Family Practitioner Committee Research Articles

Accuracy of electoral registers and Family Practitioner Committee lists for population studies of the very elderly.

The purpose of the study was to assess the accuracy of Family Practitioner Committee (FPC) lists for identifying very elderly people registered with general practitioners. The accuracy of available FPC lists was checked against the most recent electoral register to determine which recorded individuals were still living at their FPC registered addresses. This was followed by a postal and home visit enquiry to validate the accuracy of the electoral register. The study was carried out in the London borough of Hackney. The investigation was confined to persons aged 85 and over. Of a total of 3018 people listed as being 85 years or over by the FPC, 1183 (39%) were listed on the electoral register. Of these, 751 (63%) were living at their registered address, ie 25% of the people in the original FPC list. A further 154 (5%) of the original list were not recorded on the electoral register but were alive at the FPC recorded address. the use of FPC lists alone to identify the very elderly in an inner city population is too inaccurate to be of value. The combined use of FPC lists and the electoral register is better but one in six persons will still be missed.

Role of community pharmacies in prevention of AIDS among injecting drug misusers: findings of a survey in England and Wales.

To determine the current and potential roles of community pharmacists in the prevention of AIDS among misusers of injected drugs. Cross sectional postal survey of a one in four random sample of registered pharmacies in England and Wales. Project conducted in the addiction research unit of the Institute of Psychiatry, London. 2469 Community pharmacies in the 15 regional health authorities in England and Wales. Willingness of pharmacists to sell injecting equipment to known or suspected misusers of drugs; pharmacists' attitudes to syringe exchange schemes, keeping a "sharps" box for use by misusers of drugs, and offering face to face advice and leaflets; and opinions of community pharmacists on their role in AIDS prevention and drug misuse. 1946 Questionnaires were returned, representing a response rate of 79%. This fell short of the target of one in four pharmacies in each family practitioner committee area in England and Wales, and total numbers of respondents were therefore weighted in inverse proportion to the response rate in each area. The findings disclosed a substantial demand for injecting equipment by drug misusers. After weighting of numbers of respondents an estimated 676 of 2434 pharmacies were currently selling injecting equipment and 65 of 2415 (3%) were participating in local syringe exchange schemes; only 94 of 2410 pharmacies (4%) had a sharps box for used equipment. There was a high degree of concern among pharmacists about particular consequences of drug misusers visiting their premises, along with a widespread acceptance that the community pharmacist had an important part to play. Promoting the participation of community pharmacists in the prevention of AIDS among misusers of injected drugs is a viable policy, but several problems would need to be overcome before it was implemented.

Cervical screening and family practitioner committee registers.

Cervical screening and family practitioner committee registers.

Accuracy of family practitioner committee registers.

Accuracy of family practitioner committee registers.

General practitioners' continuing medical education within and outside their practice.

To study continuing medical education 96 out of 101 general practitioners chosen at random from the list held by a family practitioner committee were interviewed. The results provided little evidence of regular attendance at local postgraduate centre meetings, though practice based educational meetings were common. Thirty one of the general practitioners worked in practices that held one or more practice based educational meetings each month at which the doctors provided the main educational content. Performance review was undertaken in the practices of 51 of the general practitioners, and 80 of the doctors recognised its value. The general practitioners considered that the most valuable educational activities occurred within the practice, the most valued being contact with partners. They asked for increased contact with hospital doctors. The development of general practitioners' continuing medical education should be based on the content of the individual general practitioner's day to day work and entail contact with his or her professional colleagues.

Evaluation of the cervical cytology screening programme in an inner city health district.

District health authorities have been instructed to operate a cervical cytology call and recall screening programme using the age-sex registers held by family practitioner committees. A detailed evaluation of implementation in an inner London district showed that 477 out of 687 (69%) invitation letters sent to women by the family practitioner committee were either inaccurate or inappropriate: almost half of the recorded addresses were incorrect and a further fifth of the women were not eligible for a test. Overall, 90 women had a smear, which is only 13% of the total but 43% of those found to be eligible. The findings did not differ significantly with age. The findings have major implications not only for the effectiveness of call and recall for screening for cervical cancer but also for the future development of screening for breast cancer in such areas.

