The British Journal of General Practice

Tags: HMSO, Royal College of General Practitioners, British Medical Journal, South Western Regional Health Authority, London, general practice, community, Royal College, health surveillance, Policy Statements, Primary Care Medical Advisory Committee, Occasional Papers, health centres, practitioners, primary care, percentage, Primary Health Care, National Health Service, Department of Health and Social Security, RCGP, health visitors, Behavioural problems, Coronary heart disease, district nurses, Family planning, Community psychiatric nurses, primary health care team, Devon Family Practitioner Committee, maternity services, management arrangements, Community nurses, Community hospitals, nurse prescribing, excess deaths, 26 Management, personal care, primary prevention, respiratory disease, hypertension, Alcohol consumption, Family health service, Bristol Plymouth Subcommittee, Cervical cancer, Dr Michael Hall, South Western Region, FRCGP General Practitioner, Postgraduate Medical School, Occasional Paper, FRCGP, MRCGP General Practitioner Woodbury, Devon, British Journal, The Journal, Somerset Health Authority, General Practitioner, Hospital Medical Advisory Committee and Regional Primary Care Medical Advisory Committee, Medical Advisory Committee, General practitioners, South Western Regional Hospital Medical Advisory Committee, South East London, MRCGP General Practitioner Bow, Devon, Regional Adviser, Regional Primary Care Medical Advisory Committee, Health Care, Devon Family Health Services Authority, North Devon Health Authority, General Medical Services Committee, Bristol The Committee, Health Services, Medical Auditfor Primary Health Care Teams, British Journal of General Practice, Royal Statistical Society, College of General Practitioners, Department of Health, Silverton Steele R, Department of General Practice, Family Practice
Content: The British Journal of General Practice Journal of The Royal College of General Practitioners The British Journal of General Practice, formerly the Journal of the Royal College of General Practitioners, was one of the first academic journals of general practice in the world. It is published monthly and contains editorials, original articles, book reviews, and correspondence covering all aspects of modern general practice. Its policy is to describe and comment on all new developments in general practice and it publishes exclusively many of the important policy decisions and reports of the Royal College of General Practitioners. The Journal is sent to all Fellows, Honorary Fellows, Members, Associates and Corresponding Associates of the Royal College of General Practitioners, and also to a growing number of private subscribers including university postgraduate medical centEes, libraries, institutions, and individuals in over 40 different countries of the world. All subscribers receive Policy Statements and Reports from General Practice free of charge with the Journal when these are published. The Occasional Papers are not distributed free but are available whilst in print from the College's Sales Office at prices shown regularly in the Journal and other College publications. The Policy Statements, Reports from General Practice, and Occasional Papers cover in depth aspects of special importance to general practice and form some of the most authoritative data and source documents available. Details of current publications are given on the inside back cover. The subscription to the Journal is adjusted annually. Single copies are also available, prices on application. Subscription enquiries from non-members should be made to Bailey Bros & Swinfen Ltd, Warner House, Folkestone, Kent CTl9 6PH. (Tel: 0803 850501). Vocational trainees can apply to the Membership Secretary of the College to become Associates at a quarter of the current membership rate, which includes receipt of the Journal, Policy Statements, and Reports from General Practice when published.
