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Proposals for fundholding were greeted with scepticism by many general practitioners, and in Scotland the BMA persuaded the government to allow a scheme to test the arrangements as a demonstration project operating "shadow" practice funds. This allowed the six selected practices to set up administrative and computer systems without the worry of dealing with real money. The shadow fundholding scheme has since been extended to small practices and to a trial of fundholding for all services except accident and emergency. The six practices in the original pilot have all become fundholders and are beginning to effect improvements in the service to their patients. However, with more practices becoming fundholders negotiating contracts with providers is becoming increasingly complicated and more time and money needs to be put into this aspect.

The military component of a rural general practice is described with details of increased workload and morbidity for conditions associated with emotional stress.

Proposed increases in the average hours of surgery sessions of general practitioners as part of the government programme for improving primary health care may result in more use of deputising services to provide off duty cover. The satisfaction of patients with such a service was studied during one week of October 1987 at nine of the 29 branches of Air Call Medical Services in urban areas in Britain by means of a postal questionnaire. Of a sample of 4626 callers to the service, 3887 (84%) responded. An estimated 32% of the patients expected that a doctor from their own practice would have attended them, 19% expected that they would be admitted to hospital and 8% were admitted. Over 90% of patients were satisfied with the telephonist's handling of the call; 79% of those visited were satisfied with the waiting time; and over 80% were satisfied with various aspects of the doctor's handling of the visit (bedside manner, communication, taking of history, physical examination, and explanation of findings), the lowest figure being for explanation of findings (81%). Satisfaction was generally higher during the daytime; among the elderly, especially men; and among patients who did not anticipate that a doctor from their doctor's practice would call. The results suggest that a high proportion of patients were satisfied with the deputising service they received.

It has been shown that to provide a high standard of care general practitioners probably need to book consultations at intervals of at least 10 minutes. In this study the maximum list size for which a general practitioner might be expected to provide a high standard of care was determined from calculations of the time spent consulting, based on various consultation rates and list sizes and assuming that consultations were 10 minutes long. If good quality care is to be provided and is to include the range of services suggested in the government's recent green paper average list sizes should probably be no more than 1750, and lower in areas of high demand and high need. In addition to this, minimum standards could be determined for such measures as facilities available in surgeries, practice records, and accessibility of doctors to ensure that basic services were offered by all general practitioners.

BACKGROUND: New government guidance on cooperation in child protection confirms the importance of the general practitioner (GP) contribution. While research highlights the concerns of others about their role in the multi-agency process, relatively little is known about the views and experiences of GPs themselves. AIM: To examine the understanding that each of the key professional groups had of its own and each other's roles in child protection to identify those factors seen to enhance or inhibit the effective performance of these roles. METHOD: The research formed part of a larger investigation of the role of health professionals in child protection, which combined case study investigations of child protection networks in three health authority sites with a regional survey of Area Child Protection Committee members. RESULTS: A lack of correspondence was identified between GPs' perception and performance of their role in child protection and the expectations placed upon them by other child protection professionals and government guidance. CONCLUSION: The study identifies the need for more explicit discussion of the nature and extent of the GP role in local interagency child protection networks.

Over 20,000 people are living with HIV infection in Australia. From the early days of the epidemic general practitioners (GPs) have been closely involved in providing HIV care including antiretroviral therapy (ART). Training programs began in 1990 with about 200 GPs currently trained to provide ART. However there are limited data available on uptake and outcomes of GP HIV care. This review will present data on current GP involvement in providing HIV care as well as treatment outcomes. A Medline search was conducted using the terms general practice, HIV and Australia. Abstracts from local conferences were also reviewed. The major identified study of treatment uptake is HIV Futures [1], a national survey of approximately 1000 HIV+ve people performed every 2 years. Over the last 10 years this study consistently reports that about 50% of all HIV specific care is provided by GPs. One study describes an audit of 500 HIV+ve patients starting treatment in primary and hospital sites [2]. This found that there were comparable and high levels of adherence to guidelines on ART initiation in both general and specialist practice. A cohort of 168 patients followed for over 10 years in an Australian GP reported that 24% had been lost to follow‐up, 7% died and 68% continued in care with 98% receiving ART with 96% having an undetectable viral load (<400) [3]. These outcomes were similar to those reported in the long‐running national Australian HIV Observational Database (AHOD). Robust data show that about half of all HIV care in Australia is provided by GPs. Limited published data on adherence to guideline and treatment outcomes suggest comparable result in general practice versus specialist settings. GP care appears to be an acceptable and effective approach to HIV management although more research on treatment outcomes is needed.