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During the latter half of 1990 the Royal Air Force established a medical evacuation chain in support of the British First Armoured Division during Operation Granby (known as Operation Desert Storm in the USA). Medical contingency plans, formulated prior to embarkation from the UK, foresaw the need for five aeromedical staging facilities sub-deployed throughout the east of the Arabian Peninsula. The early days of the deployment found personiel busy with the construction of tented and hardened facilities and with the establishment of local operating procedures. Many problems were initially encountered, especially with supply, communications and in co-ordinating with collaborating coalition and host nation units. Nevertheless, progress was rapid and non-combatant operations were started within days of arrival. As the ground offensive became more imminent, traning took on a sense of urgency. Advanced first aid techniques were taught to all non-medical staff, whereas doctors, nurses and paramedical personnel were taught ACLS and ATLS skills. All studied field hygiene, the hazards of nuclear, chemical and biological warfare, casualty handling, battle psychology and the intricacies of loading and unloading various types of aircraft. By the start of the ground phase of the war the British evacuation chain was fully operational and capable of treating and transferring hundreds of casualties per day. In the event, only about 850 patients were transported down the evacuation chain during the conflict, and less than 10% of these were battle casualties. This paper presents an overview of the British aeromedical evacuation system and discusses, in more detail, the establishment and operation of the busiest aeromedical staging facility at Al Jubail in the Eastern Province of Saudi Arabia. [ABSTRACT FROM AUTHOR]

The article discusses the cost and effectiveness of in vitro fertilization (IVF) technique in Great Britain. The development of IVF presents the providers of health care with several problems. Inequality of distribution will become a problem if the new technique would be taken up by the private sector. In the present financial climate of the country it appears that National Health Service funding will be available to meet the demand for IVF.

The article focuses on medical specialists. It says that patients are given an abysmally low standard of care by being given various prescriptions and by being referred to a narrow-minded specialist. It mentions that most of the costs of the British National Health Service are committed to specialist care although there are only few patients who need it.

The article focuses on the alteration in health care model for elderly people in Great Britain. The need for the change in treatment approach emerged due to diminishing younger workforce and rapidly growing number of elderly people. The effectiveness of all advances in care for the elderly is undermined by government policies and particularly due to the ways of spending money.

The article focuses on the pitfalls of current health care screening programs in Great Britain. The history of audits of cervical screening programs in the country is being reviewed. The procedures of designing an audit and setting standards for it are discussed. It is emphasized that the shortcomings should be identified and accordingly the improvement plans should be implemented.

This brief paper contextualises the reform of health care in the UK National Health Service, before introducing the papers in this special edition. [ABSTRACT FROM AUTHOR]

Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives, when hormonal and physical changes are often accompanied by psychological and social evolution. Access to sexual health and sexual well-being (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high-income countries. A systematic review of the enablers and barriers to women (including trans-gender and non-binary people) aged 40–65 years accessing SHSW services in high-income countries was undertaken. Four databases (PubMed, PsycINFO, Web of Science and Google Scholar) were searched for peer-reviewed publications. Findings were thematically extracted and reported in a narrative synthesis. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their healthcare professionals (HCPs), and the over-arching effect of stigma, social connections and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities and financial incentives to access services for under-served groups. Efforts are needed to enhance education about SHSW and related services among midlife women and their healthcare providers. This increased education should be leveraged to improve research, public health messaging, interventions, policy development and access to comprehensive services, especially for midlife women from underserved groups. Plain language summary: Sexual health and sexual wellbeing services for midlife women in high income countries Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives. Access to Sexual Health and Sexual Wellbeing (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective of this systematic review was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high income countries. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their HealthCare Professionals (HCPs), and the over-arching effect of stigma, social connections, and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities, and financial incentives for under-served groups to access services. The appetite for education about SHSW and SHSW services among midlife women and their HCPs should be capitalised upon, and utilised to improve research, public health messaging, interventions and access to holistic services, particularly for midlife women from under-served groups. [ABSTRACT FROM AUTHOR]

