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The paper seeks to identify determinants of general practice staff's intention to further implement a smoking cessation expert system, a computer‐generated tailored intervention, following their participation in an effectiveness study.

Written questionnaires based on the I‐Change Model, a socio‐cognitive model, were left in general practices where the expert system had been trialled. Respondents intending to continue their use (intenders, n=62) were compared to those who did not (non‐intenders, n=27).

Eighty‐nine individuals from 55 practices responded (73 per cent). GPs were more often intenders than general practice assistants. Responses from the same practice were not significantly related to each other. Intention to continue using the expert system was determined by a more positive attitude towards the expert system, a social norm towards engaging in smoking cessation activities, and higher self‐efficacy. Practice staff who had actively offered the expert system to their patients were more likely to be an intender.

Cognitive factors and trial involvement determined intention to further implement the expert system. Discussing barriers with practice staff could increase motivation to implement and ownership. Intenders can aid the implementation process by sharing experiences with non‐intending peers.

Considers the use of information technology in the UK National Health Service (NHS) as the government pledges to connect every doctor or general practitioner (GP) to the NHS’s information superhighway by the year 2002. This paper uses a case study of a particular UK health authority as a vehicle to illustrate the complexity of the social and technical considerations surrounding this issue. At a grass roots level, the adoption and diffusion of information technology within general practices (surgeries or groups of GPs) is highly varied and there are huge contrasts in the levels of commitment to information management. Within the case study this is evident on an individual level, in that some GPs enthuse about technology, while others are positively “technophobic”. On the general practice level, there are other elements to consider, especially in relation to the levels of financial support available. Non‐fund holding general practices in socially deprived areas are far less willing to embrace information management and technology. One explanation suggested for this is based on priorities: when faced with the option of “cruising” the information superhighway, as opposed to treating seriously ill patients living in socially deprived areas, the former may simply be relegated as less important.

The purpose of this paper is to describe a national, comprehensive quality indicator set to support delivering high-quality clinical care in Irish general practice.

Potential general practice quality indicators were identified through a literature review. A modified two-stage Delphi process was used to rationalise international indicators into an indicator set, involving both experts from key stakeholder groups (general practitioners (GPs), practice nurses, practice managers, patient and health policy representatives) and predominantly randomly selected GPs. An illustrative evaluation approach was used to road test the indicator set and supporting materials.

In total, 80 panellists completed the two Delphi rounds and staff in 13 volunteer practices participated in the road test. The original 171 indicators was reduced to 147 during the Delphi process and further reduced to 68 indicators during the road test. The indicators were set out in 14 sub-domains across three areas (practice infrastructure, practice processes and procedures, and practice staff). Practice staff planned 77 quality improvement activities after their assessment against the indicators and 31 (40 per cent) were completed with 44 (57 per cent) ongoing and two (3 per cent) not advanced after a six-month road test. A General Practice Indicators of Quality indicator set and support materials were produced at the conclusion.

It is important and relatively easy to customise existing quality indicators to a particular setting. The development process can be used to raise awareness, build capacity and drive quality improvement activity in general practices.

The authors describe in detail a method to develop general practice quality indicators for a regional or national population from existing validated indicators using consensus, action research and an illuminative evaluation.

Policymakers implementing pay-for-performance schemes within general practice should seek to design schemes which work with rather than against the professional values and goals of general practitioners. In this way, schemes are more likely to enhance the practitioners' engagement. The purpose of this paper is to show how this was done in two case studies of pay-for-performance design and present the lessons from this study for policymakers.

A Most Similar Systems collective case study of the design of two pay-for-performance schemes for general practitioners, the United Kingdom's Quality and Outcomes Framework (QOF) and the New Zealand’s Performance Management Programme (PMP) was undertaken, involving 26 semi-structured interviews with policymakers, documentary and literature analysis.

Innovation in processes was found in both case studies which facilitated engagement by general practitioners in the formulation and implementation of these schemes. These were careful selection of highly skilled design teams, use of principle-based negotiation techniques and academic mediation of indicator selection. In addition, in England the majority of members in the combined QOF design team were general practitioners. The evidence from these two case studies reinforces approaches to scheme design which seek to harness rather than challenge medical professional values and which maximise the participation of general practitioners in the design process. Achieving funder/practitioner collaboration should be a key goal in the policymaking process.

Pay-for-performance scheme designers can improve their ability to engage general practitioners in scheme design and scheme uptake by adopting approaches which actively engage general practitioners as designers and users of such schemes.

