This unique book is the first to bring together primary care experiences from around the world, with emphasis on non-Western regions. Utilising published articles that profile different countries' primary health care, accompanied by expert commentaries, the book consolidates global primary health care information over the past decade. Profiling the different countries' primary health care systems and their implementation of primary health care policy, as promoted by WHO and WONCA, the guide provides evidence of how countries and regions can introduce primary health care and family practice to improve their health care infrastructure and delivery. The book is essential reading for policy makers, health educators and academic leaders in primary care and students of global health and provides useful background for those entering or established in clinical family practice around the world.

This text is based on the practical experience of pilot schemes which have identified a variety of opportunities and innovative ideas which others can adopt and develop. This book is a reference for principals and managers of fundholding practices, those thinking about becoming fundholders, and for the managers of provider units seeking to expand their services, including the commissioning authorities.

'Fundamental changes in the Health Service demand a radical shift in approaches to patient core. The NHS is becoming increasingly led by the primary care sector. This has a greater meaning than simply more involvement of GPs in secondary care purchasing. It means that we start from where the patient is, in their own home and community. We provide care for them there and only move them into secondary services if and when it is appropriate to do so. 'Extending Primary Care shows that it is possible to experiment beyond traditional boundaries in these areas. It will provide encouragement to people who work in some of these difficult settings by showing what can be done... This book could not be more timely as a resource to many managers who will need to extend their own understanding of primary care - in the fullest sense of the whole team of people in primary care and the associated community health services.' From the Foreword by Barbara Stocking

This work adopts a modern approach to quality assurance and quality improvement in general practice. It provides an introduction to the subject, enabling readers to see how best to proceed in their own practices. It revises and updates previous books by Donald and Sally Irvine on clinical audit by placing audit within the wider quality context. It is designed to provide an easily accessible approach to the basic tenets as well as speculating on the future developments in this area, and should be of interest to all members of the practice team. The themes of the book are illustrated by reference to the five major case studies provided, which describe in some detail the various ways of starting, implementing and maintaining quality assurance in general practice today. Practical examples of Total Quality Management, the use of British Standard 5750, Kings Fund organizational audit, Investors in People, and Fellowship of the Royal College of General Practitioners by assessment, are also provided. These studies are written by the practitioners, medical and non-medical, who have themselves been through the experience of turning theory into practice.

This overview of the NHS Research and Development Programme is written by people who are at the leading edge of its implementation. It integrates the issues of research management and funding with the importance of focusing research on the needs of the customer (the NHS) and the challenges of implementing the findings of research into clinical practice. The experience of the authors extends from developing local research networks to managing a national research programme, reflecting the scope of the NHS strategy and the potential of this book.

Management controls on prescribing have greater impact on a GP's freedom of choice than on any other matter requiring clinical judgement. However, in order to deliver the most effective patient care, the GP needs a much broader base of knowledge including, for example, an understanding of basic pharmacological principles and the process of conducting clinical trials. This book deals systematically with the practical aspects of prescribing throughout primary care. It provides the busy GP with readily-accessible information so that the benefit to patients and the pratice can be maximized.

With the advent of the new health authorities, multifunds and consortia, it is likely that the GP's professional leadership of primary care will rapidly become only one of a number of provider options. This book defines some of the future options for the organization of primary care. The evolving possible roles of GPs and practices in these changing circumstances are examined closely. As the new health authorities come into full legislative force, how will they deploy the combined financial allocations for primary and secondary care to support their new capacity to enter into local contracts? Which health care providers will emerge in this market place in response to this shift in commissioning power? These are critical questions for general practice. With contributions from a variety of sources that reflect the varied origins of organizational initiatives, this is a book for planners, providers and purchasers of extended primary care.

All GPs undertake the non-NHS work, some of which can add substantially to practice income. This book describes a wide range of fee-paying work which GPs are uniquely qualified to undertake; it shows how opportunities for this work arise and how to become involved in it. For many, the financial benefits are greatly enhanced by the professional satisfaction such work brings.

The harmful consequences of alcoholism for the unborn child are still largely unknown. This book presents a detailed description of fetal alcohol syndrome as well as fetal alcohol spectrum disorders with respect to their clinical presentation, diagnosis, epidemiology, and pathogenesis. It also includes detailed considerations of underlying psychopathology, prevention, and therapy as well as the social consequences and impacts to patients.