Background In 2015 the Joint Royal Colleges of Physicians Training Board (JRCPTB), acting on behalf of the three UK Royal Colleges of Physicians, launched a set of quality criteria designed to improve the educational experience of Core Medical Trainees. Methods The criteria were developed with key stakeholders from Core Medical Training (CMT) and monitored via the General Medical Council's annual National Training Survey. This paper describes the development, implementation and impact of these criteria, which have been implemented by UK postgraduate schools of medicine since 2015. Results There were trainee-reported improvements from baseline (2015-18) in at least eight out of the 13 core criteria measured. Conclusions The results demonstrate that a coordinated UK-wide approach to quality improvement, focused on a specific set of clearly defined and measurable outcomes that galvanise trainer engagement, can lead to greater trainee satisfaction in a demanding area of medicine without significant additional resources. [ABSTRACT FROM AUTHOR]

The National Health Service in Britain has recently undergone a major reorganization. It has moved away from being a planned system of health care delivery to a demand driven system organized on the principles of (quasi-) market competition and quality assurance. These changes are intended by government to `empower' the consumer (patient) with real choice and to incorporate the health professionals within a more effective and efficient system of hospital management. It is in this context that the paper examines the usefulness of `postmodernity' as an explanation for the emergence of new `flexible' organizational forms within the hospital service. The paper will concentrate on the ideological and organizational contradictions between state policy and local practice, especially in relation to issues of managerial vs professional autonomy and control. [ABSTRACT FROM AUTHOR]

Rationing of National Health Service expenditure is inevitable, difficult, controversial, and it is unusual for the public to have a direct say in setting healthcare spending priorities at the local level. This paper presents a case study of public involvement in the allocation of some £60 million by a Primary Care Trust in North West London. Market research based techniques were used to demonstrate that the public are indeed capable of making these rationing decisions, given the right support. The results of a collective decision making process are reported, as are the effects on healthcare spending in this locality. [ABSTRACT FROM AUTHOR]

This paper considers the changing role of primary care both within the NHS, but also in health care in a broader sense. Introducing the reforms made by the Labour government, it also considers other mechanisms through which primary care has been broadened, including the introduction of NHS Direct, as well as the growth of complementary and alternative therapies, and considers the implications of these changes for healthcare financing. It suggests that changes in primary care have considerable potential to transform health services, and make governments rethink their health reforms. [ABSTRACT FROM AUTHOR]

The capacity of the state to delivery healthcare has been affected by a number of factors and is intimately interconnected with the process of globalisation. This has led to a changing political economy and new context for health care financing, not only for the NHS, but for Europe and beyond. This paper considers these changes and explains the process of policymaking that led to the NHS internal market reforms of the 1990s. [ABSTRACT FROM AUTHOR]

The teaching of the social and behavioral sciences as disciplines within the education and training of health care professionals is a relatively new phenomenon in the United Kingdom. The push for their inclusion in medical, nursing, midwifery, and radiography curricula is a consequence of major changes in the system and service of health care in Britain, which lent a greater urgency to the professionalization of these occupations. This, in turn, called for professional and educational validating bodies to fundamentally reorganize courses, to raise their academic level, and to encourage widespread research into learning styles, continuing professional development, and alternative educational delivery modes such as open and distance learning. In teaching sociology across a range of newly developed health care courses we have had to consider the dynamics of United Kingdom health care education that prompted their development. This paper is based on our experiences in designing, implementing, and evaluating such courses. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic generated a series of profound and unprecedented challenges for health and social care systems and those frontline clinicians responsible for delivering services including nurses. One consequence has been the rapid and widespread introduction of a range of digital tools, solutions, and initiatives. In the United Kingdom, this has required clinical leadership to drive implementation and adoption of digital innovations across the system, ranging from those in senior executive board level positions to those on the frontline. Findings: This commentary presents a framework highlighting the breadth of digital transformations which emerged as a consequence of the U.K. health and social care systems' response to the COVID-19 crisis. The framework outlines the different levels of digital transformation, ranging from what we have termed "ceremonial adoption" to isolated automation, organizational integration, and full systems integration. We reflect on the nursing leadership practices that need to be in place to support these changes. Conclusion: Whilst acknowledging the extraordinary results achieved by the COVID-19 driven tsunami of digital transformation, we reflect on the essential steps required to translate these nascent, isolated efforts into fully integrated, long-term solutions. We also offer recommendations for clinical digital leaders and suggest steps that will be crucial to translate the temporary and/or limited interventions into effective, permanent features of our health and social care systems, while also providing a platform on which to build future digital capabilities. We will inevitably continue to see an increase in the use of technology in everyday clinical practice, and nurses are well positioned to take a lead in its widespread adoption. [ABSTRACT FROM AUTHOR]