Attendance and non-attendance for breast screening at the south east London breast screening service.

To ascertain the reasons for a low rate of response for breast screening. All relevant aspects of the organisational process examined, including general practitioners' notes. Non-responders visited and interviewed. An inner city breast screening service working on the model advocated by the Forrest report. 288 Women aged 50-64 registered with several general practices and invited for screening by post. Determination of factors important for success of breast screening programmes. After five women were excluded by their general practitioners the response rate was 129 out of 283 (46%), but 99 (35%) of the women did not receive their invitations because of inaccuracies in the family practitioner committee's database and general practitioners failing to check women's addresses completely. Increased rates of response will depend on enabling general practitioners to check addresses and on an increased awareness of the importance of information.

Responses by general practitioners in Avon to proposals for general practice in the white paper Working for Patients.

To determine the views of Avon's general practitioners about the general practice proposals within the government's white paper Working for Patients. Postal questionnaire survey. A county in south west England. All general practitioner principals (n = 537) under contract with Avon Family Practitioner Committee. 492 doctors (92%) responded to the survey. More than three quarters of the respondents were opposed to the government's proposals on budgets for specific surgical procedures, prescribing, and diagnostic tests; and between 63% and 93% felt negative about advantages that might accrue from the proposals. Over three quarters of general practitioners were in favour of family practitioner committees monitoring work load, prescribing, and referrals. General practitioners in large, potentially budget holding practices held similar views to doctors in smaller practices. Avon's general practitioners substantially reject most of the government's proposals about general practice in the white paper Working for Patients.

Mental health, job satisfaction, and job stress among general practitioners.

To identify sources of job stress associated with high levels of job dissatisfaction and negative mental wellbeing among general practitioners in England. Multivariate analysis of large database of general practitioners compiled from results of confidential questionnaire survey. Data obtained on independent variables of job stress, demographic factors, and personality. Dependent variables were mental health, job satisfaction, alcohol consumption, and smoking. National sample of general practitioners studied by university department of organisational psychology. One thousand eight hundred seventeen general practitioners selected at random by 20 family practitioner committees in England. None. Determination of the combination of independent variables that were predictive of mental health and job satisfaction. Women general practitioners both had job satisfaction and showed positive signs of mental wellbeing in contrast with other normative groups. Conversely, male doctors showed significantly higher anxiety scores than the norms, had less job satisfaction, and drank more alcohol than their women counterparts. Multivariate analysis disclosed four job stressors that were predictive of high levels of job dissatisfaction and lack of mental wellbeing; these were demands of the job and patients' expectations, interference with family life, constant interruptions at work and home, and practice administration. There may be substantial benefit in providing a counselling service for general practitioners and other health care workers who suffer psychological pressure from their work.

Preliminary results of a district call scheme for cervical screening organised in general practice.

A recognised problem with the cervical screening programme in the United Kingdom is the failure to include women who have never had a cervical smear test, who are a high risk group. The implementation of a district based call scheme in East Berkshire in 1986 is described whereby women aged 20-64 with no record of a cervical smear test who were judged to be eligible for testing by their general practitioner were sent a personal invitation from their general practitioner to attend for a test. A list of high risk unscreened women was kept by each practice, and a duplicate sent to the cytology laboratory to update the central records. Six months after each batch of invitations had been sent the resulting number of women having a smear test was assessed. Forty three of 51 practices approached agreed to participate in the five year scheme. During the first year lists were sent to the 43 participating practices. The first list was returned to the cytology laboratory by 37 practices and the second by 33; practices varied in their responses, however, some needing considerable persuasion to return the lists. Of 972 identified unscreened women from the total 3757 women listed in the lists of the family practitioner committee, 247 (25%) had a cervical smear test in response to the invitation, representing an overall increase of 7% in the screened population. The preliminary findings of the five year study have shown that screening can be improved by a systematic call scheme. Coordinated support from the area health authority in health education, monitoring of screening, and feedback of data from the scheme to practices is required to reduce the proportion of unscreened women.

