Gill Rowlands

Do primary care professionals work as a team: a qualitative study.

Teamworking is a vital element in the delivery of primary healthcare. There is evidence that well organised multidisciplinary teams are more effective in developing quality of care. Personal Medical Services (PMS) is a health reform that allows general practices more autonomy and flexibility in delivering quality based primary care. Practices in the locality where this study was conducted were offered resources to employ additional staff. Such arrangements provided the opportunity to expand and develop Primary Care Teams. In this qualitative study, semi-structured interviews were conducted with primary care professionals in 21 second wave PMS practices. Some participants felt they had used PMS to build their teams and develop quality based patient care. For other practices teamworking was limited by the absence of a common goal, recruitment difficulties, inadequate communication and hierarchical structures, and prevented practices from moving forward with clear direction. The study indicates that changing the contractual arrangements does not necessarily improve teamworking. It highlights the need for more sustained educational and quality improvement initiatives to encourage greater collaboration and understanding between healthcare professionals.

Identifying patients with ischaemic heart disease in general practice: cross sectional study of paper and computerised medical records

Abstract Objectives: To identify patients with ischaemic heart disease by using a practice computer and to estimate the work required to do so. Design: Cross sectional study. Data from the notes and from the computer records of 1680 patients were used to build a database. This was used to compare different methods of identifying patients with ischaemic heart disease. Setting: 11 general practices in the Battersea primary care group in south London. Subjects: 1 in 40 random sample of patients aged 45 or older. Main outcome measures: Numbers of patients identified with ischaemic heart disease. Results: The combination of the Read code for ischaemic heart disease (G3) and a prescription for a nitrate had a 73% sensitivity and a yield (100/positive predictive value) of one case of ischaemic heart disease for every 1.2 sets of notes reviewed. By searching the records of patients also receiving aspirin, atenolol, digoxin, or a statin, the sensitivity was increased to 96% but the yield fell to one in three. Conclusion: Although commonly used to identify cases, a computer search for G3 code or nitrate missed almost 30% of patients with ischaemic heart disease. A substantially higher percentage of patients can be identified by adding other drugs to the search strategy.

Community pharmacy treatment of minor ailments in refugees

Objective:  To evaluate a scheme offering pharmacy referrals for minor ailments in a refugee community. To determine if minor ailments could be managed by pharmacists offering over‐the‐counter (OTC) medication, free of charge, to refugees exempt from prescription charges.

A knowledge audit of the managers of primary care organizations: top priority is how to use routinely collected clinical data for quality improvement

Technology has provided improved access to the rapidly expanding evidence base and to computerized clinical data recorded as part of routine care. A knowledge audit identifies from within this mass of information the knowledge requirements of a professional group or organization, enabling implementation of an appropriately tailored knowledge-management strategy. The objective of the study is to describe perceived knowledge gaps and recommend an appropriate knowledge-management strategy for primary care. The sample comprised 18 senior managers of Primary Care Trusts: the Chairman, Chief Executive Officer, or Research and Development Lead. A series of interviews were recorded verbatim, transcribed and analysed. Knowledge requirements were broad, suggesting that a broadly based knowledge-management strategy is needed in primary care. The biggest gap in current knowledge identified is how to perform needs assessment and quality improvement using aggregated routinely collected, general practice computer data.

Locum and Salaried General Practitioners: An Exploratory Study of Recruitment, Morale, Professional Development and Clinical Governance

Sessional general practitioners (SGPs) form a growing proportion of the GP workforce. Previous studies have linked morale and education to retention for principal GPs but there has been little previous research on SGPs and their underlying retention rate is unknown. This study calculated the underlying retention rate of SGPs and assessed which factors influencing recruitment and retenEducation for Primary Care (2008) 19: 285–302 # 2008 Radcliffe Publishing Limited