The management function is practice-based primary care and who performs it varies by practice. While the number of practice managers increase and their role continues to unfold in response to NHS changes, the development of practice management as a profession is contained if not constrained by GPs, as both employers and as the dominant profession within primary care. This stimulating review of the responsibilities, opportunities and future prospects of management in primary care, based on workshops with GPs and practice managers, identifies their respective management development needs and the ways in which these might be met.

The quality of health care in the US depends on the patient's ability to pay and his or her insurance cover, at an annual cost of $3600 per head of population. In the UK, the quality of care costs less at an annual cost of $1000 per head of population, although care is sometimes delayed through a lack of resources. This book compares the two systems from the viewpoint of primary care, identifying some models of excellence from which both can benefit. It draws on the experience of the NHS reforms in the UK and the political imperative to control costs and improve the service in the US.

The NHS pension scheme is the largest in Europe. This guide explains how it works and how to maximize its benefits and avoid its pitfalls. The book covers: recent changes to the scheme including new provisions for early retirement; personal pensions, financial planning and investment options; advice on preparing for retirement and working after retirement; state benefits; and health and leisure in retirement. It is written for all NHS staff and should be of particular value to GPs and salaried doctors.

General practice is the cornerstone of primary care in the UK. However, this traditional model has been challenged by new visions of its role, particularly a responsibility for improving health as well as for the care of illness, and a responsibility for populations as well as for individuals. This book focuses on the development of general practice as a framework within which community nurses and other professionals can build their contibution to the future of primary care. In so doing it shows how the care of general practice can be maintained and strengthened. This work is intended for all primary care staff, including doctors, nurses and managers, and for anyone interested in the future of primary care in the changing NHS.

This book deals with the area of marketing in general practice. It presents a step-by-step guide to the nature of marketing in which each aspect is presented in short, separate chapters accompanied by questions, checklists and practical examples. It is based upon the lessons learned by a number of GPs and practice managers over a variety of situations and concludes with a comprehensive case study of one particular practice with which the authors worked. Readers of this book should gain a clear idea of the nature and purpose of marketing techniques and how the opportunities now becoming available can benefit both practice and patients.

For GPs and practice managers the challenge of the NHS reforms is to understand the business context in which general practice operates. Of the many skills learned from commerce and industry needed for the development of an effective strategy, business planning has been demonstrated to bring important benefits to the practice. However, for many the concept is necessary but unfamiliar. This book sets out to demystify the subject, explains the benefits and, by way of numerous examples, shows how they can be applied to the single-handed GP and group practices, whether or not they are fundholders. It suggests that good clinical care is not possible without the necessary planning and management skills to run a business.

As soon as this book first appeared in 1990 it became the standard text for the new generation of practice managers with responsibility for implementing many of the radical changes taking place in general practice. It required reprinting several times to satisfy demand and has since undergone two major revisions to ensure that it is up to date. This Third Edition incorporates several new chapters and new contributors, who reflect efficient and patient-friendly practice, and the continuing evolution of the NHS reforms. Topics are presented in clear, comprehensive and concise terms, from which managers will derive confidence and understanding, whether they use the book for background reading in the practice, or as a textbook on the many training courses that have now adopted it.

This is a book about primary care clinicians and the "clinical uncertainty" endemic to their work. Even when seemingly straightforward, each patient raises unique questions regarding how best to listen to their complaints, empathize with their suffering, or respond to their silences.

This book is also about "addressing" uncertainty in primary care practice and "engaging" it. Engagement requires knowledge, explicit and tacit, placed in the service of a single patient s problem. It also requires carefully managed communication, facilitating dialogue with the patient and encouraging shared problem-solving.

Most importantly, this book is about "collaborative engagement with case-based uncertainty in the setting of small groups of clinicians. "Sommers and Launer contend that the medical profession s tradition of working independently should be augmented with an explicitly shared, collegial one of jointly creating wisdom through practice-based learning.

An international panel of expert clinicians and educators provides: Perspectives on clinical uncertainty in the medical literatureA taxonomy of clinical uncertainty with patient examplesAnalysis of the educator role to support clinicians in engaginguncertainty A compendium of small group methods for collaborative engagement with clinical scenariosAnalysis of the special challenges ofcollaborative engagement

A mind-opening manifesto, "Clinical Uncertainty in Primary Care" will equip primary care clinicians, educators, public health and behavioral health professionals with resources for infusing practice with meaning through collegial collaboration.

