Certain observations arose from the implementation of multicentre research on ‘ecotherapy’. Very diverse community groups of people with a range of disabilities, undertaking horticulture and nature conservation as a therapeutic and social enterprise, provided an unexpected conception. We coined the term embracement to capture the meaning of an activity we found in many ‘bottom-up’ examples of social inclusion. Self-organizing groups grow by the members’ choosing to embrace a common identity, which included and integrated health, social and environmental dimensions. Embracement is self-directing, spontaneous and collective, with the potential group members being the driving force.

Devolved accountability for primary care has been introduced into the UK through a range of local contracts for personal medical services (PMS) authorized by the 1997 NHS (Primary Care) Act. These four exemplary case studies illustrate the PMS pilot programmes and represent a diversity of emerging organizational developments that appear to be responding effectively to different health care needs and environments. This is particularly apparent at those sites targeting the most marginalized patient groups where interprofessional collaboration and interagency partnerships are characteristic of a new and broader primary health care approach. Elsewhere the PMS pilots retain and indeed may extend some of the more restrictive practices of the conventional primary medical care model. Future policy formulation, therefore, needs to promote flexible management structures and processes which can support, through local contracts, the further development of more comprehensive and population-based primary care.

This paper presents the findings of a study designed to explore myocardial infarction (MI) survivors' experiences of their heart attack, to obtain their views on existing services and to gather ideas for a new, community-based cardiac rehabilitation initiative. Despite the increasing emphasis on the consumer ‘voice’ in health service delivery, little research has been published exploring the experience of MI from the patient's perspective. This is of particular significance given the study's location in a disadvantaged urban area where the uptake of conventional hospital-based cardiac rehabilitation is poor. The study is based on qualitative, semi-structured interviews with 20 myocardial infarction survivors in southeast Nottingham. Participants were identified from the list of those invited to participate in a local hospital's cardiac rehabilitation programme. The interviews were carried out in patient's home between one and 12 months after the MI, were tape recorded and subsequently transcribed. Thematic analysis reflected both the issues identified in the interview schedule but also some unexpected findings elucidating the survivors' own perspectives. The paper is structured around four key themes: the story of the heart attack; the way survivors' lives have changed; experiences of existing services and ideas for service development. The paper concludes that MI should be understood as a long-term rather than an acute condition and discusses the implications for service delivery.

In the UK, older people who are resident in care homes because of their needs for social support and personal care receive their health care from primary health care. Although there is increasing input from district nurses in care homes (Audit Commission, 1999), there is little knowledge or recognition of the primary care nursing contribution. This paper reviews two types of research literature: studies that consider the health care needs of older people in residential care homes that could inform nursing support and interventions in care homes, and research that describes the nursing involvement with these settings. The paper argues that on the basis of the research reviewed many of the health problems older people in care homes experience could be avoided or improved by primary care nursing support and intervention. A reassessment is needed of how the interface between community and residential care is managed so that older people in care homes have access to appropriate health care support.

This paper describes a number of themes that emerged from a qualitative research study into the effects of a parenting programme on family life (Mockford, 2000). Existing research points to many valuable outcomes of parenting programmes including improved maternal psychosocial health (Barlow and Coren, 2000), improved relationships (Grimshaw and McGuire, 1998; Smith, 1997) and reduced child behaviour problems (Barlow, 1999; Patterson et al., 1993; 2002b). There has, however, been little qualitative work undertaken with parents who have attended a parenting programme. The findings from this study show that in addition to many positive consequences, there were a number of unintended consequences of attending a parenting programme. In particular, women spoke of the difficulties that they faced at home when trying to apply the techniques that they had learned on the parenting programme. These difficulties included gaining the support of partners in implementing the techniques learned, changing their established habits and those of their partners, finding the time to parent together, and incorporating the techniques into their already busy lives. These findings also suggest that a change in one parent’s approach to parenting may result in increased discrepancies in parenting techniques between the parent who attended the programme and the parent who did not, and that this may result in parental conflict.

This paper presents a section of the findings of a case study of a newly established community rehabilitation team (CRT) comprising physiotherapists, occupational therapists and nurses. The findings reported here address issues of interdisciplinary teamwork that arose during the project. All eight members of the team were interviewed as well as three ex-team members. The data were collected by semi-structured interviews and analysed using thematic content analysis (Strauss and Corbin, 1990). The findings suggest that when recognized barriers to teamwork are eradicated, such as geographical separation and different employers, teams such as the CRT can achieve high levels of teamwork. A problem that took longer for the CRT to resolve, however, was that of flexible working across traditional professional and hierarchical role boundaries. The paper concludes that the difficulties that need to be overcome when a new team and new service are established concurrently, should not be underestimated.

