In the UK, policy changes in primary health care research and development have led to the establishment of primary care research networks. These organizations aim to increase research culture, capacity and evidence base in primary care. As publicly funded bodies, these networks need to be accountable. Organizational science has studied network organizations including why and how they develop and how they function most effectively. This paper draws on organizational science to reflect on why primary care research networks appear to be appropriate for primary care research and how their structures and processes can best enable the achievement of their aims.

Management practice arising from parallel policies for modernizing health systems is examined across a purposive sample of 16 countries. In each, novel organizational developments in primary care are a defining feature of the proposed future direction. Semistructured interviews with national leaders in primary care policy development and local service implementation indicate that management strategies, which effectively address the organized resistance of medical professions to modernizing policies, have these four consistent characteristics: extended community and patient participation models; national frameworks for interprofessional education and representation; mechanisms for multiple funding and accountabilities; and the diversification of non-governmental organizations and their roles. The research, based on a two-year fieldwork programme, indicates that at the meso-level of management planning and practice, there is a considerable potential for exchange and transferable learning between previously unconnected countries. The effectiveness of management strategies abroad, for example, in contexts where for the first time alternative but comparable new primary care organizations are exercising responsibilities for local resource utilization, may be understood through the application of stakeholder analyses, such as those employed to promote parity of relationships in NHS primary care trusts.

ObjectivesTo assess the effectiveness and feasibility of mandatory, multidisciplinary education, in the context of a primary care organisation service development programme for diabetes care. To identify any obstacles to change and to measure changes in knowledge, service organisation and attitudes after a university based course in diabetes care.The courseIt was mandated by the primary care group of Ladywood, Birmingham, UK, that one general practitioner and one nurse from each practice should attend a course in diabetes care, which comprised 30 hours spread over 3 months, with three pieces of assessed coursework and a written examination. The programme, led by a shared vision of committed local leaders, also included consultant‐led community diabetes clinics, shared software for all providers, and payment for minimum primary care standards.DesignA longitudinal study of the first cohort of the course, using a questionnaire administered at the start of the course and repeated one year later.SettingLadywood Primary Care Group, Birmingham, UK, comprising 38 practices in this area of high deprivation.Main outcome measuresComparison of the mean knowledge scores of 16 general practitioners and 12 nurses in relation to 68 diabetes‐related topics before the course and one year later. Measurement of changes in the organisation of diabetes care within practices during the year after the course. Views on the acceptability of mandatory, multidisciplinary education.ResultsThere was a statistically significant increase in the mean knowledge scores of general practitioners (p≤0.01) and practice nurses (p≤0.01) over all topics. There were statistically significant changes in many organisational aspects of diabetes care within practices, for example the proportion undertaking annual reviews and having dedicated time for diabetes clinics. Several obstacles such as time and resources, both human and financial, were identified by participants as barriers to further change. The mandatory course was accepted by most participants. The experience of doctors and nurses learning together was regarded by some as an unexpected benefit of the course.ConclusionA defined need for education in primary diabetes care as part of a service development programme was met successfully by this course and found acceptable. There were measurable changes in the knowledge of health care professionals one year after the course. Improvements in the organisation of diabetes care were reported, which can be attributed to the whole programme, not only the course, although the usual obstacles to change were found. Future research is needed to identify the persistence of the changes and their presence in a larger sample and in other settings. A mandatory, multidisciplinary education might be usefully adopted by primary care organisations in their service development programmes. In particular this is relevant to the implementation of the UK national service framework for diabetes. Copyright © 2001 John Wiley & Sons, Ltd.

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Alternative approaches to the comparative analysis of international health systems developments are reviewed in relation to the advent of new primary care organizations in countries with parallel 'modernizing' policies. A framework for transferable learning between these is articulated and its design described. This is derived from priorities defined by lead policy and practice representatives in UK primary care. It points to the benefits of examining the interaction of critical new public management and planning functions as an effective vehicle for identifying both individual country role models and shared international experiences. Illustrative examples are provided in five subject areas ranging from local engagement to multiple forms of financing.