GP Cluster Research Articles

Public health, primary care and the 'cluster' model

This issue of the European Journal of Public Health contains a series of Viewpoint contributions from Professor Adany and colleagues concerning a Hungarian programme for the improvement of primary health care in that country. The programme is supported by the Government of Switzerland. The aim is to encourage general practitioners to participate in services with a public health and population focus. The aim is thus to create a primary health care system that, in addition to traditional patient care services, focuses on health promotion, disease prevention and restoration of health within communities, as well as the effective rehabilitation of chronically ill people. A so-called ‘GP cluster model’1 will be created, each cluster consisting of a network of collaborative primary care practices (each will comprise six practices). In addition to the traditional curative services, these clusters can provide health-promotive and disease-preventive services by sharing the time and cost of employing staff working in these areas, such as public health professionals, health psychologists, physiotherapists and dieticians. This is an important initiative, worthy of attention and careful evaluation. It adds to present efforts across the WHO …

Dementia skills and competencies for primary care liaison: a model for improving identification and timely diagnosis

The need to improve the response of primary care in terms of identification of people with undiagnosed dementia has long been recognised. The role of Primary Care Liaison was identified as a possible solution. An in-depth consultation was undertaken to identify professional competencies required in executing such a role. Comprehensive literature and policy reviews were conducted to establish draft competencies or different options/combinations of competencies and competency levels. Consultations with a wide range of professional stakeholders (n = 23) and over 70 users and carers were conducted through focus groups, electronic document circulation and telephone interviews. An Equality Impact Assessment was conducted concurrent to the consultation. The literature demonstrated a clear need both to improve the rate of diagnosis for people with dementia and to improve the way in which the diagnosis is made. The stakeholder consultation repeatedly affirmed that without a diagnosis the person with dementia and their caregivers did not get access to the appropriate services, and validated the need for a role that would be able to improve a system that would deliver an early and 'timely' diagnosis. Competencies, based on the literature and policy documents, were developed and debated through the consultation processes. Three main areas of competency were identified: counselling; screening; and health education and promotion. The competencies identified require a skilled experienced professional approach. A useful team model would be that the role is placed within a 'GP cluster' as accessibility to GP records and collaborative working with GPs is essential within the role. Personal continuing professional development has a high profile in maintaining these competencies.

SCF-Xα scattered wave cluster study of molecularly adsorbed NO on Ni

SCF-Xα SW calculations have been performed on model clusters representing molecularly adsorbed NO on different sites of Ni surfaces: on-top and fourfold hollow positions on Ni(100) and a threefold site on Ni(111). The chemisorption bond is found to be formed through adsorbate-to-metal donation mainly via 4σ̃gs and 1π̃gp orbitals and back donation into the 2π ∗ orbital of NO. The molecular 2π ∗ orbital interacts with a manifold of substrate levels leading to a “broadening” of this level. A strong mixing of the 2π ∗ orbital both to the 1 \\ ̃ gp cluster orbital and to the band like 2π manifold leads to a weakening of the intramolecular bond of the adsorbate, especially for hollow site adsorption. The chemisorptive bond strength is found to increase with the metal coordination of the adsorption site leading to a definite preference of hollow positions over on-top positions.