Factors influencing the career choices of general practitioner trainees in North West Thames Regional Health Authority.

The aim of this study was to identify those factors influencing general practitioner trainees when choosing their future place of work, with particular reference to those issues that might be relevant to a choice of practice in inner London. A questionnaire was sent to the 90 trainees undertaking the final component of general practice training within North West Thames Regional Health Authority in May 1991. Seventy five doctors responded to the questionnaire, of whom 47 (63%) were women. Forty five per cent of women indicated that they wished to work part time, compared with 6% of the men. Only 21 trainees (28%) said that they would consider working in inner London, 36 (48%) stating that they would definitely not work in this location, with only nine (12%) indicating a willingness to work in a single handed practice and 21 (28%) in a two doctor practice. Specific factors identified as important when choosing a practice included a good working relationship with partners and staff, the presence of a practice nurse and practice manager, attached health authority staff, opportunities for postgraduate education, and good relationships with hospitals. Of the 800 practices in the north west Thames region, 62% are either one or two doctor practices, these being more prevalent in inner London areas where training practices are less common. Given the preferences expressed by trainees, future recruitment in inner London is likely to be more difficult than elsewhere.(ABSTRACT TRUNCATED AT 250 WORDS)

The efficacy of a national Family Health Services Authority based cervical cytology system.

District health authorities have been instructed to operate a cervical cytology call and recall screening programme using the age-sex registers held by the Family Health Services Authority. This paper reports the results of a 1989 survey of women from two diverse health districts to determine the uptake of cervical screening between these health districts. The results show a low uptake in all areas, even after accounting for inaccurate information. Many invitations were sent to the wrong address, or to women who were not eligible for a smear test. The former was a particular problem in the inner city district of Parkside. The provision of an effective scheme will depend on all those involved addressing the problems found by this study. This is essential if general practitioners are to meet the new targets for payment set by the government for cervical cytology screening.

Low immunization uptake rates in an inner-city health district: fact or fiction?

Immunization uptake rates are assuming considerable importance as performance indicators for district health authorities (DHAs) and general practitioners (GPs). Data from the Cover of Vaccination Evaluated Rapidly (COVER) programme suggest that immunization uptake rates in innercity districts are well below the 90 per cent target. Using Parkside DHA, a district with consistently poor uptake, as an example, this paper has examined the accuracy of the Child Health Computer (CHC) records on which the COVER figures are based. In October 1989 a cohort of 1485 children born between April and June 1988 were identified. The 462 children identified by the CHC as immunization defaulters (using diphtheria and tetanus immunizations) were followed up by contacting child health clinics, GP surgeries and parents. This exercise revealed that 195 children were in fact immunized and 176 children were erroneously listed, largely because they were no longer resident at the address given. Only a small proportion of this information had reached the CHC by the end of the follow-up period. In addition to high population mobility, information inaccuracies appeared to be caused partly by a failure in data transfer between GPs and the DHA and by failures in data transfer between districts. Overall, the results of the study suggest that there is a considerable discrepancy between actual and recorded immunization uptake levels in Parkside and probably other inner-city areas. This will have a considerable impact on GPs and other health professionals who are striving to achieve 90 per cent targets.

Warts and all.

If the government wishes to promote minor surgery in general practice as an alternative to hospital care, it must demonstrate a much greater commitment to the task, argue Chris Smaje, Sean Boyle and Rosemary Beardow.

Developing care in the community: GPs and the HIV epidemic.

Services for HIV infection and AIDS in Parkside DHA have been largely hospital based with little active involvement of local GPs. In response to the wishes of those with HIV/AIDS and predicted increases in the number of patients the DHA is now developing an AIDS strategy which identifies the development of primary and community care as a major objective. A postal survey of all 263 GPs within the DHA was undertaken in order to ascertain their views about the role of primary care in the management of HIV infection/AIDS. Replies were received from 75% (196). The responses to the survey indicated both the potential of general practice and willingness of GPs to be involved in the care of this client group. However, two key issues in developing this strategy were identified. These were information exchange and confidentiality. It is suggested that both hospitals and general practice must develop rigorous confidentiality policies to overcome these difficulties.

Evaluation of the cervical cytology screening programme in an inner city health district.

District health authorities have been instructed to operate a cervical cytology call and recall screening programme using the age-sex registers held by family practitioner committees. A detailed evaluation of implementation in an inner London district showed that 477 out of 687 (69%) invitation letters sent to women by the family practitioner committee were either inaccurate or inappropriate: almost half of the recorded addresses were incorrect and a further fifth of the women were not eligible for a test. Overall, 90 women had a smear, which is only 13% of the total but 43% of those found to be eligible. The findings did not differ significantly with age. The findings have major implications not only for the effectiveness of call and recall for screening for cervical cancer but also for the future development of screening for breast cancer in such areas.