This paper was motivated by the adverse results of a study that evaluated implementation of a structured health needs assessment tool in health visiting. It examines the conceptual basis of three approaches to needs assessment, exploring their relevance to the purpose of health visiting and their links with prioritizing, targeting and promoting health in practice. It is intended to help health visitors, their managers and service commissioners to explain and understand the different requirements and expectations in each approach.

British Government policy emphasizes that targeting and prioritizing are the means by which inequalities can be redressed and resources directed towards those in greatest need. Needs assessment processes are increasingly invoked as the mechanism through which health visiting services can best be deployed. Health visitors are expected to help identify service priorities and to target their efforts effectively and efficiently. Access to services and user empowerment are also important aspects of the NHS modernization agenda. These concepts are fundamental to health promotion, which has been the consistent underlying purpose of the health visiting service since its inception.

In this discussion paper, three approaches to needs assessment are unravelled, which focus on prioritizing, targeting and health promotion. It is suggested that these different purposes relate, in turn, to the expectations and requirements of public health, organizational efficiency and user empowerment. There are important benefits associated with each of the three approaches, but their underlying principles, purposes and requirements differ. Failure to appreciate such differences can lead to misunderstandings, confusion and even offence. A single instrument cannot successfully meet the expectations of all three approaches to needs assessment. Instead, a needs assessment system is necessary, to meet the contradictory requirements of public health, organizational efficiency and user empowerment.

In the UK, primary care groups and trusts (PCG/Ts), also known as primary care organizations (PCOs), are the organizations that will drive forward the primary care development agenda outlined by the government. We undertook a study to investigate the views of PCOs on the place of research in primary care development and their role as participants in the research process. The study population consisted of all PCOs in south London (n = 23). An initial structured questionnaire explored the organizations’ perceived research needs, the potential of the primary care research community to meet those needs and their current research activity. This was followed by semistructured interviews during which the participants were asked to discuss their views on the place of research in their primary care development agenda and in particular how research might inform the development of clinical skills and services in the short and medium term. The third stage of the project was an action based workshop at which general practitioners (GPs) and primary care nurses developed research questions arising from the earlier stages of the study. The PCOs identified three key areas of research support: public health, health economics and nursing research expertise. Research support was needed to help them identify population health needs and to evaluate new models of care and shifting professional boundaries. In contrast to traditional primary care research, PCOs required rapid delivery of research results, particularly when these were used to inform the commissioning of services. Our study has highlighted that PCOs have a development agenda requiring rigorous research and evaluation to ensure the best outcomes for patients. The differing skills, roles and responsibilities of PCOs, PCRNs and academic departments show how partnerships might develop to further research and development in primary care.

In this paper we attempt to explore the meaning, understanding, usefulness and reality of multidisciplinary research in primary care and provide examples. We debate the issues around roles of people in multidisciplinary research, the value of such research and its application to patient care. We also discuss the perceived threats and opportunities to multidisciplinary research, possible reasons for such perceptions, funding, and research governance, education and training issues. We then go on to consider the emerging relationship between primary care organizations (PCOs) and primary care research teams. We specifically address the activities of research general practices and their implications in terms of contributing to multidisciplinary research and training. We question the traditional model of academic research; raise awareness and need for grassroots primary care research and the importance of capacity building through a multidisciplinary model. We have tried to suggest examples and models of multidisciplinary research that can be seamless, include a range of practices and health professionals, and performs research that is contextual, pragmatic and directly beneficial to patients. We feel that for a successful multidisciplinary research workforce in primary care to become a reality, several key areas need to be addressed. Perhaps the most important of these may involve a conceptual change in thinking by all concerned in that we believe that research in primary care should become an integral part of routine primary care in the same way as health professionals routinely see patients or conduct audits. This could, however, only happen if there is commitment, support and a vision for the future of primary care research from decision makers. Local research networks and PCOs need to work closely together in identifying, nurturing and maintaining multidisciplinary research interest.

Primary care research networks are fundamental to developing primary care-based research. A significant amount of their work is with locally organized projects. Working effectively with externally funded trials is another crucial way to inform the evidence base. There is little information on how trial teams may best work with multiple networks. We examined factors that might assist and impede collaboration between an externally funded trial and networks by exploring the systems networks used to assess externally approved trials. A large RCT was used as an example of an external trial. Networks were identified in areas where the trial could provide the intervention. Eighteen networks were sent standard letters asking for information about contacts and assessment procedures. We examined how long it took to identify a liaison person, what processes were used to assess the trial and how long these processes took. Sixteen of 18 networks (89%) agreed to work with the trial. Most networks provided initial information within a month of being contacted. There was no standard process for approving externally funded trials. The time taken to gain final approval varied from one week to three months. There is enthusiasm among networks to work with externally funded studies. It is feasible and can be successful, but current systems for approval are variable and often time-consuming. A defined turnaround time and central mechanism for approving trials could result in greater engagement of external trials with networks and an increased likelihood of a successful research.