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PubMed1973

Gazetteer of general practices in the Aylesbury area.

One reason for defects in communication between hospitals and general practitioners may be that hospital staff lack information about local practices. We compiled a handbook giving information about 55 (86%) of the practices which use the district general hospital group in Aylesbury. This included biographical details about each doctor in each practice, when he was available on the telephone, what ancillary staff worked in the practice, and so on. The handbook was given to 500 staff in all grades and departments in the group. It seems to have been effective in improving communications, relationships, and morale within the area.

Books↗
PubMed1994

Using patient and general practice characteristics to explain variations in cervical smear uptake rates.

OBJECTIVES: To produce practice and patient variables for general practices from census and family health services authority data, and to determine the importance of these variables in explaining variation in cervical smear uptake rates between practices. DESIGN: Population based study examining variations in cervical smear uptake rates among 126 general practices using routine data. SETTING: Merton, Sutton, and Wandsworth Family Health Services Authority, which covers parts of inner and outer London. MAIN OUTCOME MEASURE: Percentage of women aged 25-64 years registered with a general practitioner who had undergone a cervical smear test during the five and a half years preceding 31 March 1992. RESULTS: Cervical smear uptake rates varied from 16.5% to 94.1%. The estimated percentage of practice population from ethnic minority groups correlated negatively with uptake rates (r = -0.42), as did variables associated with social deprivation such as overcrowding (r = -0.42), not owning a car (r = -0.41), and unemployment (r = -0.40). Percentage of practice population under 5 years of age correlated positively with uptake rate (r = 0.42). Rates were higher in practices with a female partner than in those without (66.6% v 49.1%; difference 17.5% (95% confidence interval 10.5% to 24.5%)), and in computerised than in non-computerised practices (64.5% v 50.5%; 14.0% (6.4% to 21.6%)). Rates were higher in larger practices. In a stepwise multiple regression model that explained 52% of variation, five factors were significant predictors of uptake rates: presence of a female partner; children under 5; overcrowding; number of women aged 35-44 as percentage of all women aged 25-64; change of address in past year. CONCLUSIONS: Over half of variation in cervical smear uptake rates can be explained by patient and practice variables derived from census and family health services authority data; these variables may have a role in explaining variations in performance of general practices and in producing adjusted measures of practice performance. Practices with a female partner had substantially higher uptake rates.

Adult↗
PubMed1995

Family doctors and change in practice strategy since 1986.

OBJECTIVES: To investigate the changes in practice strategy that have taken place since 1986. DESIGN: Comparison of practices in 1986 and 1992. SETTING: 93% of group practices (26 practices) in a single family health services authority. MAIN OUTCOME MEASURES: Changes in staffing, premises, equipment, clinic services, and incomes between 1986 and 1992. RESULTS: In 1986, 28% of practices employed a nurse; in 1992, 92% did so. Between 1986 and 1992, 14 cost-rent schemes costing more than 10,000 pounds had been started. Certain practices, designated innovators, were more likely to possess specified items of equipment than other practices. Computer ownership was widespread: 77% of practices had a computer, compared with 36% in 1986. In 1992, 16 practices had a manager, compared with 10 in 1986. Clinic services provided by more than half of practices were well established services (antenatal, for example), new services for which a payment had been introduced (such as diabetes, asthma, minor surgery), or the more readily provided "new" clinic services (diet, smoking cessation). Gross income increased, but so did practice costs, especially for innovators. Practices in the more affluent area of the family health services authority were still more likely to invest in their premises and staff, and to provide more services than those in the declining area. In the more affluent area, practices had higher costs but also higher incomes. CONCLUSION: Between 1986 and 1992, practices in this area invested heavily in equipment and services, but differences remain, depending on the location of the practice. Investment has increased, particularly in the more deprived part of the area, so that the inconsistency in standards has been much reduced. Practice incomes have risen, but so also have workload and costs.

Aged↗
PubMed1992

Physician recruitment: the elements of a successful search.

Before attempting to recruit a new physician for a practice, it is important to gain a background in the elements involved in a successful search--such as physician supply data, recruitment strategies, and incentives. Armed with an understanding of the physician market, recruiters are better prepared to proceed with a search that will meet the needs of potential candidates, as well as their own requirements.

Contract Services↗
PubMed2000

Research in primary care: extent of involvement and perceived determinants among practitioners from one English region.

The lack of research evidence relevant to and generated by general practitioners (GPs) has been a concern in the context of a putative primary care-led National Health Service (NHS). However, very little has been published on the current extent or determinants of research activity among United Kingdom primary care doctors. We surveyed all (n = 2770) service GPs in the West Midlands Region in order to quantify their research involvement and to explore determinants of this. The response rate was 49% (n = 1351). A total of 84% of responders reported participating in research or audit, with 16% having initiated their own research; 9% of GPs had been published in a peer-reviewed journal; 6% had generated research funding; and 3% had held a research training fellowship. The characteristics positively associated with initiating research included an involvement in teaching, having research-active partners, the availability of protected time, and working in a larger practice. The most commonly perceived barriers to undertaking research were lack of time (92%), lack of staff to collect data (73%), and a lack of funding (71%). In all, 41% of responders reported no interest in research. Overall, the extent of research activity among responding GPs appears to be greater than is often assumed. Recent NHS research and development proposals to strengthen and develop research in primary care are, therefore, relevant in highlighting changes to address these issues.

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PubMed1993

General practice careers: changing experience of men and women vocational trainees between 1974 and 1989.

The aim of this study was to consider the careers pursued by men and women general practitioner trainees following the completion of their training, and to assess changes since 1974. It was based on a postal questionnaire survey involving 995 doctors who had completed general practice vocational training in the Oxford region between 1974 and 1989. A total of 796 doctors replied to the questionnaire (498 men and 298 women, overall response rate 80%). The vast majority of ex-trainees were working in general practice at the time of the survey (men 87%, women 71%). Women were less likely to have become principals than men (75% versus 97%). Most women (71% of those completing training before 1988) reported at least one period of non-employment. While the duration of maternity leave dropped only slightly during the 15 years studied, the length of voluntary and involuntary unemployment experienced by women fell markedly. Men experienced little unemployment with no change in length of unemployment over time. Considerably fewer women than men (6% versus 13%) had become involved in teaching or training. The degree of difficulty in choosing and following a general practice career remained constant over time for women. In contrast there was a significant increase in the difficulties experienced by men. The proportion of men and women completing training in 1984-89 who found following a general practice career 'difficult or very difficult' was similar (10% of men, 13% of women). The possibility of improving these experiences, particularly by encouraging flexibility in the early years after completion of training, is discussed.

Adult↗
PubMed2002

Working in partnership to develop evidence-based practice within the massage profession.

In view of changing policy and recommendation for complementary medicine, the moves towards regulatory mechanisms and an evidence base for practice, there is a need to establish the extent to which this is happening within professions and identify away forward that will benefit the individuals and organisations involved. This paper outlines the views and opinions of professional masseurs at the Northern Institute of Massage in the North of England and discusses how such a professional organisation for massage can work in partnership with Higher Education to develop a stronger evidence base for practice. The study concludes that a significant number of practitioners of the Northern Institute are aware of the need for an evidence base for practice but need to be supported in finding, reading and applying research findings to their practice. A partnership between professional organisations for massage and higher education can benefit both parties and help to facilitate change for the future.

Adult↗