This multistakeholder study looked at the current provision of care for patients with multiple sclerosis (MS) within North Hillingdon, from the perspective of both the patient and the healthcare professional. Using in-depth interviews and focus groups, the study explored the patients' perception of their current care provision and unmet needs. Six main themes emerged from the research: lack of support at diagnosis; lack of information (both short and long term); social isolation; the impact on the family and carers; nonpresentation of other medical problems; inequality of access to care, and a lack of continued and co-ordinated care. The multidisciplinary focus groups and questionnaires carried out with hospital consultants, doctors, GPs, practice nurses, district nurses and physiotherapists echoed these themes. The main proposal that emerged from the data was to have an individual with expert skills and knowledge in managing MS, to be appointed at Primary Care Trust (PCT) level. This proposal would allow a best possible model of care to be offered to all patients with MS across a PCT, and in so doing meet demands of clinical governance.

This paper provides a summary of an exploratory study based on an interpretive approach, aiming to elucidate how professional executive committee members of one primary care trust see their role and the training they need to fulfil their functions. The effective delivery of local and national health priorities in the newly created PCT depends on these members having the knowledge and skills needed to carry out their work. At the time of the study, no one had assessed whether or not the members had the requirements for their role. The study was conducted in 2002 during the first six months of the creation of the PCT. Using questionnaires and semi-structured interviews, the study examined the perceived training needs of the 26 participants. Data analyses were in two stages. Analyses of the questionnaires involved entering the responses into a statistical programme. These were categorized into four areas: intellectual, financial/commissioning, service issues and other issues. Matrices of the responses were developed for the group and for each executive participant. In addition, a further matrix was designed, with a weighting applied, to show the order of importance for each competency. The second stage of data analysis involved content analysis of the verbatim transcripts. Themes identified from the coded analysis include the participants’ views of the direction of the professional executive committee, and concerns about them. The paper shows that the training needs of the committee members are not so easily determined because of lack of clarity of their role, and the part they play in the development of managed clinical networks and in securing co-ordinated and seamless care for the PCT’s patient population. The paper concludes by suggesting that some of the difficulties faced by the executive committee members were not of its own making, but were due to the rapid nature of organizational change in the National Health Service. This project contributes to the knowledge base about executive committee members, group interaction and dynamics, as well as having practical implications for delivering both local and national health targets. Future research could address the extent to which the PEC’s role has been clarified and whether this has been helpful in contributing to the redesign of services.