Problems with a 'target' approach to access in primary care: a qualitative study.

We report an analysis of the qualitative phase of a study of patients' and carers' views of primary care services, focusing on their experiences of access to face-to-face general practitioner (GP) consultations during the period when new access policies were being implemented. Practices interpreted the new policy in various ways; restricted interpretations, including restriction of access to telephone booking, could cause distress to patients. Patients and carers welcomed flexible interpretations of the policy that offered choice, such as a choice of GP, or of booking in advance.

Randomised controlled trial of the effectiveness of feedback in improving test ordering in general practice.

Objective: To assess the effectiveness of feedback on the number of pathology tests ordered by general practices.

Design: Randomised controlled trial.

Setting: General practices in two primary care groups in Leicestershire, UK.

How important is personal care in general practice?

Objectives: To explore patients' perceptions of the features of personal care and how far these are shared by healthcare providers; whether a continuing relationship between a health professional and a patient is essential for personal care; and the circumstances in which a continuing relationship is important.

Design: Qualitative analysis of semistructured interviews using the "framework" approach.

Setting: Six general practices in Leicestershire.

Devising and establishing the face and content validity of explicit criteria of consultation competence in UK primary care nurses.

Aim: The aims of this study were (a) to devise a set of prioritised criteria of consultation competence which primary care nurses need to acquire and (b) to determine the face and content validity of these criteria.

Method: The criteria of consultation competence as contained in the Leicester Assessment Package (LAP) were modified for use with primary care nurses and sent to a stratified sample of UK primary care nurses (n=1126) to determine their face and content validity.

Results: Support for the seven categories of consultation competence varied from 93-98% and for the 39 component competences from 88-98%.

Randomised controlled trial of tailored strategies to implement guidelines for the management of patients with depression in general practice.

Background: Various methods are available for implementing change in the clinical behaviour of general practitioners (GPs). Although passive dissemination of information is generally ineffective, other methods can be variably effective. Few studies have investigated the impact of tailored methods.

The Data Protection Act (1998): implications for health researchers.

Aims: This paper reports on the methods used in two studies to obtain access to subjects to comply with the common law duty of confidence laid out in the Data Protection Act (1998) and discusses the researchers' problems in interpreting the procedures.

Rationale: The amendments to the United Kingdom (UK) Data Protection Act (1998) are causing confusion within the health service and academic institutions. There is a need to balance patient confidentiality with the requirement to conduct vital, unbiased research in which health service professionals are not subject to ethical dilemmas.

Features of primary care associated with variations in process and outcome of care of people with diabetes.

Background: There is now clear evidence that tight control of blood glucose and blood pressure significantly lowers the risk of complications in both type I and type II diabetes. Although there is evidence that primary care can be as effective as secondary care in delivering care for people with diabetes, standards in primary care are variable. Previous studies have shown that practice, patient or organisational factors may influence the level of care of patients with diabetes.

Features of primary health care teams associated with successful quality improvement of diabetes care: a qualitative study.

Background: In quality improvement activities such as audit, some general practices succeed in improving care and some do not. With audit of care likely to be one of the major tools in clinical governance, it would be helpful to establish what features of primary health care teams are associated with successful audit in general practice.

Objective: The aim of the present study was to identify those features of primary health care teams that were associated with successful quality improvement during systematic audit of diabetes care.

Referral for autopsies: analysis of 651 consecutive deaths in one general practice.

Autopsies represent a key instrument in educating doctors and may aid quality assurance for primary and secondary care. This study shows that only a few patients have an autopsy, of which the majority are carried out at the request of the coroner for medicolegal reasons. Better education and communication between general practitioners, hospital clinicians, pathologists, and coroners may increase the rate of autopsies.