Whilst much good practice relating to research support for rural PCTs undoubtedly exists, little has been published about the processes that facilitate such successful support. This paper outlines the nature of a collaborative venture between a Research & Development Support Unit, HRDNoW, and a Primary Care Research Network, CumbReN in providing research support to three rural PCTs in North Cumbria. In doing so, the paper highlights how research capacity is built through a combination of inputs at an individual and organisational level and looks specifically at the outcomes of this collaboration.

General practitioners have always had special interests. Recent policy initiatives in the UK, organizational changes and changing attitudes by the Royal Colleges have meant that there is an increasing interest in the development of a new role for GPs with special interests (GPSIs). This paper considers what methodology is best suited to examining change, while that change is still developing. Specifically, it offers a model that identifies different forms of knowledge; anticipated, explicit and tacit and considers how these can combine in an evaluative model for innovations in primary care. The paper goes on to identify potential benefits and risks of a shift towards GPSIs. It develops a picture of GPSI services in one PCT and focuses on two disciplines, orthopaedic medicine and urology. Views of those GPs providing these services are reported and are linked with the possibilities that a new form of general practice might emerge without general practitioners.

There has traditionally been a low level of engagement of primary care practitioners with research. In the UK, primary care trusts (PCTs) now have some responsibility for the encouragement of research and development in primary care. The aim of this study was to assess the current level of research activity and capacity for research within a PCT. A questionnaire, incorporating a recently developed and validated research and development culture index, was sent to all 572 health care professionals and staff under the auspices of North Tyneside Research PCT. Data analysis used nonparametric tests of association including chi-squared, Mann–Whitney U and Spearman's rank order correlation. There was a 50.3 per cent response rate to the questionnaire. Groups more likely to show an increased capacity for research included those with postgraduate qualifications and those in post for the least time. General practitioners were less likely than other professional groupings to declare personal skills or aptitude for research. The two most important factors thought to contribute towards the development of a culture of R&D were having access to people to support development and changes in professional practice and having access to training and development opportunities. The use of the R&D culture index enabled groups to be identified that may be more research interested and can therefore be targeted to increase research capacity. The R&D culture index could be used by other PCTs wishing to define and develop research capacity in primary care.

Department of Health efforts to make primary care more effective depend on the availability of relevant research findings. This implies a need for management and organization research, but it is not clear what role practice managers will play in this. The priority given to research governance also raises questions about how best to manage research in primary care. The aims of this study were to identify practice managers' involvement in research, their attitudes to research and their training needs. To do this, we conducted a postal survey of all general practices in East London and Essex. Of the 622 practices, 510 employed a manager. Of these, 232 responded, giving a 45% response rate. One hundred and forty-five (62%) respondents had been involved in research and 90 had been as a practice manager. Forty-five (20%) had some research training. Most had a positive attitude to research. The most commonly requested training topic was ‘How to manage research projects’. They wanted research to be conducted on delivering effective health care, access and appointments systems, patients' expectations of general practice, team management and their own role in the NHS. We conclude that managers have two distinct roles in research. First, undertaking research into management and service delivery and secondly managing and supporting research in the practice. Most need further training to take these forward. Research networks could do more to involve managers.

The need for effective collaboration when working with survivors of domestic violence is an urgent one. This paper outlines an innovative project that will examine the antecedents of homicide by a current or former partner. The early stages of the project including analysis of closed homicide case records and a survey of police officers' experience of collaboration with health and social care providers is presented. Early findings suggest opportunities where intervention could in future situations prevent homicide.

Due to migration, an increasing number of the elderly in Sweden will be foreign-born, ‘old migrants’. Old migrants will need help from society with health care and social service. Migration may influence people's health and thus also their consumption of health care and social service. The aim of the present study was to discuss migration and health with the focus on old migrants by a review of literature, and to describe the pattern of health care and social service consumption among old migrants living in Sweden, studying whether there were any differences compared with old people born in Sweden. The results showed that there is a lack of data describing old migrants' health. Available data indicate poorer self-rated health, more chronic illness and impaired mobility capacity. There are some Swedish studies describing morbidity and mortality among migrants in Sweden. These are consistent: migrants have more health problems in general and migrants from the Nordic countries have a higher mortality rate. There are no public statistics about old migrants' consumption of health care and social service in Sweden. Some studies show that old migrants consume less than native Swedes. Other studies indicate the same or higher consumption of health care, but lower consumption of social service among migrants. In conclusion, few studies concern health and consumption of health care and social care among old migrants; the results are divergent and there could be several different explanations for dissimilarities, such as migrational background, cultural distance, time of residence, socioeconomic position and adaptation in the new society. Thus, further studies are needed.

