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Objectives To examine the strengths and weaknesses of the national and local schemes for preregistration house officers to spend four months in general practice, to identify any added value from [...]

The NHS Plan promises that letters about patients will be copied to them as of right. Yet, beyond a few small studies, little is known of the views of clinicians and patients about the process, and few have any experience of it. The aim of this study was to elicit the views of clinicians and patients about the idea of copying general practitioner (GP) referral letters to patients (part one), and to describe the experiences of GPs and patients actually involved in the process (part two). The setting was one health district in the north of England (part one) and three research practices in the same district (part two). A questionnaire survey was used to elicit the views of 214 consultants, 260 GPs and 584 patients (part one), and semi-structured interviews to assess the experience of 11 GPs and 48 patients involved in the process of copying referral letters (part two). The main outcome measures were the perceived and reported benefits and disadvantages of copying referral letters to patients and the practical implications of making this a routine activity. In the first part of the study, replies were received from 148 hospital consultants (70), 144 GPs (55) and all the patients in an opportunistic waiting-room sample. Seventy-six of these consultants (55) but only 49 of the responding GPs (34) thought that referral letters should be routinely copied to patients. This compares with 499 (85) of the patients surveyed who were in favour of this in principle. Potential benefits suggested by clinicians included better informed patients and improved communication. There were concerns about making patients anxious and about the difficulty of writing letters that were both comprehensible to patients and informative to colleagues. In the second part of the study, GPs involved in copying letters to patients experienced no major problems in writing letters that patients could understand but which were also fully informative to consultants. There was some increase in administrative workload. A sense of increased openness in the communication process was reported. Patients valued seeing a copy of their referral letter and few admitted to any major problems in understanding its content. In general, they felt better informed about their illness and better prepared for their outpatient appointment −44 patients (91) thought copying letters should become routine practice. In this study, carried out before the NHS Plan was published, a majority of consultants supported, with some reservations, the idea that patients should receive a copy of their GP referral letter. Surveyed GPs anticipated major difficulties in copying letters to patients, and most were not in favour of this becoming routine practice. Patients and GPs actually involved in copying letters reported important benefits but also identified issues which will need to be addressed before copying letters can be effectively implemented as a routine activity.

General physician Jamie Harrison, Rev Rob Innes and Professor Tim van Zwanenberg look at the doctor-patient relationship. Richard Normann explores the idea of co-production as a way of explaining interactions in such service relationships, highlighting the experience of being served. Co-production challenges patients to reflect on their part of the bargain and to engage in encounters beyond their own limited self-interest. INSET: Book offer.

This article focuses on the book 'Rebuilding Trust in Healthcare.' Building trust between general practitioners and patients is doubly important at a time when many people worry about a loss of trust in institutions in general. The world of healthcare has suffered from a series of scandals involving individual doctors, teams and institutions. The highly publicized adverse reports of heart surgery at Bristol and retention of children's organs at Alder Hey, plus Harold Shipman's court case, exposed the general public to accounts of medical activity which appeared shocking and which was, on occasions, criminal in nature. Trusting relationships are fundamental to maintaining and improving health and healthcare in our society. INSETS: Book offer;Foundations of trust.