A review of primary health-care organization

A contract for the provision of community nursing and associated services was drawn up between the Plymouth Community Unit and general practitioners associated with a fundholding practice at a health centre in Devon in October 1991. This project, which aimed at applying purchaser/provider principles, contained some novel features and was subject to evaluation and review after 6 months. An evaluation which had four main aspects was carried out, consisting of interviews and questionnaire assessment of staff attitudes, patients' views of the effectiveness of aspects of the practice health-promotion activity, an analysis of staff activity data before and during the pilot phase and an examination of the documentation concerned with critical issues which had arisen. Questionnaire data indicated that staff motivation and enthusiasm for the project was high and that patients' views on the practice facilities were generally positive. The role of the Macmillan nursing service at this practice was greatly enhanced during the pilot project with a fourfold increase in the number of visits carried out. Over 120 h were spent by health visiting and district nursing staff on issues surrounding the pilot project including attending additional meetings. The results are discussed in relation to service benefits to patients, the effect on the cohesion of the primary health-care team and issues of fundholding and are considered in the context of models put forward for the future development of community-based nursing care.