Background: The importance of infection prevention and control (IPC) services to prevent threats from healthcare-associated infections and improve the quality of healthcare delivery is undeniable. However, IPC services across the UK and Ireland have substantial variability in terms of team structures and delivery models. Aim: The aim of this study was to define an optimal IPC service in different contexts and settings within the United Kingdom and Ireland. Methods: This mixed methods study adopted discussion huddles with IPC teams to explore various components of IPC programmes and services. A Nominal Group technique was then undertaken to achieve a group consensus of what an optimal infection prevention service should look like. Results: Five discussion huddles were conducted which included 53 participants in total. Key themes arising were IPC Service Priorities, IPC Service Enablers for Success, and Necessary Skills and Expertise Required for Delivering an Effective IPC Service. For the nominal technique, 45 responses were identified which were determining the key priorities for an effective IPC service and 69 responses for establishing key enablers for success. Discussion: These findings supported the development of a conceptual model for designing an optimal infection prevention service, which can be used to develop IPC services at an international, national, regional and local level. A focus is required around implementation of these highlighted enablers, so are effectively embedded into infection prevention and control services, and wider healthcare settings. [ABSTRACT FROM AUTHOR]

Information about several papers discussed at a meeting of the Section of Medical Education of the Royal Society of Medicine on November 12, 1980 and February 11, 1981 in Great Britain is presented. Discussions are concerned on how health resources may be best allocated between the requirements for patient care services and the specific needs of learners. It featured various physicians including Robert Lowe, Malcolm Forsyth and John Woodall.

The article reflects on the prospects of health care for elderly in Great Britain. In this context, the proposed changes mentioned by the government for the National Health Service which incorporates the general practice contracts and the White Paper Working for Patients have also been discussed. The proposed changes do not mention about elderly patients in detail.

Introduction: Women are not usually taught about the menopause formally, and many general practitioners have relatively little training. The aim of this study was to explore perimenopausal women's attitudes and knowledge of the menopause. Method: An online survey was designed to evaluate attitudes and knowledge of the menopause in women older than 40 years. The survey was generated with Qualtrics XM® and promoted via social media. In all, 3150 women started the survey. In this study, data from 947 perimenopausal women were analysed. Results: Regarding women's attitudes to the menopause, 38.8% were accepting of it but more than 30% were dreading it. The women had experienced a number of menopause symptoms including mood swings (68.9%), brain fog (68.3%), and fatigue (66.8%). More than 90% of women had never been taught about the menopause at school, and more than 60% did not feel informed at all about the menopause. School was thought to be the best place for menopause education to start (83.6%). In all, 68.2% of women had only looked for information about the menopause as their symptoms started and they had talked to friends and used a variety of websites to look for information. When asked for their free-text views on the menopause, thematic analysis produced four themes: the overarching knowledge gap, the onset and impact of symptoms, perimenopause: the hidden phenomenon, and managing symptoms: differing schools of thought. Conclusion: Lack of education for women and their general practitioners is causing perimenopausal women to go through this important stage in their lives with a lack of knowledge and appropriate medical care. It is essential that women are taught about the menopause, from school onwards and that we offer health professionals appropriate training starting from the medical school curriculum. [ABSTRACT FROM AUTHOR]

