Primary care research networks are considered to be fundamental to the development of a relevant research base in primary care. Networks must be responsive to members' research and training needs in order to evolve. The aims were to gather information about the perspectives, barriers to participation, research interests and training needs of primary care staff interested in participating in the North Central Thames Primary Care Research Network (NoCTeN). A postal questionnaire survey documented training needs and barriers to initiating or developing practice-based research. Focus groups were convened to gain an understanding of needs and explore practical means of addressing these needs. Seventy per cent of practices (57/82) responded to the questionnaire survey. Two focus groups were convened with general practitioners, and one group with practice nurses. Clinical commitments were considered the greatest barrier to research participation. Respondents were keen to participate in research relevant to their practice population. Training was viewed as ideally being project specific and practice based. Mentoring schemes were advocated, together with methods to encourage primary care staff to develop research ideas and access appropriate training. Although there were common themes, there were also differences between general practitioners' and nurses' perceived needs. Investigation of members' perspectives and needs enables networks to respond appropriately and practically. Addressing barriers should encourage members to participate in research and increase primary care-based research activity.

Primary Care Groups and Primary Care Trusts have the task of achieving an integrated health care service, serving local communities. A regional Education and Training Consortium commissioned a 1-year study to provide information in order to develop a workforce strategy that aimed to achieve this agenda. The study involved individuals who plan, provide and/or manage primary and community health care service in three Health Authorities, working in partnership. The three phases of data collection included focus groups, individual interviews and a survey, which produced qualitative and quantitative data. The findings outlined in this paper primarily focus on practice nurses and integrated care. Several tensions emerged in this context which could inhibit the development of integrated care. These included conflict within professional relationships, inequality in pay and working conditions, a lack of understanding of how integrated care would or could translate into practice and turbulent environmental contexts. We argue, these tensions often created gaps between policy, practice and professional discourses which, unless acknowledged and understood may result in integrated care remain a health, but unachievable, rhetoric.

The objective of this study was to determine the views of Somerset GPs, on the quality of communication from hospitals, with particular reference to the cancer patient. A questionnaire was designed as a result of focus group discussions with 22 GPs. This questionnaire was then sent to all Somerset GPs, of whom 312 participated. The questionnaire was designed to ascertain the perceived quality of communication from hospitals. The results of the study concluded that most GPs believe good communication is more important with cancer patients than with other patients. Written communication was regarded as being very good with the exception of discharge information which should provide more detail on follow-up and treatment plans. However, more detail was desired on potential side effects of treatment and recommended action, as well as on prognosis. It was generally felt that greater use of fax and e-mail would be helpful.

General practitioner activity is increasingly under pressure to monitor its performance. The involvement of service users in the development and assessment of services is said to be a key feature of this process. This article reports on the acceptability among general practitioners of a patient-completed post-consultation measure of outcome (the Patient Enablement Instrument; PEI), and its use in conjunction with two further indicators of quality, namely time spent in consultation and patients reporting knowing the doctor well. The survey was conducted using focus groups and the administration of a postal questionnaire among a group of general practices that had participated and received feedback from a large quantitative study testing these measures. The focus group study provided useful insights into general practitioners' perceptions of patient assessment of their performance and their concerns surrounding the measurement of general practice activity. The general practitioners' perceptions of the measures under the study were enmeshed within these concerns overall. The PEI was seen as being generally acceptable as a measure of patient assessment of care, and the methods of data collection were acceptable for routine use in general practice. General practitioners who performed better in terms of their feedback scores generally approved more of the proposed measures. However, these general practitioners were not comfortable with the concept of assessment of the clinical interaction by patients, and were anxious to link such assessment explicitly with clinical (disease-related) outcome. Doctors who performed ‘better’ were no more likely than those who performed less well to advocate more use of patient assessment, or to believe that patient assessment of consultations is a reliable quality indicator. These concerns need to be addressed if patients' assessments of their care are to be taken seriously.

Problems with regard to the recruitment and retention of general practitioners (GPs) have been largely attributed to disquiet over ongoing government health reforms, together with increased administrative and surgery workloads, low morale and stress. This study aimed to provide empirical evidence of the scale of the workforce crisis in GP recruitment and retention, and the type of initiatives being developed to address local problems. Postal questionnaires were sent to directors of primary care in all 100 health authorities in England, and to directors of postgraduate GP education. Problems associated with recruitment and retention were mainly confined to less attractive locations, primarily deprived urban areas. Sources of new recruits mainly consisted of local training schemes. Numerous initiatives had been set up to address local problems, but these tended to be piecemeal and small scale. Although there was widespread awareness of problems with regard to the recruitment and retention of GPs, there was little evidence of co-ordinated approaches to offset future problems.

The aim of this study was to explore the views of Primary Care Organisation (PCO) clinical governance leads on the implementation and development of clinical governance within primary care in the south west region. A grounded theory study using focus groups, research interviews and negotiated feedback reports was designed for use in the primary care setting. The subjects were a purposeful sample of 16 PCG-level clinical governance leads. Four main categories emerged from the data. These included: (1) defining clinical governance; (2) the process of implementing clinical governance; (3) positive aspects of clinical governance; and (4) concerns about delivering clinical governance. At the time of collecting the data (approximately 1 year after the introduction of clinical governance), there was evidence of a culture in primary care where clinicians valued efforts to improve the quality of patient care and enjoyed their own involvement in decision-making at a grass-roots level. However, whilst the concept of clinical governance was received with enthusiasm, the delivery of clinical governance faced challenges. These challenges included the paucity of ear-marked funding, the speed of implementation, the volume of work, and the impact on the clinical governance lead's relationships at home and at work and on his/her emotional wellbeing.