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In April 1999, 481 English Primary Care Groups (PCGs) were created. The National Primary Care Research and Development Centre is leading a three year longitudinal study, in conjunction with the King’s Fund, to track the development of PCGs. The implementation of clinical governance is an important responsibility of PCGs. This survey aimed to describe initial progress in implementing clinical governance in primary care, and to describe barriers to change. Data were collected in autumn 1999, using a questionnaire to clinical governance leads, in a random sample of 72 PCGs. PCGs have put considerable effort into the development of clinical governance and an extensive range of activities were planned for tracking quality of care. However, PCGs face barriers in implementing clinical governance and they must foster a culture of engaged participation by practices and practice staff. PCGs must also be given the time and resources needed to implement clinical governance.

The paper seeks to show that the new General Medical Services (GMS) contract will provide opportunities for NHS staff to enhance their roles, so it is important that adequate training assessment and quality control systems are set in place. This paper assesses the implications for NHS staff in primary care.

In this paper a review of policy documents was undertaken.

The paper finds that enhanced services set out in the new GMS contract may be provided by primary care organisations and healthcare professionals other than those located in general practitioner (GP) practices. As nurses and other healthcare professionals take on tasks previously conducted by GPs, so GPs will take on more consultant tasks previously confined to secondary care. Personal Medical Services (PMS) and GMS are converging in their contractual obligations and the opportunities offered to staff. As well as General Practitioners with Special Interests (GPwSIs), Practitioners with Special Interests (PwSIs) are important developments, which could promote recruitment and retention in the nursing and allied health professional workforce. Nurses and other healthcare professionals will be the main source of staffing for services shifted from secondary care.

The paper shows that it will be important to identify whether these professionals can substitute for GPs, the boundaries to that substitution, and whether recruitment and retention are enhanced. Training for GPwSIs and PwSIs will be introduced or expanded but also needs accreditation and validation.

The paper provides an overview of the implications of the new GMS contract for nurses and other NHS professionals.

Primary Care Groups (PCGs) represent a natural evolution of the various models – total purchasing, multifunds and locality commissioning – embraced by the term “primary care commissioning”. They will involve large numbers of different professionals working together to commission improved health care for their populations. The total purchasing pilots (TPPs) were the subjects of an extensive evaluation which has highlighted the significance of developing and improving relationships between the key players as a prerequisite for the successful implementation of their strategy. Management arrangements were central to this success. Similar considerations will be of crucial importance for the PCGs which are considerably larger and more complex organisations than the TPPs.

Primary care cancer lead clinicians (PCCLs) act strategically in primary care trusts (PCTs) in England to improve communication and understanding of cancer across primary and secondary care and provide a link between Cancer Networks and primary care. The aim is to evaluate the first three years of the initiative.

A postal questionnaire was sent to all PCT chief executives in all PCTs in England and some were passed on to other PCT managers for completion. The response rate was 61 per cent. PCT directors of public health were the largest group of respondents (29 per cent). Most (74 per cent) PCCLs were GPs and 22 per cent were nurses.

PCCLs were most likely to focus on palliative care and preventive services. Key achievements were identified as raising awareness of cancer, developing relationships and promoting primary care. The personal skills of the PCCLs were important as was support of colleagues at all levels. Lack of time was a major barrier to achievement, as was a lack of understanding of the role from others. Links with the Cancer Networks were being developed. About 85 per cent of managers wanted the role to continue.

The paper illustrates that PCCLs are at the forefront of improving cancer services in primary care. They are particularly important in view of the priority of reducing premature deaths and promotion of healthy lifestyles.

Personal medical services pilots were introduced in England in 1998 to provide increased flexibility to general practitioners practising in deprived areas, to improve service provision and reduce inequalities. The aim of this study was to identify health authority perspectives of the achievements of their pilots. Less than half of the health authorities agreed that their pilots’ original objectives had been completely achieved. Support, commitment and enthusiasm from within and outside the pilots, and the ability to be flexible, were helpful in promoting change management. Obstacles were financial difficulties and a lack of understanding of personal medical services. The opinion was that personal medical services had made a highly regarded contribution to the local health economy, especially in the provision of new services and the promotion of new staff roles. The results provide lessons for primary care organisations in England and elsewhere in terms of the factors required to successfully implement change.