Background: Dementia is a life-limiting illness, but the trajectory of dying can be difficult to establish and care at end of life can be variable and problematic. Methods: This UK study was carried out to explore the end-of-life-care experiences of people with dementia from the perspective of their family carers. In-depth interviews were conducted with 40 bereaved family carers of people with dementia. Results: Forty family carers (male n = 9, female n = 31) age range: 18–86 years were interviewed. Issues with poor communication were common. The hard work of caring and issues regarding unpredictability of living and dying with dementia were also commonplace within the study. Only three patients were referred for specialist palliative care support at the end of life, all of whom had a dual diagnosis of dementia and cancer. Conclusion: This qualitative study has identified that there are several gaps in the end-of-life care of people with dementia, and frequently, there is poor communication during the last year of life. The need for high-quality integrated care for people dying with dementia with appropriate support during the last year of life is identified. COVID-19 has disproportionately affected people with dementia, and in the post-pandemic era, there is an urgent need to ensure every person dying with dementia is supported to die in their preferred place and that family members are supported and enabled to be treated as the 'expert' in terms of their knowledge of their relatives' care and preferences. [ABSTRACT FROM AUTHOR]

Objective To present results from the NHS breast screening programme (NHSBSP) from 1994 through to 1999 and to examine the extent to which interim targets are being achieved. Methods Data were collated from all screening programmes in the UK on standard statistical returns. Performance of the screening programme was evaluated using calculated targets based on comparison with the Swedish two counties (STC) randomised controlled trial. Results In the early years of screening (1988–1993), the NHS programme was detecting more DCIS but considerably less invasive cancers than expected, based on the STC trial. Since the screening year 1993/94 (1 April to 31 March) the standardised detection ratio (SDR) measure of the detection of invasive cancers has increased by 36% from 0.83 to 1.13. The SDR has been greater than 1 since 1996/97 suggesting that the NHSBSP has only been screening as efficiently as the STC trial since this date. Uptake for screening has been relatively stable over time at approximately 75%. Conclusions The NHSBSP has made considerable advances in performance since its inception in 1988 and screening uptake and age standardised invasive cancer detection rates are (by 1999) well in excess of targets. The early years of screening were characterised by good uptake but a low sensitivity for the detection of invasive cancers. It is anticipated that the screening programme will have an increasing impact on breast cancer mortality, particularly in the 55–69 year age group over the coming years. [ABSTRACT FROM AUTHOR]

The article presents information on the issues related to the government policy for public health and the efficient production of hospital services. The promotion of consumer choice and the provision of information to the public are the main principles of the current government policy in Great Britain. The performance of hospital is manifested in the National Health Service.

A national survey of the current methods used by specialists to evaluate pituitary function in the UK was performed by postal questionnaire. Seventy-three respondents, of whom 89% were consultants and 80% clinical endocrinologists, returned the questionnaire. Fifty per cent routinely used the insulin stress test (IST) to evaluate the hypothalamo-pituitary-adrenal (HPA) axis, while 50% routinely used tetracosactrin stimulation, there being little overlap between the two groups. This represents a significant change in clinical practice since the last survey in 1988. In those who used ACTH stimulation there was almost an equal split into those who administered the tetracosactrin intramuscularly (45%) or intravenously (47%). Furthermore, either the peak or 60 min cortisol value was used by 71% when interpreting the result of the test, despite the fact that in previous studies only the 30 min cortisol value has been shown to correlate with the IST result. The IST remains the most frequently used method to assess growth hormone reserve in adult subjects. The thyrotrophin-releasing-hormone and gonadotrophin-releasing-hormone tests are still used routinely by approximately a quarter of clinicians. These results provide data that could be used to develop guide-lines for the use of tests to investigate pituitary function. [ABSTRACT FROM AUTHOR]

The article offers a discussion on the acceptance of prosthetic counterparts as replacement for malfunctioning heart valves in the routine of clinical procedure for the period of 25 years in Great Britain. An outline of the major developments of heart valve replacement from its inception is discussed. Recently, there was still no agreed standard data presentation on the size of valves.

