No abstract

Technology has provided improved access to the rapidly expanding evidence base and to computerized clinical data recorded as part of routine care. A knowledge audit identifies from within this mass of information the knowledge requirements of a professional group or organization, enabling implementation of an appropriately tailored knowledge-management strategy. The objective of the study is to describe perceived knowledge gaps and recommend an appropriate knowledge-management strategy for primary care. The sample comprised 18 senior managers of Primary Care Trusts: the Chairman, Chief Executive Officer, or Research and Development Lead. A series of interviews were recorded verbatim, transcribed and analysed. Knowledge requirements were broad, suggesting that a broadly based knowledge-management strategy is needed in primary care. The biggest gap in current knowledge identified is how to perform needs assessment and quality improvement using aggregated routinely collected, general practice computer data.

(i) This study was rapid and sustained a high level of energy and purpose among stakeholders. Action research is an appropriate method to apply to transformational change in the modernization of health-care systems; (ii) Modelling of system dynamics is a critical dimension to the success of whole system change; (iii) Primary care commissioning power is an under-used, but influential, lever for change. At a point when the PCT commissioning structure is under threat, this project exemplifies primary care's ability to engineer change in acute hospital services.

In the UK, primary care groups and trusts (PCG/Ts), also known as primary care organizations (PCOs), are the organizations that will drive forward the primary care development agenda outlined by the government. We undertook a study to investigate the views of PCOs on the place of research in primary care development and their role as participants in the research process. The study population consisted of all PCOs in south London (n = 23). An initial structured questionnaire explored the organizations' perceived research needs, the potential of the primary care research community to meet those needs and their current research activity. This was followed by semistructured interviews during which the participants were asked to discuss their views on the place of research in their primary care development agenda and in particular how research might inform the development of clinical skills and services in the short and medium term. The third stage of the project was an action based workshop at which general practitioners (GPs) and primary care nurses developed research questions arising from the earlier stages of the study. The PCOs identified three key areas of research support: public health, health economics and nursing research expertise. Research support was needed to help them identify population health needs and to evaluate new models of care and shifting professional boundaries. In contrast to traditional primary care research, PCOs required rapid delivery of research results, particularly when these were used to inform the commissioning of services. Our study has highlighted that PCOs have a development agenda requiring rigorous research and evaluation to ensure the best outcomes for patients. The differing skills, roles and responsibilities of PCOs, PCRNs and academic departments show how partnerships might develop to further research and development in primary care.