In 2003, Gateshead Primary Care Trust, England established a virtual Centre for Enabling Health Improvement (CEHI). The aims included support for the wider public health workforce and development of resources for health to enable allied professionals to improve the health of the people of Gateshead. In 2004, the CEHI steering group held a launch to provide a networking opportunity for staff.

Participatory appraisal methods informed the workshops for the launch that aimed to throw light on the concerns of the public health workforce in their day-to-day working lives. Three participatory workshops were planned: a mapping workshop, a workshop about your working week and the timeline workshop. These aimed to find out from the 89 delegates what was special about their work, what the problems were and what were the solutions. The adoption of participatory methods underpinned one of CEHI’s strategic goals namely, that the wider public health workforce would contribute to planning and shaping CEHI’s future plans.

The results illustrated the delegates’ insight about special features of their work, for instance: valuing opportunities for multi-disciplinary working; issues such as inequalities in accessing services and solutions such as the provision of better integration of teams.

The launch shaped a new approach to the delivery of public health in Gateshead by acknowledging and valuing the contribution of its public health workforce. The participatory workshops provided a positive experience for the delegates by contributing to the collection of information that formed the basis for future activities such as the organisation of networking events on current health topics including health needs assessment and lifestyle issues.

Various initiatives have been tried to improve the quality of primary care in England and Wales in the last fifteen years. Such initiatives can be divided into quality improvement (QI) and quality assurance (QA).

This paper looks at three contrasting models, drawn from data from 48 semistructured interviews with personnel from three primary care organisations (PCOs): two primary care trusts in England and one Local Health Board in Wales.

The first model was collegiate, a voluntary doctor-led initiative begun during the period of GP fundholding. The second is clinical governance, a current government-imposed system administered by PCO officers, which has attracted limited engagement from GPs. The third is the Quality and Outcomes Framework of the new GP contract, which was generally described positively, although the process of administering it was experienced as bureaucratic.

The three models correspond with three organisational types: networks (which use peer relationships to achieve goals), hierarchy (which use ‘top-down’ requirements and monitoring) and market (which use contracts). Although doctors have traditionally preferred network-style arrangements, the success of these arrangements in sustained QA and QI has been questionable. The importance of hierarchical arrangements is inevitable, given the functions and constitution of PCOs, and the risk that GPs will disengage is similarly inevitable. However, it is important that PCO officers find ways to engage GPs as much as possible in quality initiatives if patient services are to improve.

The RESPECT (Randomised Evaluation of Shared Prescribing for the Elderly in the Community, randomised over Time) trial was a multi-centre pragmatic trial of pharmaceutical care in the community, which took place in five areas of East and North Yorkshire.

This paper reports a qualitative study designed to explore attitudes of community pharmacists towards the process of ‘pharmaceutical care’ as tested in the trial.

We recruited 21 pharmacists from the trial into four focus groups, moderated by an independent researcher, and analysed using a thematic qualitative approach.

Four themes emerged from the data: the pharmacist–patient relationship; the pharmacist–general practitioner (GP) relationship; the pharmacists’ continuing professional development; and the role of peer support. Pharmacists welcomed this opportunity for more collaborative working with patients, GPs and peers.

There is evidence of sub-optimal teamwork between community pharmacists and GP prescribers, which could be improved by more joint training and by new extended roles for pharmacists.

To assess perceptions related to facets of community pharmacy usage within the Portuguese general population.

An ONSA (The Governmental Public Health Observatory) instrument was used, the ECOS (EmCasaObservamosSaúde) sample. This consisted of a national representative sample of household units with atelephone. General demographics and pharmacy users’ perceptions related to five facets of community pharmacy usage were collected by telephone interviews.

Almost one-third (31.9%) of the participants were probable chronic drug users, hence in regular contact with the community pharmacy. Thirty-four percent preferred not to talk with the person who dispenses their prescribed drugs. Most users (47.6%) expressed opinions of pharmacists as being health care rather than business oriented, although one quarter of the sample was not sure. A large majority (73.7%) would like pharmacists to participate in their treatment decisions, but 55.1% did not seem able to distinguish between pharmacists and non-pharmacist technical staff working at the pharmacy counter. Most significant predictors of users’ dichotomous perceptions related to the usage facets surveyed were age, education and occupation. Being older, less literate and economically inactive increased the odds of inappropriate users’ perceptions of the pharmacists.

Results showed that erroneous concepts and behaviours exist within the Portuguese population in relation to the community pharmacists’ role. This is a matter for pharmacy professional and educational bodies to take into account when developing intervention strategies, in particular when communicating with the general public.

A small number of prescriptions ordered by the patient from their general practice remain uncollected and hence undispensed. No research has been published on this phenomenon and on how this is managed. We aimed to evaluate this in one primary care trust.

To find out what prescription items are not collected, and why.

A descriptive cross-sectional analysis of prescription data. Semi-structured interviews with 21 primary health care team members, and 10 patients who had apparently not collected their prescription. Fifty-seven patients from the lead author’s practice were telephoned and gave their comments.

Twenty general practices in the Gateshead Primary Care Trust.

Nineteen practices provided suitable data for analysis from one month’s uncollected prescriptions plus total items issued during the same period of time. All suitable patients who had uncollected prescriptions from 10 practices were invited to participate in a telephone interview. Similar patients from the lead author’s practice were telephoned and invited to comment.

On average 0.5% items were uncollected. Drugs for a specific diagnosis (eg, cardiovascular drugs) were significantly less likely to be uncollected than drugs prescribed either symptomatically or for a presumptive diagnosis (0.48% versus 0.67% uncollected, respectively, P < 0.001). Many uncollected prescriptions were due to administrative causes: few resulted from patient error or forgetfulness. The majority of patients reported obtaining their medication. No adverse events arising from uncollected prescriptions were reported.