This paper focuses on one aspect of a research study exploring the cognitive processes of decision making by 11 nurse practitioners and 11 general practitioners from the south east of England, using six patient scenarios during 2000. It sets out to explain some of their decision-making processes. This paper is part of a larger study discussing the use of information processing theory as a framework for exploring decision-making. Schema theory is used to provide explanation of correct and incorrect responses to the six scenarios. The paper explores areas in which cognitive overlap occurs and uses the participants’ examples to illustrate schema functioning. The usefulness of information processing theory to explore decision-making by nurse practitioners is also addressed. The paper concludes by suggesting that information processing theory and ‘think aloud’ approaches were suitable for identifying errors in decision-making, and could therefore be used as a teaching tool. Change is required in the culture of primary care organizations if shifting emphasis towards developing collective responsibility and greater openness is to be achieved.

The treatment of mental health problems is now a national priority in the UK. With a prevalence rate of 23% in the general population and 75% of the population visiting a GP each year, the role of primary care in the detection, management and treatment of mental health problems is pivotal. However, around 20% of mental health problems remain unidentified by GPs. Many reasons may contribute to this. One reason is cited as being the training received by GPs, although research into this has yielded inconclusive results. This study aimed to investigate qualitatively the attitudes of GP registrars, firstly towards dealing with mental health problems in primary care and secondly in relation to the training and support received. Sixteen semistructured interviews were conducted and analysed thematically. Results indicated that GP registrars in this study understood the psychosocial nature of mental health problems and felt confident in detecting these issues in their patients. However, they were less secure about the management of mental health problems due to a number of constraints such as inadequate time, lack of knowledge of referral pathways and local resources, and a limited understanding of the psychology of mental health problems. They appreciated the support provided by their trainers, the training practices and the vocational training scheme (VTS). They would benefit from additional input concerning assessment and management of psychological problems, and discussions around their new role as a GP, acknowledging its potentials and limitations.

The changing demands on primary health care have focused attention on workforce diversification. Although skill mix has been researched for some time, exploration of delegation decision-making is an underresearched topic. This limits the sharing, teaching and monitoring of the inherent skills. Utilizing focus groups, this exploratory research was therefore designed to map delegation perceptions, experiences and decision-making processes of health visitors and districts nurses in a primary care trust in the north of England. The focus group discussions revealed a diversity of delegation practices. Decisions were driven by both pragmatic and needs assessment factors. Issues around the delegatee, the delegator, patient need and structural factors were strongly influential. Delegation of aspects of ‘established’ care was at times in conflict with the philosophy of holistic care. The research suggests that it is important to recognize the community context of practice increases the complexity of delegation decision-making.

The aim of the present study was to review the district nurses’ documentation of patients suffering from chronic pain conditions and to investigate whether the documentation changed after the introduction of specifically educated, district nurses (‘pain advisers’) at the primary health care centres (PHCC). A study area with five PHCCs and a control area with seven PHCCs were selected. One ‘pain adviser’ was introduced at each PHCC in the study area. The district nurses in the study area and the control area were asked to register all the patients older than 16 years with chronic pain conditions with whom they were in contact. The records of all the registered patients were collected in two periods (before and after the introduction of the pain advisers) and a review of different aspects of the nursing documentation related to chronic pain was performed. The nurses’ documentation regarding the patients’ chronic pain conditions was found to be incomplete and minimal. After the introduction of ‘pain advisers’ into the study area, some improvements were found in both areas. Our results indicate that the introduction of ‘pain advisers’ to some extent improved the documentation in the study area, but that further interventions are needed in order to improve it further.