A postal questionnaire was successfully used to determine general practitioner views about the quality of the health care services available to their patients. In the case of hospital services, 75 of the 112 respondents (67 per cent) chose orthopaedics and 52 (46 per cent) chose ophthalmology as services in need of improvement. Other hospital‐based services, chosen by at least ten general practitioners, were gynaecology, gastroenterology/endoscopy, medicine for the elderly, radiology/ultrasound, psychiatry and physiotherapy. Only 74 general practitioners chose community services, with health visiting being chosen by 25 respondents, district nursing by 24, physiotherapy by 20 and chiropody by 18, as being in need of improvement. The survey was intended to provide a basis for a dialogue between clinicians, managers and general practitioners, about how the quality of services could be improved and how they might be developed in the future.

Research Governance has been introduced to regulate research involving National Health Service (NHS) patients and staff but the process is lengthy and bureaucratic and has improved little since its introduction. The paper seeks to investigate changes over time.

A comparison between two studies, one in 2003‐2004 and the second in 2004‐2005, provided the opportunity of observing the process of Research Governance as it was developing. Both studies included postal questionnaire surveys and interviews with study participants.

In order to achieve Research Governance approval, application forms have to be completed, reviews undertaken, sponsors and indemnity information identified and honorary contracts from individual PCTs applied for. Honorary contracts can require references and health and Criminal Records Bureau checks. The process reduces the time available for research and employs large numbers of people, yet is still inefficient. Some of the requirements reduce the quality of the research and researchers' rights are marginalised.

The studies took place in a rapidly changing research environment. Further studies should continue to assess the situation and report any progress in making Research Governance less onerous for researchers.

There is an urgent requirement to investigate how procedures can be simplified and made less bureaucratic and costly, and to protect the rights of researchers. Without this, primary care research will be seriously disadvantaged and may become impossible to pursue.

The study compares process over time and shows that achieving Research Governance approval is seriously limiting research in primary care.

To successfully purchase, commission and manage health services at the primary care level requires accurate, reliable, up‐to‐date and appropriate information for use by trusts, health authorities, and by the soon to be operational primary care groups. The national total purchasing evaluation has provided evidence which will be relevant to primary care groups, particularly in the areas of information technology (IT) and access to information. Progress in developing independent purchasing by total purchasers was slower than anticipated because of the large number of factors which had to be taken into account, of which IT and information were just two. Accurate and timely information will be crucial for primary care groups if they are to move from level 1 to level 4 without undue delay.

Primary care in the UK has been the subject of numerous changes and reorganizations since 1990. Each innovation in organization, with the exception of fundholding, has been the subject of evaluation. However, the complexities of some innovations make the evaluation process problematic and this is further complicated by the trend towards central policy decision making being subject to local interpretation and implementation, by means of simultaneous devolution and centralization. This paper discusses the challenges and problems posed by attempting to evaluate these new organizations, particularly with regard to whether or not they can be considered to be “successful”. It draws specifically on the national evaluation of the total purchasing pilots and indicates how the findings can be applied to primary care groups.

Contracts and interim local evaluation reports for the 14 first wave PMS pilots in Northern and Yorkshire region were analysed by documentary analysis. Both contracts and reports were found to vary considerably in size and scope. Most contracts contained aims and objectives that were too broad or vague to guide project management and they lacked useful milestones. This made it difficult to identify criteria for measuring success. The local evaluation reports were also of variable quality. It is recommended that contracts should be accompanied by a development plan containing specific objectives, timescale and process for implementation as well as an evaluation strategy. The relative importance of different targets should be agreed and specified at the outset, to allow weighting of partial success, where some objectives, but not others, are achieved. Project milestones would be made explicit and measurable in the development plan. More clarity in contracts and evaluation for future pilots is essential.