Events associated with NPfIT reinforce that the use of IT does create hazardous circumstances and can lead to patient harm or death. Large-scale patient safety events have the potential to affect many patients and clinicians, and this suggests that addressing them should be a priority for all major IT implementations.

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Junior doctors' perceptions of general practice are expressions of a hospital-centric culture. Criteria for career choice are diffuse and complex. There was no evidence that the 1990 GP Contract deterred recruitment. The compromise between intrinsic satisfaction and lifestyle may be significant for GP morale.

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Objectives-To identify doctors who are vocationally trained but not currently practising as principals in general practice; their reasons for not practising as principals; and whether the prospect of a re-entry course would appeal to this group.Design-Postal questionnaire survey based on semistructured interviews.Subjects-Doctors who had been vocationally trained but were not currently practising as principals: 351 possible subjects identified by a process of "networking."Setting-Trent Regional Health Authority. Concern has been expressed that applications to general practice vocational training schemes have been falling. 1-3 It has also been noted that substantial numbers of doctors who have been vocationally trained for general practice are not working as principals-that is, as unsupervised doctors who hold a contract with a family health services authority or health board."The most recent major studies of medical staffing have not found any problem in recruitment or retention in general practice.7-9 Since these studies were carried out, however, there have been important changes in the NHS which have had or will have major implications for the medical workforce."' "The increase in numbers of women entrants to medical schools means that there are now more women than men completing vocational training schemes.812 As the participation of women in general practice work is often lower than that of male doctors,2 these women make up fewer whole time equivalents. In addition, as general practice is perceived as becoming more stressful,"3 many general practitioners are looking to take early retirement.2 The establishment of a task force to look at manpower reinforces the possibility of an impending problem in general practice.'4The Policy Studies Institute's most recent publication on doctors' careers discusses many ofthe problems that women doctors face in their attempt to continue in medical work.'5 One of the recommendations made in this report is that re-entry training should be available, and indeed the report commented that the near universal support for more help for women doctors to keep working was rather unexpected. Moreover, many male doctors feel they would benefit from more flexible working practices and the chance to spend more time with their families.Against this background, we set out to identify a group of doctors who have been vocationally trained but are not currently practising as principals, to establish their characteristics and their reasons for not practising as principals. We also wished to explore whether the prospect of a re-entry course for general practice would appeal to this group of doctors. MethodsSubjects were defined as doctors in Trent region who had been vocationally trained but were not now principals in general practice. Establishing the size and whereabouts of this group presented methodological problems, and it was accepted that we would not necessarily define a representative sample or even the total number ofthis specific group.We therefore attempted to identify as ...

Although the project is still at an early stage, daily analysis of NHS Direct data has the potential to detect symptoms in the community that could be related to deliberate releases of chemical or biological agents or to outbreaks of disease. For this surveillance to act as an 'early warning' of illness resulting from a microbiological or chemical cause, the NHS Direct surveillance needs to be fully integrated into an appropriate public health response (which may require diagnostic samples to be taken from callers).

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