Background: Day care services support older people living with long-term conditions (LTC's). Aims: The aims of the study were to determine outcomes in terms of loneliness and health-related quality of life for older people with LTCs attending day care services in the United Kingdom. Methods: Newly referred older people with LTCs to day care services in North West of England and Wales were invited to participate. The EQ-5D-3L and De Jong Loneliness questionnaires were completed at recruitment, 6 and 12 weeks. Results: Ninty-four older people (64% female), age range 65–99 years; mean number of LTCs 4.3 (range: 2–9) were recruited. About 52% lived alone and 36% lived in one of the 20% most deprived local authorities in England and Wales. Outcomes over 12 weeks were comparable for paid, blended, and for volunteer-led services. Conclusion: Following the Covid-19 pandemic, it is increasingly urgent to support older people with LTCs who may have lost physical and cognitive function during lockdown and to support their recovery. Our study suggests that volunteers can provide services and complement the care provided by paid staff, freeing up resources and enabling increasing numbers of older people to be supported. [ABSTRACT FROM AUTHOR]

Data sharing of Electronic Health Records from general practices to secondary care in Leeds occurs through the so-called Leeds Care Records, which collects a specific set of codes from primary care, known as 'Active Problems', and presents it to the user. Variability on its content is a known issue. To explore general practitioners' views on their use of 'Active Problems' and on sharing data, so lessons could be learnt on how to homogenise and improve shared data. Assessing Leeds general practitioners' views through two parallel processes (60 online surveys and 17 interviews). General practitioners feel they do not have the time nor the training required for keeping a shared approach to concise and current Problem Lists in electronic patient records. Action is needed to reduce current variability, and to improve the quality of shared information. Some types of codes currently present in Problem Lists have very little support among general practitioners who consider the focus should be on long-term conditions and probably adding current acute diagnoses and life expectancy items and not omitting sensitive information. There is a perceived need of training and time to update Problem Lists if their quality is to improve. [ABSTRACT FROM AUTHOR]

The article highlights the symposium on health care workers which was conducted by the National Health Service in Great Britain. In the symposium, speakers from various organizations discussed, concern for the occupational health care of health care workers. Among the speakers who participated in the symposium are Dr. John Lunn of St. Mary's Hospital and Dr. P. T. Penny of Somerset Health Authority.

The article discusses the auditing of surgical results in private practice in Great Britain. The National Institute for Clinical Excellence has been tasked with making sure that authoritative national guidance is made available to all health professionals on the latest drugs and technologies. However, this can only be accomplished by surgeons auditing the result of other surgeons.

Purpose We report our experience of a paediatric orthopaedic network, based on a 'hub and spoke' model, covering the South West of the United Kingdom. We identify the areas of most clinical concern, the effect of the network on streamlining patient management and the benefits of the network to the clinician. Methods Prospective data were collected from the minutes of the bi-annual meetings of the South West Paediatric Network (UK) between November 2006 and May 2012. Data collected included details of the condition, previous treatment, problems, complications and advice given. Cases continue to be followed up in subsequent meetings. Results In total 131 cases were included and hip conditions were discussed most frequently (35.1%). The most common indication for discussion was to support and confirm the local management plan. In total, a mean average of 8.75 cases in total were presented per consultant during the study period, with those within ten to 12 years of starting independent practice presenting the majority. The clinical outcome for patients discussed in this forum was local provision of care in 74%, with transfer to the regional centre in 15.7%. Following advice, 14% of direct referrals were given appropriate advice and avoided a journey to the tertiary centre. Conclusion The network has enabled local provision of care, reduced the burden of travel on patients and prevented unnecessary referrals to the tertiary centre. Additionally, it provides a mechanism to reassure and educate clinicians. [ABSTRACT FROM AUTHOR]

The article discusses the use of syndromic surveillance in the Emergency Care Data Set (ECDS) project initiated by the Royal College of Emergency Medicine in England. Topics covered include the goal of improving the collection and quality of data in emergency departments, the mandated changes to national clinical emergency care data sets and the driving factors for implementation of ECDS.

The article presents views and insights of the author concerning key beliefs about jinn that healthcare professionals might bear in mind when treating their Muslim patients in Great Britain. The author offers information about the historical background of jinn and how to treat those who believe that jinn are the cause of symptoms or unusual behavior. He also shares his own perspective about religion as unseen realms.

The author reflects on the proposed changes by Prime Minister Tony Blair within the National Health Service that involved the establishment of new patterns of health care in Great Britain. He shared his solution in dealing with other aspects of patients' problems through the creation of an extended team that included a practice counselor, a psychologist and a community psychiatric nurse.

The article presents the opinion of the author on the better treatment of psychiatric patients in the community and the need of good mental health service in Great Britain. According to the author about one-fifth of the work of general practice in the country is involved directly or indirectly with psychiatric problems. He says that most of these psychiatric problems are managed by general practitioners, without any referral to specialist psychiatric services.

