General practitioners and nursing staff: a complete attachment scheme in retrospect and prospect

The concepts of community care and primary care in the UK: the 1960s to the 1990s

The concepts of community care and primary care in UK health policy have emerged over a number of decades. This paper uses historical methods to investigate the changing definitions of community care and primary care in health policy since the 1960s. It draws on published primary and secondary sources including government documents, journals and the professional press. While policy makers have tended to separate community and primary care, the roles of the professions have tended to cut across the two sectors. The emergence and substantially separate development of the two concepts in policy and professional practice between 1960 and 1990 is described and analysed, illustrating the structural constraints on integration but noting the increasing tendency for the boundaries to be called into question. The second part of the paper examines the impact of the 1990 NHS and Community Care Act, the implementation of reforms during the 1990s and the policies currently being implemented by the Labour government. Community care and primary care have continued to be treated separately in the minds of policy makers. Policy for the former has been largely driven by governments' concern to control social security and NHS spending, whilst primary care policy largely focused on the role of general practitioners (GPs) in implementing market reforms. The new Labour government has put renewed emphasis on public health and reducing fragmentation, stressing partnership and cooperation. But the continued dominance of general practice in primary care policy may continue to be an obstacle to the integration of community care and primary care.

What is primary care? Developments in Britain since the 1960s

Since 1994, health policy in the UK has focused explicitly on making the NHS 'primary care-led'. However, the meaning of primary is contested by different health professions and by policy-makers. This paper charts the major points of debate since the 1960s and suggests that there are limitations as to what general practice can be expected to deliver in respect of primary care.

Bioluminescence enhanced enzyme immunoassay. New ultrasensitive detection systems for enzyme immunoassays, II

Ultrasensitive bioluminescence immunoassays for the determination of peptides and proteins (illustrated with human urinary kallikrein, bradykinin and the determination of human urinary kallikrein antibody titers) have been developed. The usable ranges of the standard curves are from 5 pg to 5000 pg per liter. The relative intra-assay coefficients of variation of the tests were between 2 and 6%, and the interassay coefficients of variation between 4 and 12%.

The deployment of home nurses

A study in Derbyshire showed that there are wide variations in the populations served by individual home nurses. These variations are difficult to reduce. To assess the quantity and quality of home nursing that is provided more sophisticated formulae than the nurse/population ratio are necessary. For these data derived from output of work are inadequate; studies of need are required in each locality.

Team work load in an English general practice. I

A survey of the total care provided by a general practitioner and his paramedical team for 3,137 patients in Teesside in 1972 showed that even in this area of high morbidity and mortality the work load was very small. The doctor held an average of 2.3 consultations per patient per year, and the overall average for the team of doctor, nurse, and health visitor was only 3.1. By delegating work to a team of trained paramedical workers, by increasing the proportion of personal medicine, and by engaging the co-operation of his patients, the general practitioner reduced his work load considerably, without any apparent reduction in standard of care.

Evaluation of home nurse attachment in Bristol

By the end of June 1969 home nurses in Bristol were attached to 18 general practices caring for about 137,000 patients, or about one-third of the city's population. Attachment was associated with an increase by about one-third in the number of patients referred by general practitioners for home nursing. Additional benefits derived from attachment during the nine months from January to September 1969 were 2,047 items of service performed by nurses in general practitioners' surgeries, 65 home visits to patients who were not receiving domiciliary nursing care, improved communications between general practitioners and nurses, and opportunities for both doctors and nurses to widen their fields of work. The travelling expenses paid to Bristol's nurses increased by 9.5%.It is suggested that the benefits to patients, doctors, and nurses of attachment far outweigh the costs and that there is scope for extending the role of the attached nurse in the surgery and in home visiting.