SUMMARY A survey of 93 community nurses, 48 health visitors, and 45 district nurses was carried out in one area health authority where nurses had been attached to general practice schemes for up to 10 years. The purpose of the study was to determine the nurses' impression of teamwork within their attachment arrangements. Half the group surveyed had either a geographical area or other area health authority responsibilities, or both, in addition to their primary attachment commitment. No structured plan for preparing or evaluating attachment groups had been carried out by the area health authority. Only one third of attached nurses were working from premises shared with other members of the attachment group, and often facilities were poorly designed for teamwork. Health Clearly, there are still many unresolved issues and perhaps some threat to the development of primary care teams. This study was initiated by one health authority as a first step in determining how attached staff experience teamwork within their individual attachment arrangements. PurposeThe major purpose of this study was to determine how specific factors considered important in the development of primary health care teams were experienced and perceived by a group of attached health visitors and district nurses. These factors have been noted in the relevant reports and include personal characteristics, preparation for attachment, physical premises for teams, communication patterns, professional role definitions, perceptions of teamwork, commitment, and benefits versus problems in provision of patient care services.The specific aims of the project were to gain some information regarding the present working situation that attachment groups are experiencing; to try and determine if nurses' satisfaction, or lack thereof with attachment schemes is related to the specific factors listed above; to compare the responses of health visitors and district nurses; and to stimulate nurses included in the study to evaluate and look for methods of improving their present attachment arrangement. MethodsThe study was Where multiple answers were to be considered, a category of "other" and instruction to specify was included. Therefore, when the structured responses were inadequate or inappropriate, participants were encouraged to respond with their own opinions and in their own words. The questionnaire was reviewed with the nurses concerned and distributed at a special staff meeting. The questionnaire was completed independently; participation was voluntary and questionnaires were anonymous. ResultsThe results are based on the responses to the structured questionnaires completed by 93 attached community nurses (48 health visitors and 45 district nurses). The total number of possible participants was 98 so that a high response rate (95%) was achieved. The actual number of completed questionnaires was higher than the number of participants (97 as opposed to 93) as one health visitor and three district nurses were attached to more than one practice. Because these n...

An analysis of 98 health visitors and district nurses attached and non-attached to general practitioners in three local authority areas showed that most of them were aged over 40 and that many had entered domiciliary work because of the convenient hours or because of its intangible attractions. Adequate preparation for attachment was considered important, particularly a clear definition of the roles of the attached staff and their relationships to other workers in the practice.Attached staff were found to be much more satisfied with the information given by the general practitioner about their patients than were unattached staff, and the former usually had access to the patients' medical records. The principal advantages of attachment were listed as access to family history; improved co-ordination within the practice and co-operation with the social services; favourable patient response; and increased mileage and work-load; the impossibility of crossing local authority boundaries; and having to deal with families registered with more than one doctor.

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