Links and networks

We are all aware of the sea of change engul®ng health care systems around the world. Our communication systems, for example: radio, television, the internet, newspapers, academic journals and international health care organizations, constantly inform us of the health needs, demands and concerns of individuals, interest groups and countries. They criticise, praise and suggest improvements that will hopefully provide better health for populations and better health care for patients. Improved communication links have helped to change people's understanding about health care and, in turn, this understanding has had a dramatic effect on medical education. The concept of holistic health care is being translated into patient-centred undergraduate medical courses through an earlier and greater use of primary care and the community. Although links between clinicians, academics and other health care workers have always existed, and are clearly very important, they have frequently been isolated, unidirectional and designed to address immediate or short-term problems. The provision of holistic health care will inevitably require a more structured communication network. Visible linkages, such as systems, organization and educational environments must be modi®ed and overhauled. More importantly, invisible factors such as attitudes, processes and relationships, must be rethought and re-established with different values and ground rules that provide continuous threads within widespread networks. Such networks may provide unbroken routes to a variety of health care destinations, including, for example, community organizations, medical schools or Trusts. This issue of the journal includes papers exploring a number of different topics. Although these topics vary considerably in approach and content, the authors implicitly recognize that effective communication and evaluation through links and networks is essential. For example, Amanda Howe reports on an evaluation study in the UK that compares the reality of new community teaching with the rhetoric. Using questionnaires and semi-structured interviews with GPs, she identi®ed numerous interacting factors relating to tutors, students, general practices and the academic unit that may facilitate or impair community-based teaching. Howe's ®ndings suggest that successful interaction requires motivated teachers, an effective practice team and responsive students, and she proposes several linking strategies involving practices and faculties to aid success. Linking hospitals and general practices through Pre-registration House Of®cer (PRHO) rotations is advocated by the General Medical Council but such opportunities rarely exist. An evaluation study carried out by Williams and Cantillon aimed to ®nd out the views of PRHOs and their hospital educational advisers (consultants) about the inclusion of a general practice component in junior house of®cer rotations. PRHOs had reservations about its appearance on their CVs and its possible effect on their future career prospects. Although many consultants could see that junior house of®cers could bene®t from general practice placements, they were concerned that a shorter hospital experience may be counter-productive. Despite this concern, they were aware that PRHOs could bene®t from, for example, a wider view of patient care within a community setting, an understanding of the relationship between primary and hospital medicine, and could assist them in making a more balanced choice of future career. A paper by Connor and colleagues describes the evaluation of a joint training programme for senior doctors and general practitioners designed to enhance mentoring skills, and establish a formally organized mentoring network for managing junior doctors. The opportunity to train together helped `to develop a supportive and challenging network'. Several participants commented that the network had signi®cantly reduced the isolation they felt as senior doctors and had provided them with `a safe place to talk honestly about their personal and professional lives'. They also believe that mentoring networks can `provide support at a time when revalidation and clinical governance require both rigorous and continuous professional development'. Two interesting ideas that emerge from the evaluation are: ®rst, the possibility of providing training for Editorials