Few sociologists dissent from the notion that the mid- to late 1970s witnessed a shift in capitalism’s modus operandi. Its association with a rapid increase of social and material inequality is beyond dispute. This article opens with a brief summation of contemporary British trends in economic inequalities, and finds an echo of these trends in health inequalities. It is suggested that the sociology of health inequalities in Britain lacks an analysis of agency, and that such an analysis is crucial. A case is made that the recent critical realist contribution of Margaret Archer on ‘internal conversations’ lends itself to an understanding of agency that is salient here. The article develops her typology of internal conversations to present characterizations of the ‘focused autonomous reflexives’ whose mind-sets are causally efficacious for producing and reproducing inequalities, and the ‘dedicated meta-reflexives’ whose casts of mind might yet predispose them to mobilize resistance to inequalities. [ABSTRACT FROM PUBLISHER]

The regulation of medical work in the has been shaped by the post-war settlement, which lead to the creation of the National Health Service in 1948. The removal of clinical care from the market was supported over the following decades by prohibitions of the sale of human organs and gametes. That settlement is now being dismantled, with the increasing privatisation of NHS facilities. The recommodification of medicine in Britain is achieved as part of broader patterns of neoliberal globalisation. Crossborder markets in health services are realized in law through international (e.g. the General Agreement on Trade in Services) and regional trade law (e.g. European Community law). [ABSTRACT FROM AUTHOR]

The article examines the concept of the payment by results policy of the National Health Service (NHS) in Great Britain. The healthcare system in Great Britain is undergoing a series of organizational reforms with the introduction of new concepts such as choose and book, practice-based commissioning, and payment by results.

The article considers the place of minority ethnic health in the priorities of the British National Health Service (NHS). It identifies some of the NHS priorities, such as the promotion of health and the prevention and management of disease. The extent to which the NHS address the health needs of minority ethnic groups in the country is examined. It stresses the need for a balanced and considered approach to priority setting within the NHS.

In this article, the authors reappraise the evidence regarding general practice within the British National Health Service (NHS) in 2006. The authors reflect on the contribution, inherent advantages and shortcomings of the NHS. They think that British general practice should be measured against four dimensions: equity, quality of clinical care, responsiveness to patients, and efficiency. Moreover, the authors believe there are three characteristics that above all others contribute to a medical care success: co-ordination, continuity and comprehensiveness.

The article discusses the impact of human right act in clinical practice in Great Britain. The law has recognized and upheld the autonomy of the individual and the right to self-determination in a competent patient for the refusal of medical treatment. The factors that reflect primacy of the individual have been broadened by the Act. In addition, there has been a large shift in the scope of advance directives with the emergence of an emphasis that boost the human rights of the individual.

The article examines the importance and application of ethics history to the medical practice in Great Britain. The author explained that taking an ethics history would will increase the likelihood for a patient to receive the appropriate and acceptable treatment when he will be incapacitated. The implementation of the Human Rights Act of 1998 and involvement of family in making decision were also discussed.

In the past, British general practitioners (GPs) have referred patients to individual consultants. There is now a trend towards generic referral, whereby the specialist team is consulted via a single point of access. We examined the impact of this innovation on the relationship between GPs and specialists in mental health care. Sixteen groups of randomly selected GPs and mental health professionals (MHPs) in England discussed clinical scenarios involving the use of mental health interventions for patients with functional somatic symptoms. The meetings were audiotaped, transcribed and analysed to the point at which no major new themes were emerging. The final analysis was confined to a purposive sample of six of the sixteen groups, comprising 54 GPs and 15 MHPs. Although the rationale for the single point of access was clear to both GPs and MHPs, the approach erected boundaries because it impeded the establishment of professional relationships and transfer of knowledge. GPs thought the system reduced their capacity to be accountable to their patients and limited the potential for their own professional development. MHPs did not seem to be aware of GPs' concerns. Effective interprofessional management of individual patients depends upon confidence in colleagues' skills and good communication. Factors that hamper these must be addressed in the development of this system of referral. [ABSTRACT FROM AUTHOR]

The article focuses on the factors that could influence the need for drug prescription in epilepsy. Epilepsy has been considered the most common treatable disorder in Great Britain with an incidence of about 0.05%. It has been noted that the diagnosis of the condition plays a very important role in its management. Researchers found that the decision for treatment is not based on evidence but on the people's behavior, thus they aptly labeled the system as research-enhanced healthcare.