OCCASIONAL PAPER 57 Planning Primary Care "Towards even better primary care" A discussion document from: The Regional Primary Care Medical advisory committee of the South Western Region and The South Western Regional Health Authority DENIS PEREIRA GRAY, OBE, MA, FRCGP General Practitioner; Exeter; Professor of General Practice and Director; Postgraduate Medical School, University ofExeter; Director of General Practice Education, South Western Region Published by The Royal College of General Practitioners June 1992
The Royal College of General Practitioners
Honorary Editor Denis Pereira Gray, OBE, MA, FRCGP General Practitioner, Exeter Professor of General Practice Director, Postgraduate Medical School University of Exeter Editorial Board Graham Buckley, MD, FRCP(Ed), FRCGP General Practitioner, Livingston Regional Adviser South East Scotland Stuart Carne, CBE, FRCGP General Practitioner, London Angela Douglas, BSc, MRCGP General Practitioner Woodbury, Devon Clive Froggatt, FRCGP General Practitioner Cheltenham, Gloucestershire Douglas Garvie, FRCGP General Practitioner Newcastle, Staffordshire Allen Hutchinson, FRCGP Director Ambulatory Care Programme Centre for Health Services Research University of Newcastle upon Tyne Marshall Marinker, OBE, MD, FRCGP Director MSD Foundation David Murfin, FRCGP General Practitioner Llandybie Ammanford, Dyfed Roger Peppiatt, MSc, MRCP, MRCGP General Practitioner Dartford, Kent Michael Price, MA, FRCGP General Practitioner Hemel Hempstead Associate Adviser North West Thames Peter Selley, MA, MRCGP General Practitioner Bow, Devon William Styles, MA, FRCGP General Practitioner, London Regional Adviser North West Thames Colin Waine, OBE, FRCGP General Practitioner Bishop Auckland, Co. Durham Donald Woods, MA, FRCGP General Practitioner Brentwood, Essex Alastair Wright, MD, FRCGP General Practitioner Glenrothes, Fife Assistant Editor Jill Pereira Gray, BA Hons
Charter The Royal College of General Practitioners was founded in 1952, with this object: "To encourage, foster, and maintain the highest possible standards in general medical practice and for that purpose to take or join with others in taking steps consistent with the charitable nature of that object which may assist towards the same" Among its responsibilities under its Royal Charter the College is entitled to: "Encourage the publication by general medical practitioners of research into medical or scientific subjects with a view to the improvement of general medical practice in any field and to undertake or assist others in undertaking such research. Diffuse information on all matters affecting general medical practice and establish, print, publish, issue and circulate such papers, journals, magazines, books, periodicals, and publications and hold such meetings, conferences, seminars, and instructional courses as may assist the object of the College." College Headquarters The headquarters of the Royal College is at 14 Princes Gate, Hyde Park, London SW7 lPU (Telephone: 071-581 3232). Enquiries should be addressed to the General Administrator. Exeter Publications Office The Publications Office publishes on behalf of the College the series of Policy Statements, Reports from General Practice, Occasional Papers, and books and booklets. It also co-ordinates material for the RCGP Members' Reference Book. Enquiries are welcomed and should be addressed to the Honorary Editor, 9 Marlborough Road, Exeter, Devon, EX2 4TJ (Telephone: 0392 57938). Occasional Papers The Occasional Paper series was established in 1976 to offer authors the opportunity to publish manuscripts too long for publication as articles and too short for books. They are assessed for academic acceptability by members of the Editorial Board and other professionals with special interests. Readers should note that they express the views of the authors, and not the College, unless otherwise stated. Acknowledgements The Honorary Editor of the Occasional Paper series thanks the South Western Regional Health Authority for financial help in publishing this document. He also thanks the Officers of the Royal College of General Practitioners for refereeing the document for its suitability as an Occasional Paper.
Acknowledgements
The Regional Primary Care Medical Advisory Committee (RPCMAC) is indebted to the following who gave evidence or commented on the draft document:
Beales D L, Cirencester Bussey A L, Taunton, RPCMAC Buxton A, Department of General Practice, Exeter Chaffers A, District Occupational Therapist, Cheltenham Chapman A, Tewkesbury Cheyne G, RPCMAC Damant M, Department of General Practice, Exeter Davies J, RPCMAC Deeley D C, St Austell DeMendonca P, Plymouth Devon Family Health Services Authority Devon Local Medical Committee Dodson B, Hawks A J C, Paterson C and Hanson S, Taunton Edwards A, Barnstaple Ellis M, RPCMAC Elliott N, South Western RHA Essame R, RPCMAC Featherstone P, Torquay Gaymer A R, Sherborne Giles D, RPCMAC Green P, Paignton Griffiths T, Ivybridge Hall M, RPCMAC Herbert E, Devon FHSA Horne R, RCGP Jones J, RPCMAC Lush P, Gloucester
McBfide M, RCGP McCoy D, RPCMAC McLintock D M, Cullompton Makin J S, Plympton Mason A, RPCMAC Maxwell R, RPCMAC Moore P, Torquay Ogle J L, Plymouth Olsen N, RPCMAC Osborne B, Starcross Otlet A, Bristol Plymouth Subcommittee, Devon Local Medical Committee Richards C, RPCMAC Rosser J, RPCMAC Severn Faculty, Royal College of General Practitioners Sims P, North Devon Health Authority Smith L F P, Bristol Smith V, Taunton Southgate K, RPCMAC South Western Regional Association of Local Medical Committees Stead J, Silverton Steele R, Department of General Practice, Exeter Stott N, University of Wales College of Medicine Till A M, Gloucester Waine C, RCGP Whitfield M, Bristol
The Committee is particularly grateful to Dr Michael Hall who has just retired as the first chairman of the Regional Primary Care Medical Advisory Committee. It was largely through his leadership that the Committee took on the planning function.