From the Foreword: Lucia Sommers and John Launer, with the accompanying input of their contributing authors, have done a deeply insightful and close-to-exhaustive job of defining clinical uncertainty. They identify its origins, components and subtypes; demonstrate the ways in which, and the extent to which it is intrinsic to medicine and they present a cogent case for itsspecial relationship to primary care practice Clinical Uncertainty in Primary Care not only presents amodel of collegialcollaboration and support, it also implicitly legitimatesit. Renee Fox. "

The recent shifts in power, resources, influence and responsibility in primary care has increased the strain on general practice. This book is a comprehensive guide to the wide range of quality schemes available. It is unique in examining quality within the context of current practice, and it discusses future options based on new examples and research. It outlines the development of clinical governance, strategies for managing and assessing quality, continuing professional development, Department of Health policy initiatives and future trends.

Medical partnerships are highly complex legal and financial entities. This book navigates the reader through the key issues and deals with the less tangible aspects such as partnership dynamics and organisational behaviour. Examples illustrate common difficulties and offer possible choices. It is clear, practical and readable and essential for all GPs entering a partnership. It is also relevant for GPs currently in partnerships, practices considering their partnership deed, Senior House Officers and GP registrars.

The upheavals of the NHS reforms have caused a great deal of stress and uncertainty in primary care, and professional development and support for general practitioners needs to take account of this. This book offers a group supervision model which can be used to develop the core competencies needed for GPs to make the new primary care organisations work. The book analyses how primary care professionals have dealt with the various reforms of the past decade, and picks apart the paralysing culture of politeness, conflict avoidance and rivalry for power, to reveal how at the core of reform is the struggle for each GP to construct a new professional identity which integrates medicine, management and politics. It proposes ways GPs can benefit from these experiences to become equipped with the necessary competencies to be active members or dynamic leaders in the new primary care organisations. The doctor-patient relationship is no longer one-to-one, but located within a group matrix, in the same way that a GP is now required to work within a group framework. This book enables GPs to develop the essential group skills they now need, and on which the success of the healthcare reforms ultimately depends.

With every passing year, the mutual mistrust between doctor and patient widens, as doctors retreat into resentment and patients become increasingly disillusioned with the quality of care. Rich in anecdote as well as science Doctors and Their Patients describes how both have arrived at this sad shape.

This book has been written to serve as a manual for physicians practicing in a private office setting to recognize and recommend appropriate treatment for patients believed to be substance abusers. While it is not written for drug abuse specialists, it provides information regarding the diagnosis and treatments a competent, concerned physician can provide without becoming immersed in addiction treatment. Topics discussed include the degree to which a physician should become involved, when it is appropriate to refer, using other professions and volunteer groups, and useful medications. Guidelines for recognizing substance abuse, testing to confirm the abuse, confronting the patient, and motivating the patient into specific treatment are also presented. Tables and illustrations are used to summarize major points, making this an extremely useful reference tool for internists and other non-specialist private practitioners.

A Fateful Meeting A year and a half ago, I was sitting at a conference listening to Ed Noffsinger speak, and suddenly had the most profound ''Aha'' moment of my professional career. Here was someone presenting a practical and tested solution to some of the most challenging problems currently plaguing the US healthcare system, problems such as poor access to primary and specialty care; the uncontainable and rising costs of healthcare; our nation's relatively poor quality outcomes; and finally, the sense of frustration, disempowerment, loneliness, and disenfranchisement that patients and their families too often experience. Dr. Noffsinger's solution seemed deceptively simple-shared medical appointments (SMAs) that afford the highest quality healthcare to be delivered in the highest quality care experience-a group setting. Experience collected over a decade and involving more than 100,000 patient visits throughout the United States, Canada, and parts of Europe has demonstrated that SMAs, when used in primary care as well as in the medical and surgical subspecialties, lead to increased access to care, enhanced quality of care, and improved patient satisfaction. For physicians, the efficiency gains and team support from their participation in SMAs translate into much needed relief and improved career satisfaction.

This book examines the best ways to provide primary care at nights and weekends. There has been increasing demand from patients for out-of-hours care, and a great reorganisation of primary care services outside normal surgery hours. Different models of organisations are being tested, including primary care centres and nurses giving telephone advice. This book examines the tensions between public and professional expectations, and describes the range of options for providing services, with examples of good practice. It reviews the evidence about what works best, and the issues to consider in setting up different services. The contributors combine experience in organising, researching, evaluating and providing out-of-hours care, and offer practical advice, critical analysis and a political perspective. The book is an accessible and valuable contribution to this increasingly important aspect of healthcare. It is essential reading for all practitioners, managers and researchers in primary care, public health, Accident and Emergency departments, pharmacy, community nursing and ambulance services.