The need to improve the skills of primary care workers in the management of mild-to-moderate mental health problems in children and adolescents is widely recognized. One model for providing such skills is the use of specialist psychiatric nurses as interface workers in a consultation–liaison role. This aims to provide training and expert advice to facilitate the detection, assessment and management of child and adolescent mental health problems. The objective of this study is to assess the impact of a pilot scheme which placed three consultation–liaison interface workers, for 15% of their time, in primary care. This study involved a qualitative assessment of health professionals' experiences of the new system, using constant comparison analysis of the transcribed texts of five focus groups. The setting was within the participating surgeries and at the secondary care centre. The participants comprised ten secondary care workers, ten GPs, seven health visitors and three school nurses. The main outcome measure was the views of the health care professionals of the interface worker service. The results showed that primary care staff reported strong, positive effects on confidence, morale and patient care, although a few possible problems were perceived in terms of carers' understanding of brief intervention. Prior to the introduction of the new system, they felt they had little to offer children and adolescents with mental health problems, but now they had a service to offer. The interface workers had particularly enhanced their treatment skills/options. However, the secondary care workers felt that there had been little effect on their workload although only four out of 54 practices feeding into them had had interface workers appointed. Although they recognized the potential benefits for mild to moderate cases in primary care, they were also concerned that scarce resources might be being directed towards lower priority cases. This pilot study concluded that this was an efficient, effective service offering a quick response to patients, equipping primary care workers with treatment skills and having a positive effect on the numbers of referrals to secondary care. Further, more extensive quantitative work is needed to find out if these conclusions are really justified.

Antibiotic prescribing for acute otitis media is common and studies have failed to show significant short-term benefits for their use in the treatment of this condition. Antibiotic resistance is an escalating problem related to antibiotic use and the Department of Health has published guidelines advising that they are probably unnecessary in otitis media. The aims of this study were to primarily explore parents' ideas, concerns and experiences when consulting for otitis media in children. Secondly, to develop strategies that general practitioners can use to improve doctor–patient communication and the doctors' ability to negotiate management options acceptable to patients, taking into consideration current evidence-based guidelines. A qualitative research design using focus groups were employed. The study sample interviewed were parents of children. A total of 17 parents representing a range of ages and different socio-economic backgrounds attended the focus groups. Six major themes emerged from the analysis. These themes suggested that parents' were given little information and had a poor understanding of ear infections. They expected the general practitioner (GP) to primarily make a diagnosis followed by an explanation and discussion. Parents also wished to be reassured that their child was not suffering from anything more serious, in particular, meningitis. Most were happy not to have antibiotics prescribed and preferred the doctor to make the decision about the use of antibiotics. Parents were happy to consider seeing a practice nurse when their child presented with otitis media. The strategies recommended for general practitioners is to provide a diagnosis and reassure parents about meningitis and other long-term complications and to be aware that they may overestimate parents' expectations of a prescription. General practitioners should also be flexible in involving them in the decision making process.

It is anecdotally reported that general practitioners (GPs) consider much of their time is wasted by patients consulting with minor ailments. The management of minor ailments and the need to reduce pressure on GPs has been a recent focus of government health policy. However, knowledge of the lay and professional interpretations of the term ‘minor ailment’ is sparse. This study determined GPs' and patients' views of consultations perceived by patients to be forminor ailments. A face-to-face, structured interview was conducted with all consenting patients immediately prior to their consultation with two GPs, over a total of 20 surgery sessions, in England. The GP view of consultations perceived by patients to be for minor ailments was obtained. A total of 240 patients (96.4%) participated in the study. Almost 40% of interviewees (93/240) indicated that they were consulting about a minor ailment. In many cases the GPs gave a contrasting view of these consultations, with approximately half judged not to be minor ailments. Whilst there was agreement that the remaining consultations were for minor conditions, sometimes a mismatch existed in the perception of whether the consultation was necessary. In almost 30% of cases (n = 27) the GPs viewed that the patient could have managed their condition alone. Policy-makers and GPsmaintain thatminor ailments account for a substantial proportion of GP workload. However, in this study over 50% of patients had underestimated their ‘minor’ condition. Furthermore, two subgroups of minor ailment consultation were identified; those that could and those that could not be managed by the patient alone. Minor ailment consultations would therefore appear to be far more complex than trivial, inappropriate or unnecessary consultations that waste the time of GPs.

There is evidence to suggest that GPs experience significant difficulties associated with lack of support from, and communication with, hospital and other specialists in palliative care. The establishment of cancer and palliative care facilitator schemes by Macmillan Cancer Relief reflects these current concerns very clearly. This paper presents some of the findings from the first phase of an evaluation of one such GP facilitator scheme in the Welsh county of Powys. It examines the perceptions and expectations of GP facilitator post-holders during the first year of the facilitator scheme, based upon data gathered from qualitive interviews conducted on three separate occasions. The picture that emerges from the first year of this facilitator project is broadly a positive one. Facilitators have tailored their roles to fit in with and augment the practices with which they deal. Attitudes vary, but their goals of facilitation and education appear similar. Themain challenges facing post-holders is that of being aware of the possible existence of professional rivalries whilst developing their role in ways which do not encroach upon the territories of long-established colleagues.