The article offers information regarding the marketplace for medicine in Great Britain. It was stated that the market for healthcare is characterized by uncertainty and exchange of information. Consumers of healthcare are commonly ill-placed in judging how much utility is likely to be derived from a medical intervention.

Objectives: To evaluate whether the information leaflets produced by UK colposcopy clinics provide women with the information they desire and to determine when they would like to receive this information. Design: Questionnaire study and structured evaluation. Setting: The colposcopy clinic of a UK cancer centre. Participants: Forty-two women attending a pre-colposcopy counselling session and 100 consecutive women attending the colposcopy clinic. Methods: Thirty-eight standards derived from the concerns/questions asked by women attending a pre-colposcopy counselling session were used to assess locally produced colposcopy clinic leaflets from UK colposcopy clinics, the leaflets produced by the Royal College of Obstetricians and Gynaecologists and the National Health Service Cervical Screening Programme (NHSCSP), and two "leaflets" obtained from internet sites. The Gunning fog test was used to assess the leaflets' readability. A questionnaire survey of 100 women attending the colposcopy clinic was used to determine when women wanted to receive information about colposcopy. Main outcome measures: Percentage of questions answered by a given leaflet and Gunning fog scores for readability. Results: The information leaflets of 128 colposcopy clinics were received and assessed. Thirty-two clinics only sent women the NHSCSP leaflet. No leaflet answered all 38 questions. Less than half (36/100) of the leaflets answered more than 50% of the questions. In addition to the lack of advice given, different leaflets frequently gave conflicting advice. The average Gunning fog score was 9.7 (range 5.5-15.5). The majority of women (70%) wanted to receive information about colposcopy at or prior to the time of receiving their abnormal smear test result, although only 42% of women actually received information at this time. Conclusions: Many UK colposcopy clinics do not appear to be providing women with the information they require to understand their condition and the procedure that they are about to undergo. Furthermore, this information is often not provided at the appropriate time in the screening process. [ABSTRACT FROM AUTHOR]

The article reports on the campaign of healthcare agencies for the early recognition and intervention in primary care of dementia in Great Britain. The National Service Framework for Older People stressed the need for such initiative. However, general practitioners found the benefits of early diagnosis questionable.

The article points out that tuberculosis (TB) care in Great Britain faces two major challenges. These are the lack of education in TB with Great Britain and the lack of resources for control worldwide. It is proposed that two chairs with a particular interest in clinical TB be created in Britain. At the international level, scarce funds could be shifted towards TB control.

The article presents the second part of a series of articles about the British National Health Service (NHS). In this study, researchers describe moves toward explicit prioritization of patients in other countries, particularly New Zealand. Experiences suggest new directions for the NHS and pitfalls to avoid. New Zealand introduces a nation-wide system for explicitly prioritizing and booking patients for elective surgery.

The article outlines the medical history of the Royal Society of Medicine (RSM) in Great Britain since 1907. It could be noted that RSM's transformation from the Royal Medical and Chirurgical Society loosely designated specialist. This transformation could be attributed to the merger of 17 societies with the federal structure. This is considered to be the first acceptance made by a national institution assessing that the practice of medicine is becoming specialized.

The article focuses on the public health outputs from the British Paediatric Surveillance Unit and similar clinician-based systems. The unit is therefore conceived as an active surveillance mechanism and an efficient way of focusing reporting through a single channel. The public health outputs include, informing policy decisions on screening, providing information for clinical governance, monitoring the progress of public health interventions and responding to public health emergencies.

The article examines the physician's dilemma of rationing and ethics in health care in Great Britain. Several brief extracts from stories told by various health care workers about the effect of rationing choices on their daily work, are presented. The relationships between ethics and the processes of care, ethics and the structures of care, and ethics and the outcomes of care, are also discussed.