Research evidence does not necessarily translate into changed management for individual patients, but that may not mean that the evidence has been ignored. Drawing on accounts from general practitioners, we use a study of non-rheumatic atrial fibrillation (NRAF) to illuminate the processes by which practitioners became aware of and assimilated research evidence. We follow that with an account of how the evidence was incorporated into practice protocols for anticoagulation and then applied to a review of individual patients' records. Practitioners used a range of sources of evidence. They reported difficulties arising from their own skills and circumstances and from the perceived quality of the evidence. Creating a protocol involved overcoming problems of scheduling, resources and managing judgements about the value of the review process. In applying the protocol practitioners drew on their knowledge of the patients' preferences, circumstances and previous specialist consultations. As a result, practitioners made judgements that evidence, combined with prior experience, did not support the initiation of anticoagulation in 52% of an unselected primary care population with NRAF. Our findings have implications for evidence-based practice and for practitioner education.

and Discussion. The evaluation demonstrated value in relation to traditional research outcomes and also, notably, in relation to professional contribution. Future policies may need to address: the indicators used in measuring the success of such schemes; the relationship between what individuals choose to do and its context within national policy on research and development; and the sustainability of involvement in research.

The data collected confirmed that patients excluded from the authoritative randomized controlled trials predominate among patients cared for in general medical practice. Practitioners overestimated the prevalence of NRAF in their patients and underestimated the extent to which their current practice offered intervention. Practitioners initially overestimated the amount of change required in patient management. In reviewing their patients' records with the intention of following evidence-based practice, practitioners explicitly described and regarded as appropriate their reasons for not prescribing anticoagulation to certain individuals. The review process was time-consuming and will need to be repeated as further evidence emerges.

A new interprofessional primary care team was established in a greenfield site. Using anethnographic approach, significant experiences in the formation of the team were documented and specific problem areas were defined and addressed using action research principles. The nature of the problems experienced and the processes used in their resolution are described and related to current policy recommendations and to existing literature on the theory and practice of team development. Problems include: the potentially varied expectations and managerial requirements of collaborating partners, the lack of clarity over professional roles and associated essential competencies, and the appropriate management and development of specialist professional roles. Conclusions drawn concern the complexity of the issues raised by interprofessional team working, and the value of existing techniques and models in this setting, such as the viable systems model, 360 degree appraisal and action research.

The role of appraisal within professional development has assumed a higher profile in response to national policies including those relating to clinical governance and workforce development. Under the guidance of a service development manager trained in human resource management, a new interprofessional Primary Care Practice Team near Cambridge defined and implemented a new appraisal system drawing on the principles of 360 degree appraisal. The appraisal system was designed to support the service function and the team culture, and took into account good management practice and the requirements of partner organizations and professional affiliations. This paper describes how the system was introduced, tailored to the particular needs of the interprofessional practice team, and evaluated. Early experience suggests that the approach enhances understanding of roles and responsibilities and is supportive to interprofessional team development. It is well received by team members involved and by some of the external partner organizations. However, it is demanding on resources and concerns were raised about the completeness of this approach to appraisal.