The Committee is also grateful to Dr Alastair Mason, Regional Medical Officer, South Western Regional Health Authority, for arranging for the work to be done and helping to secure its publication.
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66 Index
Accreditation, 53 Acute infections -management of, 29 Aims -primary care, 43 Alcohol consumption, 26, 27 Ambulance service, 37 Asthma -diagnosis rate, 46 management, 30 Behavioural problems -management, 30 Cervical cancer, 45 Cervical cytology -percentage uptake, 44 Children -born out of wedlock, 8 Child health surveillance, 23 Chronic disease -asthma, 30 -behavioural and personality problems, 30 -depression, 30 -hypertension, 30 -management of, 30 Clinics -versus opportunistic, 25 Community consultants, 38 Community hospitals, 30, 57 Community nurses (district nurses), 35 Community psychiatric nurses, 37 Complaints, 47 Complementary practitioners, 38 Computing in primary care, 13, 39 Consultation and planning, 16 Consultations -length, 32 Continuity/time -arithmetic of primary care, 20 Coronary heart disease, 28 Cost-effectiveness -South Western Region, 50 -QALYS, 50 Deafness -management, 31 Deaths avoidable, 45 -babies, 8 -cervical cancer, 45 -hypertension, 45 -influenza, 7 -obstetric, 45 -rates, 45 -respiratory disease, 45 Definitions -core team, I -needs, 6 -outcomes, 43 -primary care, I -teamwork, I -wants, 5 Dental caries -diagnosis rate, 46 Depression -management, 30
Diagnosis rates -asthma, 46 -dental caries, 46 -hypertension, 46 Diet and weight, 26, 27 Disability -management, 31 Dispensing, 24 Elderly -deaths from influenza, 7 -needs, 6 Epidemiological approaches, 9 Equipment, 12 -computers, 13 Family health service authorities -planning, 55 Family planning, 9, 22 Features of general practice -child health surveillance, 23 -dispensing, 24 -family planning, 22 -lifestyle, 26 -maternity services, 23 -minor surgery, 24 -opportunistic versus 'clinic', 25 -overview, 24 -services to patients, 22 Fellowship by assessment, 42 Financing the NHS, 14 -capitation basis, 15 -comparisons with other countries, 14 -cost-effectiveness, 50 Functional status, 46 Fundholding, 17 General dental practitioners, 37 General practitioners -as general physicians, 29 -as generalists, 32 -group size, 11 -numbers, 56 -professional qualifications, 56 -role, 8, 43, 56 Group practice, 15, 56 Health centres -management, 15 -premises, 11 health professionals -ambulance service, 37 -community consultants, 38 -community psychiatric nurses, 37 -complementary practitioners, 38 -general dental practitioners, 37 -ophthalmic services, 37 -pharmacists and prescribing, 37 -planning for, 57 Health visitors, 35 Healthy living, 26, 44 Higher professional education, 53 Home, 19 Homeless, 9 Home visiting, 19 Hospitals -admission, 49 -community, 30, 57 -discharge arrangements, 49
-outreach services, 16 -patient satisfaction, 47 -referrals, 49 Hypertension -death rates (age 35-64), 45 -diagnosis rate, 46 -management, 30 Independent contractor status, 17 Indicative prescribing budgets, 38 nurse prescribing, 38 Influenza -excess deaths in the elderly, 6 Inner cities, 10 Learning difficulty -management, 31 Levels of care -fourth tier, 3 -framework for planning, 55 -primary care/general practice, 3 -secondary care, 3 -self-care, 3 -supporting higher tiers, 3 -tertiary care, 3 -WHO triangles, 