Primary care: core values Contracting for general practice: another turn of the wheel of history

Abstract

Objective: To assess whether provision of educational leaflets or questions on contraception improves knowledge of contraception in women taking the combined contraceptive pill. Design: Randomisation of women into three groups according to type of educational leaflet on contraceptive information. These groups were subdivided into two on the basis of questions on contraception asked by the doctor or practice nurse. The women were followed up by postal questionnaire 3 months later. Setting: 15 general practices in South and West region. Subjects: 636 women attending check up appointment for repeat prescription of the combined contraceptive pill. Main outcome measures: Knowledge of: factors causing pill failure, subsequent action, emergency contraception, and all the rules (pill rules) that apply to the contraceptive pill. Results: 523 women returned completed questionnaires (response rate 82%). Knowledge of contraception with no intervention was low with only 10 (12%) women knowing all the pill rules. Educational intervention had a highly significant effect on knowledge of: factors causing pill failure (likelihood ratio 2 = 22); subsequent action (21); emergency contraception (24); and all the pill rules (22) (P < 0.01 in all cases). Improvement in knowledge of all the pill rules occurred with provision of the summary leaflet (28% knew all the rules, adjusted odds ratio 4.04, 95% confidence interval 1.68 to 9.75), the Family Planning Association's leaflet (27%, 3.43, 1.45 to 8.09), and asking questions (26%, 3.03, 1.30 to 7.00). Asking questions in addition to provision of leaflets improved knowledge of contraception further for the summary leaflet (39%, 6.81, 2.85 to 16.27) but not for the Family Planning Association leaflet (21%, 2.58, 1.07 to 6.18). Conclusion: Women attending check ups for repeat prescriptions of the contraceptive pill should be provided with educational leaflets on contraception or asked relevant questions to help improve their knowledge of contraception. Asking questions in addition to providing a summary leaflet is time consuming, but results in the most knowledge gained.

How and why do GPs use specialist palliative care services?

“…The specialist develops expertise within the complexity of a defined clinical area, and the generalist (in general practice) focuses on the complexity of the patient's medical, psychological and social contexts. 6 It has been estimated that between 25% and 65% of palliative care patients will need specialist palliative care advice on symptom control, 7 and access to such advice can be an important source of support to the primary care team. The role of the general practitioner (GP) is central to community palliative care, as most of a patient's last year of life is spent at home under the care of the primary health care team.…”

“…4 Palliative care, however, represents a small proportion of the average GP workload, and maintaining skills and expertise can be a challenge, 5 particularly given increasing workloads and administrative responsibilities. 6 It has been estimated that between 25% and 65% of palliative care patients will need specialist palliative care advice on symptom control, 7 and access to such advice can be an important source of support to the primary care team.…”

Educational opportunities in palliative care: what do general practitioners want?

“…Keeping updated in palliative care skills can be difficult for GPs, 9 whose workloads have increased with a shift of focus from secondary to primary care. 10,11 Recognition of the need to support GPs to update and maintain palliative care skills has led to increasing attention being paid to methods of education and training. 9,[12][13][14] In addition, a number of studies have explored which palliative care topics GPs would like to learn about.…”

Labour's health policy is having paradoxical effect in Iberian countries

“…The Labour government's white paper The New NHS 2 has produced a paradoxical effect in Iberian countries; some conservatives are using it as an excuse for resisting change. The arguments against competition and the desire to stabilise primary healthcare trusts and for general practitioners to change from being independent contractors to being employees3 are seen by some as British recognition of our traditional southern health policy. These people wrongly believe that the movement to increase general practitioners' control of access to hospital care and funding should be avoided; accordingly, they believe that doctors must remain salaried civil servants.…”