The modernisation of general practice in the UK: 1980 to 1995 and beyond. Part I

Professional predictions: June Huntington's perspectives on joint working, 20 years on

In 1981, June Huntington published a study of social work and general practice which rapidly became influential. In it she offered a sociological analysis of these two occupations to explain the difficulties and conflicts which had arisen between them and to predict the future course of their relationship. In this paper we revisit Huntington's propositions and assess the extent to which her predictions have been realised in the UK context. We adopt her perspective of the two organisational cultures of general practice and social work to consider her claims, particularly with respect to developments in social work. We then outline her depiction of the likely evolution of interprofessional relationships over the past two decades, considering the generalisability of experiments in collaboration, conflict with the medical profession, tensions within social work itself, and the sense of 'crisis' in relationships between professions. To promote debate with colleagues in different disciplines, this paper ends with a series of questions about the likely impact of care trust formation on social work.

Skill mix between nurses and doctors working in primary care-delegation or allocation: a review of the literature

The fundamental role of primary health care teams (PHCT) is to deliver effective services to the local population. Demands on the PHCT have increased since the early 1990s and, with the advent of Primary Care Groups (PCGs), will continue to do so in a primary health care led National Health Service (NHS). Rapid changes, however, raise questions about the feasibility and delivery of new services with skill mix and the distribution of workload within the PHCT being key issues. This paper reviews the literature on workload in primary care, attitudes to delegation, inter-professional relationships and teamworking and concludes that in order to deliver the vision of a primary care led NHS, meet the health care needs of users, address the inevitable anxieties of general practitioners and bring forth the professional aspirations of nurses and other health care professionals, more equitable and less hierarchical models of multi-professional teamworking in primary care will be most successful.

Use of prescribed drugs among older people in Japan: association with not having a regular physician

OBJECTIVES

Minimizing the overuse of prescribed drugs among older people is a goal of geriatricians and healthcare policy makers. Indirect evidence indicates that use of prescribed drugs is more common in Japan than in some Western countries, but the actual situation in Japan is unknown. The first aim of this study was to clarify the use of prescribed drugs among older people in Japan. We also tested the hypothesis that using five or more prescribed drugs is associated with a situation that is modifiable and is relatively common in Japan: not having a regular physician.

DESIGN

A cross-sectional survey.

PARTICIPANTS

Subjects representing the Japanese general population aged 65 years and older were selected by two-stage stratified sampling; 617 persons were eligible for the study.

MEASUREMENTS

Each subject was given a self-report questionnaire about current medications, sociodemographic characteristics, current state of health, health-related quality of life, and whether they had a regular physician. Among users of prescribed drugs, the association between using five or more prescribed drugs and not having a regular physician was assessed by univariate analysis and by stepwise logistic regression.

RESULTS

The questionnaire was returned by 491 (80%) of the eligible subjects, 299 (61%) of whom were taking at least one prescribed drug. Nearly 30% of those subjects were taking at least five prescribed drugs. The distribution of the number of prescribed drugs being taken was positively skewed; the minimum was one and the maximum was 17, the middle 50% of the values ranged from two to five, and the median was three. About half of those who were taking at least five prescribed drugs did not have a regular physician. Compared with those who had a regular physician, those who did not were 2.5 times more likely to be taking at least five prescribed drugs (95% confidence interval, 1.4 - 4.6).

CONCLUSIONS

Older people in Japan are less likely to be taking many prescribed drugs if they have the continuity of care provided by a regular physician.