PCG/T health priorities. We then comment, in some detail, on one particular scheme as an example – the Bradford salaried non-principal scheme. The background to the scheme is described, as is the process of selecting both scheme GPs and host practices. The impact in terms of personal and professional development of the salaried GPs is discussed. Evaluation of the scheme from the perspective of the salaried GPs (via a focus group) found that the main attractions of the scheme were the opportunity to gain experience of inner city general practice without the commitment to a partnership, opportunities for professional development, and support from the peer group of salaried GPs. A number of concerns were raised relating to the clarity of their role in the practices, in particular, the extent to which the salaried GPs were being used to absorb practice workload rather than, as proposed, to facilitate practice development.

The purpose of this explorative study was to ascertain what kind of guidance and support first-time mothers expected from public health nurses (PHN) at child welfare clinics, while they were still on the maternity ward after delivery. Data were collected by an open-ended question as part of a questionnaire between January and May 1995. The sample comprised 219 mothers. Content analysis was applied. Mothers' expectations focused both on the content of support and on the mode of interaction. Mothers expected that issues concerning mainly the child, but also the mother, and the whole family would be discussed at the child welfare clinic. Mothers expected to receive advice and instruction on childcare, that interaction would be individual and family-centred in nature, and that the care would be continuous. Mothers hoped that the atmosphere of interaction would be safe, confidential, peaceful and encouraging. PHNs were expected to have not only professional skill, that is, knowledge and competence, but also a friendly, empathic attitude and a sense of humour. Mothers' expectations of the PHN varied greatly, so the support provided by the PHN should be based on charting the family's need for support, not on routine guidance and counselling. Further research should focus on how the family's need for support changes during the child's first year of life.

Prescribing Analysis and Cost (PACT) data are sent to all GPs to assist them in monitoring their prescribing. Although the quarterly Standard Reports contain a great deal of information it is not known how GPs make use of it. This paper reports on two linked studies which explore GPs' views on PACT Standard Reports and PACT catalogue data. In the first study, interviews were carried out with 21 GPs in 16 practices selected according to criteria related to their prescribing budget. The interview schedule included questions on how the Standard Reports were used and the amount and ease of understanding of the information provided, and on use of PACT Catalogue data. The second study was a questionnaire survey of the 1047 practices in the West Midlands region in which GPs were asked how they used PACT data. Analysis of the interviews showed that GPs' views on the Standard Report varied widely although most found it helpful. Many GPs used the data in a limited way and only used a small part of them. Single-handed GPs and small practices were least likely to make use of PACT data and few practices analysed the data in any depth. Most respondents said that comparing their costs with health authority and national averages was useful for considering where to make changes in their prescribing. GPs indicated they would like the report to include some interpretation of the data with suggestions for changes which could be made. The regional survey confirmed that PACT Standard Reports are only used in a limited way and how they are used varies with practice size. We conclude that PACT Standard Reports were rarely used to analyse prescribing in any depth and GPs need more support in making better use of the data.

The purpose of the present study was to analyse maternal grief and coping with grief following the death of a child aged under 7 years. The aim was to obtain information to understand mothers' grief, in order to support them after the death of their child. Data were collected through surveys (n = 91). The questionnaire used contained an existing grief reactions checklist and open-ended questions. The data were analysed using a two-way analysis of variance, cross-tabulation and content analysis. The results indicate that the mother's grief was associated with the time elapsed since the child's death. The grief was also associated with the mother's age so that older mothers tended to display more grief reactions of a certain kind (detachment and disorganization) than younger mothers. Younger mothers experienced more personal growth than older ones. The child's age at death was associated with more disorganization among mothers if the child had been aged over 1 year at the time of death. The number of children was also associated with the mother's grief. Mothers displayed more detachment if there were other children in the family than if the child had been an only child.

This study explored the experiences of gay and bisexual men in primary care. The study was mindful of both the wider context of the HIV epidemic and the increasing acknowledgement of the role of social factors in determining health and well-being. The study informants were 17 gay and bisexual men, all of whom were registered with general practices. Two major barriers to effective communication and possibly treatment were identified. First, despite the fact that all the informants had come out – or disclosed their sexuality – in many areas of their lives, there was considerable anxiety and fear of stigmatisation in relation to doing so in the context of primary care. Second, many practices and practitioners appeared to assume that all their patients were heterosexual; there were few signals in practice environments of any awareness of gay and bisexual men. This generated problems for men wishing to discuss health needs and treatments in relation to their sexuality and to gay social networks; few practitioners had made referrals to any these networks as part of their health promotion strategy. The study raises questions about the organisation of primary care provision and its willingness to acknowledge and form partnerships with gay social networks.