Interprofessional collaboration in primary health care.

A study of interprofessional collaboration involving 148 general practitioner and district nurse pairs and 161 general practitioner and health visitor pairs was undertaken in 20 health districts throughout England in 1982-83. Data were collected using personal interviews and a prospective record of referrals and consultations. The ratings of collaboration recorded showed that only 27% of general practitioner-district nurse pairs and 11% of general practitioner-health visitor pairs were working in partial or full collaboration. Structural arrangements such as attachment, the number of general practitioners that community nurses work with, and working from the same building were found to be strongly associated with collaboration.

Attachment of a physician's assistant to an English general practice.

A final-year student from the physician's associate programme at Duke University in North Carolina, USA, worked in an English health centre for eight weeks between May and July. He managed 221 cases under supervision, and they were typical in terms of sex ratio, diagnosis, and the preponderance of children. Current social and economic trends in Britain suggest that selective under-doctoring, especially in inner urban areas, may become acute, and a type of physician's assistant specially selected and trained for the work in areas with serious and unusual problems should be considered as among the possible, even desirable, solutions.

The social and occupational characteristics of attached and employed nurses general practice.

We compared the social, professional, and occupational characteristics of nurses employed by area health authorities and nurses employed by general practitioners by interviewing random samples of 153 nurses in 113 practices situated in four rural and five urban area health authorities in England. The two kinds of nurse were similar in most professional respects but differed in their social characteristics, career patterns, and terms and conditions of employment. They also differed in the singleness of their commitment and the hours they worked in the study practices.

A comparison of the activities and opinions of attached and employed nurses in general practice.

We compared the nursing and medical activities and the opinions of nurses employed by area health authorities and nurses employed by general practitioners by interviewing a random sample of 153 nurses in 113 practices, situated in four rural and five urban area health authorities in England. The availability of a treatment room profoundly affected the work of both kinds of nurse and there were differences between them in the balance between ;caring' and ;technical' activities which may be largely attributed to the circumstances of their employment. However, their occupational histories and choices of employer appear to reflect both differences in their training and differences in their values about career and marriage.

General practitioners and postgraduate education in the Northern Region.

We describe a survey of general practitioners in the Northern Region which was carried out during the summer of 1977 as the result of a commission from the Education Committee of the North of England Faculty of the Royal College of General Practitioners. Seventy-five per cent of a one in two random sample of general practitioner principals returned a postal questionnaire in which their perceptions of postgraduate education were sought and their behaviour measured by the number of sessions they attended during the previous year at their 'usual' and other postgraduate centres. Almost half the respondents had more than a basic qualification and all but three per cent had held full-time hospital appointments, two thirds of them at the level of senior house officer or above. Their experience as general practitioner principals averaged 15 years and 57 per cent held part-time appointments outside their practices. Only four per cent had not attended any postgraduate events during the previous year but the remaining respondents had attended eight sessions on average, six of which were at their usual centres. Those attending more than the average number of sessions tended to have registered between 1950 and 1969, to work in larger practices, to hold additional appointments, or to be trainers or College tutors. Most of the respondents were conservative in their perceptions of teaching methods, the topics discussed at meetings, and the contributors to postgraduate education but the younger general practitioners and a group of established general practitioners affiliated to the Royal College of General Practitioners held more radical views. They agreed about the primacy of traditional clinical topics but were sceptical of the value of ward rounds and formal lectures and favoured the seminar and clinical attachments. They saw a need for more material about practice management and wanted experienced general practitioners and community paramedical staff as teachers in addition to hospital consultants. Most of the respondents believed that their usual centres were well organized and managed but failed to cater for the special requirements of general practitioners in non-clinical aspects of practice. Lunchtime and evenings were seen as the most convenient for weekday meetings and Sunday as the most convenient day of the week. A majority of respondents believed that post-graduate education had altered their practice of clinical medicine but only 15 per cent believed it had caused changes in their practice organization.

Paediatric home nursing scheme in Gateshead.

A scheme to provide specialised nursing care for sick children in their own homes was begun in Gateshead in 1974. Selected district nurses were retrained in the paediatric unit on which the scheme was based and nursed at home 22 children referred to them by general practitioners as the alternative to hospital admission and 39 discharged to their care by the hospital. Most of the children were aged 3 years or less and came from working-class homes. Most of the mothers who were asked were in favour of the scheme.

Nurses and nursing in primary medical care in England.

In 1974 we sent questionnaires on attachment and employment of nurses to 9214 general practices in England. There were 7863 replies (85%), of which 551 were excluded from the study. A total of 2654 nurses were directly employed by 24% (1774) of the practices, and 68% (4972) had attached nurses. Practices in health centres were larger and had greater nursing resources than those in other premises. We suggest that practices may employ nurses to compensate for ineffective nursing attachments, and we conclude that general-practice-employed nurses are becoming "professionalised".

Telephone messages received by seven general practices.

Telephone calls were recorded in seven general practices in Aylesbury in a study of communications received from the hospitals, local health authority (L.H.A.), social services department, and other sources, but excluding calls from patients.Analysis of 855 telephone calls revealed patterns of communication with the staff of the practices which have not previously been recorded. The general practitioners were central in communications from all sources except the local health authority, while calls to health visitors came overwhelmingly from the local health authority. Community nurses received only 36 (four per cent) of all the calls despite the interests expressed by hospital nursing staff in their responses to a postal questionnaire. A hypothesis is advanced to explain this discrepancy between interest and action.

The practice manager. A review and discussion of the literature.

The limited amount of literature available which describes the work of practice managers has been used as the basis for compiling a tentative job description and for the discussion of a number of actual or theoretical issues which seem to be relevant. A comparison is made at a superficial level with experience in the U.S.A.The intention is to clarify some ideas in a newly emerging aspect of community medicine and primary care with a view to exploring the possibilities for research, training and consultancy in the future.

Gazetteer of general practices in the Aylesbury area.

One reason for defects in communication between hospitals and general practitioners may be that hospital staff lack information about local practices. We compiled a handbook giving information about 55 (86%) of the practices which use the district general hospital group in Aylesbury. This included biographical details about each doctor in each practice, when he was available on the telephone, what ancillary staff worked in the practice, and so on. The handbook was given to 500 staff in all grades and departments in the group. It seems to have been effective in improving communications, relationships, and morale within the area.