This study compares two contemporaneous processes of pay-for-performance scheme design and implementation in similar systems of general practice funding and delivery at the national level, offering a rare quasi-experimental opportunity for learning lessons from comparative analysis.

Examines the sources of stress associated with high levels of job dissatisfaction and mental health among practice managers and women general practitioners, and compares the job satisfaction, mental health and job stress among practice managers and women general practitioners. Women general practitioners (n = 75) and practice managers (n = 51) completed anonymous questionnaires. Lack of communication and co‐operation between colleagues and staff were the main sources of dissatisfaction and lack of mental wellbeing for both groups. In addition, wishful thinking coping factor was predictive of job dissatisfaction and mental ill‐health. There was no significant difference between practice managers and women general practitioners on the mental health scale. Women general practitioners experienced less job satisfaction with regard to the amount of work, and hours of work than the practice managers. There may be substantial benefit in initiating a support network system for these professionals.

The purpose of this paper is to report on the findings of the first stage of a project seeking to improve interprofessional working between general practice and adult social care teams. It develops the current evidence base through findings from focus groups and reflects on the implications of the findings for interprofessional collaboration.

The project involved running seven focus groups with general practice staff and adult social work teams to explore their perceptions and understanding of each other.

The focus groups highlighted that the negative aspects of interprofessional working outweighed the positives. Negatives included perceptions of different value bases, a lack of knowledge about each others’ roles and responsibilities which resulted in resorting to stereotypes, poor interprofessional communication and a sense of an unspoken professional hierarchy with general practitioners (GPs) at the top leading preventing a culture of appropriate challenge.

The research has only been conducted with four GP practices and three social work teams that had expressed an interest in improving their interprofessional working. Therefore the findings may not be generalisable.

The case study suggests that there is a lack of effective interprofessional working between social care teams and general practice. With the current health and social care agenda focused on integration, this suggests there should be a greater focus on this area.

This paper illustrates that despite many years of policy makers promoting better integration, the quality of the interprofessional collaboration between social care teams and general practice remains poor.

Partners and practice managers are beginning to understand implications of management issues raised by recent reforms. Practices involved in this study agree the need for improvement, but partners and managers were often unable to define improvements needed. Demonstrates that effective management structure is vital to future success for general practice. To achieve this involves understanding new managerial challenges practices must meet and different organizational competences required. To change requires a radical restructure of many practice roles and several options are considered. Regardless of the chosen option the question of training remains. There is a need to involve consultants, managers, and doctors already advancing the boundaries of practice development, in a dialogue with institutions providing management training, to design suitable programmes. Academic institutions too often produce management programmes geared towards the old environment, whereas managerial skills which changes in the NHS demand from future practice managers are now required.

Looks at the role of the GP in today′s Service and examines some of the organizational and motivational problems which have to be overcome before general practice can be confident of delivering to the strategic expectations of the NHS. They are designed to raise the level of debate for more long‐term, practical support for general practice organizations. The issues involved have been researched both qualitatively and quantitatively and are grounded in a context of change. Includes excerpts from general practice profiles developed during research projects, consultancy projects and case study development work – large and small partnerships, single‐handed practices, established and “bidding” fundholders, and significantly different practice populations. These are supported by the results of questionnaires circulated to over 2,500 doctors and practice managers and the views and work of others researching and practising in primary care.

Standards for assessing and managing suicide risk were developed and incorporated into a guidance manual for general practitioners. The effects of the manual on opinions and practice were evaluated using a quasi‐experimental controlled before/after design, comparing participating general practitioners with others who did not use the manual. Thirty four general practitioners participated over a six‐month period. The intervention group showed changes in perceptions, with increased satisfaction with their own methods and in their recognition and assessment of suicide risk. Their practice changed, with increased recording of relevant factors in notes. The comparison group did not change in these ways. It is concluded that general practitioners’ practice and opinions in assessing and managing suicide risk were significantly improved using a minimal intervention. Given the importance of the topic and the small size of this study, further research is needed, examining changes in professional practice, knowledge and attitudes.

What does special education mean for general education teachers of students with disabilities? In this chapter, we share our approach to advancing values in the classroom placement of special education students in the general education setting. We will take the reader on a journey through time with “Jessie,” a special education student, as we examine the historical exclusion of students with disabilities to their inclusion in general education schools, environments and finally, general education classrooms. In doing so, we will examine the evolution of the general education teacher's role and how the historical perspective impacts current practices. Then, we will elucidate the benefits of inclusion, not only for the special education student but for the nondisabled peers as well. We will recommend values that should be maintained and practices that should be examined. This chapter will conclude with a connection between the values and recommendations of best practices for inclusive instruction.