Anxiety about medicine becoming impersonal and mechanised permeates the NHS. In addition, the popular media is full of stories about the health service and its unhappy staff, focusing on the belief that professionals and patients are being turned into assembly-line workers and objects. This is particularly prevalent in general practice, as plans for massive policlinics are revealed and payment systems shift seemingly inexorably towards incentives and targets. The ethos of family medicine, which places so much stress on continuity of care, psychosocial understanding of illness, and the careful management of doubt, is challenged by guidelines, governance, quality frameworks, and patient satisfaction surveys. General practice is being industrialized into primary care, or so it can seem.
This book explores the many dimensions of industrialization as it has occurred to other professions in the past, and analyses the origins of the current wave of reform in general practice. It analyses why industrialization is being pursued as a government strategy, and explores its benefits and dangers. It concludes that the medical profession has reasons for being perturbed by industrialization, but that it has advantages as well as disadvantages for the NHS and the public. Its conclusions may not please either policy makers or practitioners, but they offer ways for professionals working in the community to customise current changes in potentially beneficial ways.

Primary Care for Older People is a contemporary reference work on health problems in later life written exclusively by primary care professionals for primary care professionals that: integrates nursing and medical perspectives on clinical practice and service organisation. understands that well-intentioned changes in practice and service provision can have harmful effects on patients, professionals and the health service is still able to offer positive guidance to individual practitioners, practices and Primary Care Groups, about best practice and innovative multi-disciplinary care for an ageing population. It is aimed at doctors, nurses, health visitors and social workers who are trying to combine care of individuals with an understanding of the needs of whole communities. Its themes are relevant to teachers in different professional disciplines, to members of Primary Care Group and Trust Boards, to planners and managers of primary care services, as well as to practitioners. The authors bring to this book their experience in general practice and community nursing, their expertise in service development and management, and their awareness of primary care research. Dr. Steve Iliffe has been an inner-city general practitioner in London since 1978, and is Reader in General Practice at the Royal Free and University College Medical School, where he is co-director of the Centre for Ageing Population Studies (CAPS) and manages the Primary Care for Older People research and development programme. He can be contacted at [email protected]. Vari Drennan has been a community health service manager , specialist health visitor for older people and health visitor since 1980 and is currently a senior lecturer in primary care nursing in the Department of Primary Care & Population Sciences at the Royal Free and University College Medical School. She can be contacted at [email protected],

This accessible and authoritative book provides an invaluable guide to identifying, treating and preventing depression in later life. Jill Manthorpe and Steve Iliffe take a multidisciplinary approach and employ both medical and psycho-social models of depression. The medical model is used to identify symptoms, make diagnoses and work towards optimal treatment. Psycho-social perspectives provide insight into the scale and complexity of the condition and point to its social causes. The authors identify different levels of depression through in-depth analysis and consider the condition in relation to, but distinct from, dementia, psychosis and anxiety disorders, helping professionals to make the correct diagnosis. Supporting case studies show that depression, and the physical symptoms often linked to it, are amenable to treatment. The authors provide practical guidance for health and social care practitioners and suggest numerous coping strategies. This comprehensive book is essential reading for health and social care practitioners working with older people, their carers and families.

This practice and training guide is written with the needs of health and social care professionals working with people with dementia in mind. Drawing together theoretical considerations and examples of good practice, the authors look at the different stages of dementia and explain how to: * make the initial diagnosis - including guidelines for distinguishing dementia from depression; * convey the diagnosis to the person with dementia and their family - outlining the use of cognitive tests and the role of anti-dementia drugs; * support the client through lifestyle adjustments; * care for end-stage dementia patients - looking for example at the choice between community or institutional care. The book is illustrated with case studies and includes a chapter on understanding and responding to the needs of the carer - such as access to information and support - and the effect on their own health. Outlining the shared knowledge base required by health and social care practitioners, this useful and accessible work book will also facilitate inter-disciplinary and inter-agency working.