3 Lifestyle, 26 Management -arrangements, 15 -health centres, 15 -nurses, 15 -options, 15 -planning, 58 -primary health care team, 36 Maternity services, 23 Medical advisers, 'independent', 38 Medical audit, 39 -variation in performance, 40 Medical students, 41 Minor surgery -guidelines, 24 MRCGP examination, 49 Multidisciplinary training and working, 36 Needs -changes in population, 6 -children born out of wedlock, 8 -elderly, 6 -homeless, 9 -poor, 8 -special groups, 6 -teenage pregnancies, 9 -unemployed, 8 New principals, 10 Night work, 33 Nurses -community, 35 -district, 35 -health visitors, 35 -management arrangements, 15 -practice, 34 Nursing -management arrangements, 15 -planning, 56 -prescribing, 38 Obstetric mortality, 45 Occupational therapists, 36 Open access to diagnostic investigations, 29
Ophthalmic services, 37 Opportunistic versus 'clinic', 25 Outreach services from hospitals, 16 Partnership -size, 11 Patients -complaints, 47 -registration, 58 -satisfaction rates, 46 -services to, 22, 24 -surveys, 47 Personality problems -management, 30 Personal lists and personal care, 12, 21 Pharmacists -prescribing, 37 -in primary health care team, 37 Physiotherapists, 36 Poor, 8 Practice managers, 35 Practice nurses, 34 Practice organization, 34 Pregnancy, teenage, 9 Premises -health centres, 11 -inner city areas, 10 -new principals, 10 -planning, 57 -priorities for development, 10 -training practices, 11 Primary health care team -community (district) nurses, 35 -definition, I -health visitors, 35 -management, 36 -multidisciplinary training, 36 -occupational therapists, 36
67
-physiotherapists, 36 -practice nurses, 34 -practice managers, 35 Primary prevention, 26 -alcohol consumption, 27 -coronary heart disease, 28 -diet and weight, 28 -smoking, 27 -travellers, advice to, 28 Professional judgements -discharge arrangements, 49 -hospital referrals and/or admissions, 49 -percentages patients screened, 48 -professional qualification, 49 Professional organizations, 17 Professional qualifications, 49, 56 QALYS, 50 quality assurance, 42 Reaccreditation, 54 Records, 50 Registered nursing homes, 40 Registration, 58 -dental practitioners, 37 Research, 52 -planning, 59 Residential homes, 40 Respiratory diseases -deaths children aged 0-14, 45 Screening -percentage uptake, 48 Secondary care, 3 Self-care, 3 Services to patients, 22 Smoking -percentage smoking, 26, 27, 44 -primary prevention, 27 Social class, 8
Social security -benefits, 18 -uptake, 58 Specialists -training in general practice, 41 Standardized mortality ratios, 8, 28 Stress (medical and nursing), 33 Surveys -patient satisfaction, 47 Teaching -medical students, 40 -planning, 58 -in primary care, 40 Teamwork -core team, I Tertiary care, 3 Training -multidisciplinary, 36 -practices, 11 -specialists in general practice, 41 Travel advice, 29 Unemployed, 8 Violence, 34 Wants, 5 Weight -diet and, 26, 27 -percentage overweight, 44 Workload in general practice -generalists, 32 -length of consultations, 32 -practice organization, 34 -quantity of work, 32 -stress (medical and nursing), 33 Work outside the practice, 41 World Health Organization -targets, 8, 9, 27, 28 -triangle, 3
©C) Royal College of General Practitioners Typeset by Exe Valley, Exeter Printed by Bartlett Printing, Exeter ISBN 0 85084 170 4

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