General practitioner survey in Stockport: Reference cervical cytology screening service

In Stockport in early 1987 a postal survey of local general practitioners (GP's) was conducted. The response rate was high (86%) and the majority of respondents (87%) stated that they were satisfied overall with the current screening programme locally. Some of the suggestions for improving the service and points of dissatisfaction were brought to the attention of the Family Practitioner Committee and of Community Physicians at District and at Region. It is suggested that this method may be a useful form of audit.

Community care minister?

The Society of Family Practitioner Committees has called on the Government to appoint a Minister with a direct responsibility for the implementation of community care.

The Emperor's New Clothes: Family Practitioner Committees in the 1980s (Book).

The Emperor's New Clothes: Family Practitioner Committees in the 1980s (Book).

Investigation of non-responders at a cervical cancer screening clinic in Manchester.

Uptake of cervical cytology screening in a Manchester practice has been very low (14%) in spite of the family practitioner committee introducing a call and recall system. A questionnaire was used to investigate the attitudes of non-responders, who were all from social classes IV and V. Attendance was found to be inhibited by a high level of anxiety about the test and about cervical cancer, by erroneous beliefs, and by concurrent family difficulties. More than half the non-attendance was directly attributable to administrative errors, which resulted in appointments being sent to wrong addresses or to inappropriate people (four after hysterectomy, 10 who had had recent smears). These matters require urgent attention. Several simple measures might improve attendance at clinics, follow up of patients, and attitudes toward screening: invitations to attend the clinic, a register of patients and results, a simpler version of the leaflet, use of well known personalities to promote cervical screening, health education campaigns, and regular evaluation of records.

Hertfordshire sets up computerised screening.

A new county-wide system in Hertfordshire for computerised cervical cancer screening run by the four health authorities and the Family Practitioner Committee aims to contact 1000 more women.

Newly registered elderly patients: who are they and why such delay in the transfer of their medical records?

The time taken to transfer the records of elderly patients registering with a new general practice was investigated. Thirty five (5%) of a total of 671 patients aged 75 and over were entered as new patients on to the age-sex register of an urban group practice during one year. Twenty nine had moved into the area and six had changed their general practitioner for personal and other reasons. An average of 141 (range 71-296) days elapsed before dispatch of their medical records to the new practice. During this period an average of 3.5 (range 0-15) consultations with a general practitioner were recorded, indicating the need of such patients for medical care. The long delays were caused by the processing of medical records at the central register and the transfer of records between family practitioner committees and general practitioners. Delays were most apparent in the time taken for general practitioners to dispatch the necessary documents to the family practitioner committees, and these should be minimised. The use of a summary card written and updated by the general practitioner and retained by the patient would facilitate continuing care should patients change to a new practice. Meanwhile, assessment of elderly patients after registration with a new practice by a member of the primary health care team may identify problems before the records have been transferred and may help the resettlement of these high risk elderly patients.

Item of service remuneration in general practice in the UK: what can we learn from dentists?

In response to the UK Government's proposal to increase the proportion of general practitioner income accruing from capitation payments the General Medical Services Committee of the British Medical Association has called for an extension of fee for item of service provision in general practice. In this paper the allocation of resources in primary care dentistry, where fee for service provision is currently used, is analysed in order to shed light on the debate. Since dentists' fees are set in accordance with average dentist time inputs, differences in cost per treatment course reflect differences in course content. Multiple regression techniques are used to estimate a cost per treatment course function. Using cross-sectional data for family practitioner committees in England and Wales for 1982 a significant negative correlation is found between cost per course and population per dentist after allowing for patient demand and need characteristics. A 10% decrease in population per dentist is associated with a 2.5% increase in cost per course. The observation cannot be explained by dentists rationing treatment in the presence of excess demand owning to the nature of the dentist contract. These results imply that in areas of greater supplies of dentists additional course content is being induced by dentists in order to maintain workloads. Hence although fee for service provision offers a financial incentive to increase service provision it offers no incentive to allocate services efficiently, that is in accordance with greatest need. The extension of fee for service provision in general medical practice would appear to be inconsistent with an objective of allocating scarce primary care resources in accordance with patient need.

