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The nature and development of teamwork in primary health care is discussed and some barriers to effective teamwork identified. Theories of team effectiveness are outlined and methods of applying these to primary health care teams are explored. The 'constituency approach' and the theory of team innovation are examined in more detail. Team-building interventions are described as one way of improving team effectiveness but their limitations are also acknowledged. The Health Education Authority primary health care team workshops are used as an example of a team-building intervention. Research at the MRC/ESRC Social and Applied Psychology Unit, Sheffield University, is described. This is evaluating the outcomes of the primary health care team workshops in terms of team effectiveness. The research will measure viability (the extent to which the team sufficiently sustains good relationships to continue working together) and team performance (achievement of desired outcomes) pre and post workshop. Team effectiveness will be measured through team self-assessment, patient satisfaction and family health service authority designated targets for health promotion. The overall aim is to develop a model of team effectiveness for primary health care teams, which can then be used to diagnose and guide teams in their work.

The rhetoric of user involvement has featured in health policy documents for over a decade. However, there is mixed evidence as to the extent to which it is being achieved. This paper explores what is meant by user involvement, proposing that it exists at a series of levels ranging from information giving to true empowerment. Examples are presented from two practice development projects. The first sought to develop multidisciplinary audit in primary care, attempting to involve users in defining health needs and determining services. Although the project co-ordinators were highly committed to user involvement this was only achieved to a limited extent. It was concluded that there was a resistance to user involvement grounded in the fear that such involvement would increase user expectations and add to the pressures of overworked primary care teams. The second project used interviews with service users to assess the effectiveness of a team building initiative. Users were found to be knowledgeable about practitioner roles and how to access the care they required. The overall conclusion is that there needs to be a shift from rhetoric to reality at governmental and practitioner level if true user involvement is to be achieved.

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The evolution of innovative nursing and midwifery roles has been considerable worldwide and they engender job satisfaction to those occupants them. Results support international literature showing that adequate support, especially from administrators, is significant to ensuring the success of new roles. Furthermore, the careful planning for innovative role development and evaluation are important in ensuring the role is effective.