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Background. This paper describes a study to develop and test an instrument to measure the level of appropriate admissions and days of care in the paediatric hospital population. [ABSTRACT FROM PUBLISHER]

The implications of the 1997 (Primary Care) Act have been largely overlooked in the rush to establish Primary Care Groups. Allowing health authorities to develop local contracts for primary care has far-reaching implications and is an important departure from the national system of negotiation that has characterized general practice to date. This paper describes a content analysis of a sample of Personal Medical Services (PMS) pilot contracts. In the first year little attention has been given to achieving cost savings or greater efficiency and few contracts promote clinical guidelines. The difficulties of specifying services sensitive to local health needs are highlighted and the national Statement of Fees and Allowances (the 'Red Book') may not be swiftly supplanted. However, The pilots have introduced innovations such as salaried general practitioners, nurse-led services and NHS trust-managed care. The development of local contracts provides a valuable learning experience for general practitioners and health authorities in advance of the establishment of Primary Care Trusts. [ABSTRACT FROM PUBLISHER]

An interview with British Doctor Rosemary Rue is presented. She recalls the publication of the Beveridge Report, which was the start of the welfare state, as well as the coming of the National Health Service (NHS) on July 5, 1948. She talks about her clinical training at Cowley Road Hospital in Oxford, England. Details of her general practice in the 1950s are also provided.

Background There are several alternatives for providing ultrasound scanning, besides traditional hospital-based services. One such alternative is for general practitioners (GPs) to perform scanning in the community. The aim of this study was to evaluate the impact of GP ultrasound scanning on the use of National Health Service (NHS) resources in the United Kingdom (UK), and elicit patients' preferences for having an ultrasound scan. Methods A cost analysis and an assessment of quality of GP scans, based on a clinical audit and a postal survey of patients' preferences, were carried out. The setting was a rural general practice and urban teaching hospital in the Grampian region of Scotland. The analysis of costs and assessment of the quality of GP scans were based on 131 patients scanned at the practice in a 6 month clinical audit period. The survey of patients' preferences was undertaken on a random sample of 500 patients from the GPs' list and 250 consecutive patients scanned at the practice. Results The assessment of the management of patients during audit revealed that the scanner at the practice reduced the number of hospital scans, number of out-patient and in-patient visits, and emergency admissions. The unit cost of a scan was higher in the practice than at the hospital. However, when all the costs for a scanning episode were considered, the total and average costs were lower in the practice because of the avoidance of hospital visits. The results showed that the quality of GP scanning, subject to further training, was considered to be sufficient to continue scanning at the practice. Patients preferred to be scanned at the practice, and were prepared to wait up to an extra 5 days, and accept a reduction in the accuracy of scanning of up to 3.5 per cent for their choice. Who carried out the scan was not important to patients. Conclusion Although the results of the study provide some evidence to support GP scanning in this setting, further research on diagnostic accuracy and alternative models of care need to be conducted. [ABSTRACT FROM AUTHOR]

Background In the late 1990s, one NHS region created posts of ‘medical care epidemiologists’ (MCEs) to employ public health skills in NHS Trusts in pursuit of the ‘evidence‐based medicine’ agenda. [ABSTRACT FROM PUBLISHER]

Alcohol misuse is a major public health problem. In the UK, general practitioners are perceived as key players in prevention and management of alcohol problems, but may not be prepared sufficiently to undertake this work. A systematic review of the literature by computerized search of the Medline database, hand search of review article citations and a survey of relevant educational and training organizations and agencies were undertaken. Although there is no shortage of educational materials, there has been little evaluation of their effectiveness. A need for more training and support has been identified, but this requires better co-ordination and a more multidisciplinary approach. Forthcoming changes in the National Health Service and the organization of continuing professional development offer a unique opportunity to advance this agenda. [ABSTRACT FROM PUBLISHER]

The context in which medicine is practiced in Great Britain has changed beyond all recognition since the profession took its first strides into the comprehensive system of heath care enshrined in the postwar ideal of a national health service. For the first 40 years of the National Health Service (NHS) the accountability of doctors was to their patients and to a broad and non-specific professional code. The NHS at first provided a setting where doctors could exercise their skills with almost complete autonomy.