International studies consistently demonstrate that individuals diagnosed with severe mental illness (SMI) have an increased risk of co-morbid physical health problems and premature death. During the past decade, government policy in the UK has focused on improving the physical health of those with SMI. Despite this, international research has continued to report barriers to accessing appropriate services. These have been identified as emanating from service users and professionals alike, and also from institutional bureaucracy. Most of this research has reported difficulties from the perspective of various professional groups, with little attention being paid to the service user voice. Studies from the service user perspective undertaken in the past 10 years equate to six qualitative and three quantitative studies, and it appears that poor physical health care remains a problem in the developed world. The quality of this care is compromised by practical problems and interpersonal difficulties between service users and health-care providers and between providers of mental health services and those providing physical health care. This paper presents a review of the nine international studies and discusses the implications for developing policy and practices that could lead to improved physical health-care services for people experiencing SMI.

The study reported here is one part of a wider study, evaluating the role of the nurse practitioner (NP) in primary care This part of the study focussed on the views of the primary health care team (PHCT) regarding their experience of working with two NPs. A project to place Master's prepared nurse practitioners (NP) in general practitioner practices was undertaken with the intention of more fully meeting the needs of practice populations in a deprived inner city area. The roles were supported and funded by the health authority and the placements were intended to be time limited with placement and funding to be reviewed. The project incorporated a planned evaluation of the role and this included a study of consultation patterns, caseload and this particular element, a study of PHCT members' attitudes to and experiences of the role. A purposive sample of 27 staff were interviewed using a partially structured interview format. Each interview lasted around 30 minutes with two researchers undertaking both collection and analysis of the interview data. Subsequently, an additional six staff were also interviewed in an opportunistic manner, at their request. The ndings identi ed two main foci of the NP; as an 'extra pair of hands' and as a colleague undertaking a different, valuable and complementary service to existing staff. The pivotal role of the receptionist in the integration of the new role in to the practice and the acceptance of it by patients was clear. General practitioners (GPs) exhibited paradoxical views, particularly with respect to problems of throughput; the NP having longer appointments and therefore usually undertaking fewer consultations than GPs in any session, leading to perceptions of an expensive and perhaps less effective service in terms of its effect on the workload. Within the same interview however, GPs discarded throughput as an effective measure of patient care and highlighted the many bene ts of NP consultation. This tension between cost and effectiveness would bene t from more effective analysis and evaluation. The members of the PHCT express many different views, often related to their professional priorities, but all appear to support the NP role enthusiastically, considering it a positive step which bene ts the team, patient care and choice. IntroductionThis paper focuses on a project undertaken in an inner city area, with high levels of socio-economic deprivation, located in the north west of England. The former health authority responsible for primary health care services was concerned that these services were increasingly failing to meet the needs of its local populations. This was felt to be partly due to dif culties in recruiting general practitioners (GPs), and in response to these dif culties, a nurse practitioner (NP) role was conceived as one which might add to the range of services and, thus, choice available for patients. Four GP practices were selected after a bidding process to pilot the development of this role. The pilot project was supported and funded by the health au...

Despite the small number of study participants, results suggest that maternity caregivers should be sensitive to the feelings and individual nature of a woman who has experienced a vanished twin. Humanistic approaches to communication and improved methods of information based on the development of an information sheet are advised.

Primary Care Groups and Primary Care Trusts have the task of achieving an integrated health care service, serving local communities. A regional Education and Training Consortium commissioned a 1-year study to provide information in order to develop a workforce strategy that aimed to achieve this agenda. The study involved individuals who plan, provide and/or manage primary and community health care service in three Health Authorities, working in partnership. The three phases of data collection included focus groups, individual interviews and a survey, which produced qualitative and quantitative data. The ndings outlined in this paper primarily focus on practice nurses and integrated care. Several tensions emerged in this context which could inhibit the development of integrated care. These included con ict within professional relationships, inequality in pay and working conditions, a lack of understanding of how integrated care would or could translate into practice and turbulent environmental contexts. We argue, these tensions often created gaps between policy, practice and professional discourses which, unless acknowledged and understood may result in integrated care remain a health, but unachievable, rhetoric.

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