Characteristics of subjective insomnia in the elderly living at home.

Profiles of sleeping habits, subjective sleep quality, and mental and physical well-being were obtained from 1023 elderly individuals randomly sampled from the Nottinghamshire Family Practitioner Committee's records. Subjective insomnia at least 'sometimes' was reported by 37.9% of the sample. Discriminant analysis of selected health and demographic variables indicated that symptoms of anxiety, sex and self-ratings of health were the factors most influential in predicting reports of problem sleep. Thus, respondents classified as subjective insomniacs tended to have significantly higher anxiety scores, to be women, and to rate their health as below average. Relative to the non-insomniac respondents, those complaining of sleep problems also perceived their sleep latency as longer, and their total sleep as shorter. These results emphasize that, in addition to apparently 'normal' age-related changes in the structure of sleep, subjective insomnia in old age may often be mediated by the physical and psychological disorders which can accompany ageing.

Stem cells in normal growth and disease.

Proceedings in Cases Relating to Hospital Medical and Dental Staff (HM(61)112). Originally circulated to health authorities in 1961 by the Ministry of Health, this document remains unchanged since that time. The fact that the health service has moved apace, as has society, seems to have gone unnoticed. The document establishes, though by no means clearly, a series of steps starting from preliminary investigation for the establishment of a prima facie case and progressing through to a formal inquiry. These inquiries are formal and legalistic, requiring a high standard of proof, with many rights enshrined for the consultant under investigation, including the ability to comment on the proceedings, to make a plea of mitigation, and to appeal to the Secretary of State. In practice this results in years of delay and excessive cost to the various health authorities. There are currently approximately 40 NHS consultants suspended on full pay pending such inquiries, and this could add up to a cost of ?4 000 000 to the health service. There is certainly a case to be made for reviewing this disciplinary procedure which benefits neither the doctor nor the service. Until we have a clearer system which has the support of consultants and health authorities, difficult and often painful cases will continue to arise in which problems of competence may be confused with difficult relationships and interpersonal problems. Teaching districts and university based medical schools have different disciplinary procedures. The teaching districts' consultant contracts are district based and disciplinary procedures receive the attention of the district medical officer rather than being directed to the region, while teaching hospitals may direct problems through the university disciplinary procedure. Cases concerning professional conduct and competence in general practice will be directed to the family practitioner committee.

Mental health and contact with primary care services in old age

AbstractProfiles of mental and physical health status and reports of contact with primary care and personal social services were obtained from 979 individuals aged 65 years and over randomly selected from the Nottinghamshire Family Practitioner Committee's records. On the basis of personal disturbance scores derived from the Symptoms of Anxiety and Depression scale (SAD) administered at the time of interview, respondents were classified as psychiatrically ‘normal’, ‘borderline’ or ‘ill’. Those classified as psychiatrically ‘ill’ were significantly more likely to report recent contact with both general practitioners and certain personal social services than were those classified as psychiatrically ‘normal’. Intermediate levels of contact were found among those classified as borderline (between normal and ill). The prescription and use of psychotropic drugs showed a similar mental health gradient. While SAD scores were positively and significantly related to the number of reported physical health problems, the overall correlation between mental and physical health scales was modest (rho = 0.41, p < 0.001). These results indicate that while mental health problems are clearly influential in determining family doctor consultations among the elderly, a substantial number of emotionally disturbed elderly people do not consult their general practitioners during the currency of their symptoms.