Service Provision Development Research Articles

General Practitioners and Nurses Collaborating in General Practice

In 1998 the Fremantle Regional Division of General Practice (FRDGP), Silver Chain and the Health Department of Western Australia (HDWA) initiated an eleven-month trial which aimed to increase clinical integration by establishing professional partnerships between GPs and nurses. The project placed nurse in four general practices where they consulted with patients and undertook other activities that helped clarify nurse and GP roles within these partnerships. In addition to exploring some of the processes underlying development of partnerships, the project reported direct benefits for all stakeholders. For patients these included improved access and better quality of care. At an organisational level Silver Chain and general practices reported increased service provision and efficiency, additional promotion and marketing opportunities, improved networks with other providers, and opportunities for new business developments in service provision. From the professional practitioner perspective, doctors and nurses reported improved knowledge about the other profession and that the trial was an opportunity to explore role developments in the general practice context. Implications for expansion and development of a nursing role in general practice were discussed. The results suggest that further development of effective nurse/GP partnerships requires collaborative planning, close monitoring, and ongoing support for the processes of improved teamwork.

The evolving role of the clinical nurse specialist within the comprehensive breast cancer centre.

The collaborative functioning of a specialist multidisciplinary team is a fundamental prerequisite in the establishment of designated breast cancer units throughout the U.K. It is, therefore, opportune for clinical nurse specialists to examine carefully their unique contribution to the care of women with breast disease. This article explores the contemporary developments in service provision and identifies potential areas for nursing development. It is only when the role of the breast care nurse is explicitly defined can research begin to determine the effectiveness of nursing practice in terms of women's health.

Community occupational therapy in Hampshire: a review of developments in service provision

Hampshire social services, one of the largest departments in the country, have been looking imaginatively at the delivery of occupational therapy services. A review of current practice looked at innovative approaches and considered how these could be developed and incorporated into the department's strategic plan. This article contributes to the essential debate on how services can move forward in the changing climate of community care.

The changing role of Ards Mental Health Day Hospital

There has been a great deal of debate and uncertainty about the role of day hospitals. The current emphasis is on their use as an alternative to acute-in-patient care. There are, however, difficulties with this approach. This paper looks at developments in service provision in a day hospital in Northern Ireland, where the focus is on multidisciplinary assessment and group and sessional treatment, rather than day care.

How To Do It: Service provision and use of anticoagulants in atrial fibrillation

Several large trials have shown that the risk of stroke in patients with non-valvar atrial fibrillation is reduced by treatment with warfarin. Implementing this research evidence requires not only an understanding of the trials' results and of the changes that they imply for clinicians' treatment decisions but also an appreciation of the organisation, quantity, and quality of services required to support these changes. Understanding of these implications is crucial for developing services that allow changes in practice to produce reductions in stroke incidence while minimising the risks of treatment. This article considers the developments in service provision that will probably be required to support the changes in clinical practice suggested by the trials' results. These services will be provided largely by doctors, and their development has implications for doctors in both primary and secondary care.

ALCOHOL EDUCATION COURSES FOR OFFENDERS: TEN YEARS AFTER

Data from a survey of U.K. agencies are presented. Trends in service provision for drinking offenders are reported, in the context of two previous surveys. National development of service provision is examined, since the original survey, reported in 1982. Findings from the survey have suggested that the field has become stagnant, due to a failure to merge research and practice. Alcohol educators who continue to ignore lessons from such surveys may face extinction from the field.