Uncollected prescriptions are a small proportion (0.5%) of the total issued and were more likely to be for non-essential items; therefore the policy of destroying uncollected prescriptions after an appropriate period without any further action is probably safe.

An exploratory study of the Cardiff Bangladeshi community in a primary care setting, prior to the development of culturally appropriate diabetes health education.

British Bangladeshis are one of the most economically deprived communities in Britain, with high morbidity and mortality rates from chronic illness. Access and use of their services is perceived by Primary Health Care Teams (PHCTs) to be difficult, due to communication and cultural barriers.

One-to-one tape-recorded interviews were held in Sylheti, Bengali or English with an age-stratified sample from the community registered with a practice in central Cardiff. The N*DIST package was used to analyse data, with ongoing discussion of emerging themes. The topics explored in these interviews were family structure and decision making within families, meal patterns, health beliefs, experiences of primary care and barriers to engaging with the outside world.

Family structure and social patterns had many similarities with those of the local community, and dietary and health beliefs also followed ‘Western’ concepts. People were anxious to be healthy, but often did not know about core primary care services. The community places value on the opinion and support of primary care professionals. However, a major cross-cutting theme was difficulty in accessing health care (especially for women), and reasons for this are discussed in the paper. With this information, the PHCT can now consider adapting itself to improve access and communication. We suggest that our methodological approach is both relevant and achievable for those working in primary care settings in our increasingly multi-cultural, ethnically mixed communities, and is not purely the province of sociologists or academics (important learning points have been identified and highlighted).

Interventions that increase participation in physical activity and positive dietary changes may improve the health of the community through modifying the lifestyle contribution to preventable disease. However, previous evaluations have identified concerns about inequitable and unsustainable uptake, adherence and retention within healthy lifestyle schemes.

The intervention evaluated here was designed to be a 12-week intervention for participants, offering free testing of physiological indicators of health, one-to-one health advice and a range of exercise, activity and cookery classes, at no or reduced cost, at local venues throughout the community. This paper reports the findings from a small qualitative study undertaken to explore the experiences and reflections of those who took part in the intervention to different extents, including those who fully and partially participated as well as those who dropped out or declined to take part.

Sixteen respondents took part in semi-structured interviews (5 male, 11 female; 8 black, 8 white; age range 25–85).

The findings suggest that participants assessed the healthy lifestyle intervention in terms of how well it met their pre-existing needs and opportunities for change, and that they selected the aspects of the scheme that suited them, interested them and were perceived as delivering salient results. There is also evidence for a stronger role of perceived support in influencing uptake and maintenance of lifestyle changes, and that support was conceptualised by participants as one of the services offered by the scheme. Perceived support and related perceptions of reliance on the scheme to sustain lifestyle changes also suggested that in some cases full adherence to a scheme is not as likely to produce long-term adherence to lifestyle changes as compared to partial, but more realistic adherence and smaller lifestyle changes. Implications for delivering and evaluating healthy lifestyle interventions are also discussed.

Physical activity has become a major public health concern even in early childhood. This article exemplifies physical activity promotion in practice as described by public health nurses from Finnish primary health care.

We gathered the data by purposive sampling in five regional focus groups with 24 informants working in child health clinics provided for all families with children below school age. Statements associated with physical activity promotion were extracted out of verbatim transcripts. Frequency counting complemented qualitative analysis of the content of statements.

Child-centred evaluation provided by public health nurses focused on motor development, basic sporting skills and amount of activities outdoors and play and exercising habits of the child. Family-centred evaluation focused on the general activity level of the family or a member of the family and resources for physical activity. Activation and support included nearly the same issues brought up for discussion during check-ups, as a basis for counselling, or as points of reinforcement. Contradictory to a family approach in health care, most of the statements (78% out of 223 statements) were child centred. Forcefulness of statements revealed that assessment of physical abilities, including motor development, was the only topic applied with every child. Other topics were more selectively targeted for children and families with mild special needs: for example overweight, clumsy, insomniac, or restless children and sedentary families.

Even though special needs should receive specific attention in health care, we suggest more concern on physical activity of every child and the whole family in practice in order to meet modern health promotional challenges. Although the Finnish child health clinic system is unique due to its vast coverage and frequent contacts with every child and the family, the findings from this explorative research might inspire other community practitioners to start analysing their own work in view of this research.

Older people and parents of young children are the most frequent users of out of hours care. However, their needs and expectations of care may be different. The aim of this study was to explore and compare the experiences and views of these two groups following the transfer of responsibility for out of hours services from General Practitioners (GPs) to a Primary Care Trust (PCT).

Qualitative research using semi-structured interviews with 19 informants living in a geographically large, semi-rural PCT area in England served by 15 GP practices. Interviews were taped, transcribed and analysed using a thematic framework.

Older people presented with more complex health problems than young children, and expressed more reluctance at calling the service. Both groups experienced similar access problems for using the primary care centre (PCC). Older people reported fewer difficulties obtaining a home visit, though experienced continuity problems when illness episodes lasted longer than one shift. Both groups questioned the ability of a doctor to diagnose accurately using only telephone assessment.

Despite differences in presenting symptoms and attitudes to service use, older people and parents with young children experienced similar problems in accessing care at the PCC. Older people more frequently received home visits than parents with young children, and it may be that social context is not sufficiently taken into account when assessing need for a home visit. Practitioners should be aware that older people tend to minimise symptoms and should be cautious of relying on lay interpretations of illness when carrying out telephone assessments with this group.