Early retirement has become an important labour market trend for workers in professional occupations. General practitioners (GPs), however, are in short supply, and are being encouraged by the government to stay at work beyond the age of 60. In this study, which followed up a questionnaire survey of all general practitioners over 44 working in the Northern Deanery, 21 GPs took part in semi-structured interviews looking at their plans, reasons for, and feelings about, retirement. Interviews were taped, transcribed, and the text coded using themes from the interview schedule and those derived from the data. Findings are reported using a qualitative distinction between ‘happy’ and ‘unhappy’ doctors and on this basis just over two-fifths of those interviewed were ‘unhappy’, all of whom wanted to take early retirement. The major factor influencing these plans to retire was dissatisfaction with their role and none of this group would be persuaded to change their minds by various incentives such as ‘golden handcuffs’. ‘Happy’ doctors who wanted to stay in practice had found ways of accommodating themselves to change and factors outside of work provided no incentive or ‘pull’. This was not the case for ‘happy’ doctors who wanted to leave: they wanted to pursue hobbies and other interests whilst they were young enough to do so. The paper concludes that change is a major factor producing job dissatisfaction among GPs and that future generations of doctors need to be equipped with the means to cope with it, while governments need to consider the merits of stability and continuity.

In this postal survey of 1064 health service staff working closest to the Omagh bombing in Northern Ireland, approximately half reported having professional or civilian involvement. Types of involvement and posttraumatic stress disorder (PTSD) levels varied between staff groups. Staff involved both professionally and as a civilian, particularly those who witnessed the trauma, or those who had experienced previous emotional problems and trauma, had the highest levels of symptomatology. Although staff with higher PTSD symptoms were more likely to seek professional help, only a minority contacted professionals for support.

More GPs are needed, but there are concerns about retaining the existing workforce quite apart from recruiting new doctors. This survey of GP principals in the Northern deanery aged over 45, identified factors potentially encouraging them to take early retirement (before 60) or to work on beyond 60. Over a third of those with retirement plans intended to retire early. Perceived undesirable changes in the NHS and workload were the main factors influencing intentions to retire. Reducing hours and administrative duties, and improving managerial support were factors that may encourage later retirement. Financial incentives in the form of increased pensions were most attractive to those already planning later retirement. A total of 35 per cent scored above threshold for significant psychological distress, and the higher psychological distress the earlier GPs wanted to retire. Interventions encouraging later retirement should be targeted at reducing workload and administration. Interventions to reduce stress could also encourage later retirement.

This article investigates post-traumatic stress disorder (PTSD) symptoms reported by doctors working in the aftermath of the Omagh bombing. Doctors responding to surveys 4 and 17 months after the incident reported the lowest symptom levels compared with other health service staff, with only 12% (2) above PTSD threshold at 17 months. Junior doctors had higher mean PTSD scores than seniors, although numbers are too small to test significance. Possible explanations are discussed and recommendations made.

From data provided by a national census of treatment for alcohol problems in 1996, this paper reports findings on differences between types of treatment agencies in England and Wales. The overall response rate was 44% but no significant differences were found between responding and non-responding agencies in size and composition of staff. The highest mean number of clients per day was seen in NHS trust services and charitable organizations. Private (for profit) agencies showed both the highest mean age of clients and the highest proportion of men among agency types, while NHS trusts saw the highest proportion of women. Charities and voluntary organizations reported higher than average proportions of clients living in insecure accommodation. Private (for profit) agencies showed both the lowest proportion of unemployed clients and the highest proportion of those on sickness or invalidity benefits. Seventy-three per cent of clients attending NHS trust services were seen by nurses, medical or non-medical professionals; only 8% of clients attending private (for profit) agencies were seen by these professional groups. Worries about physical health were far more common among clients attending private (for profit) agencies and legal/financial problems occurred much more often among those attending voluntary/ statutory partnerships. The highest proportion of clients in residential treatment was shown in private (for profit) agencies and the lowest in voluntary/statutory partnerships and NHS trusts. Nearly all (90%) treatment carried out by voluntary/ statutory partnerships was in the form of ‘counselling’, while approximately half the clients seen by charities and independent (non-profit) organizations were in day or residential treatment. While in the overall sample, the mean percentage of clients also attending Alcoholics Anonymous (AA) was 9%, this rose to 23% of clients attending independent (non-profit) agencies. The highest proportions of clients with reported illicit drug use was in voluntary/statutory partnerships and the lowest in independent (non-profit) agencies. This paper provides a ‘snapshot’ of the variation in treatment services for alcohol problems in England and Wales, which can be used to detect trends in treatment provision in the future.

A national census of all UK specialist alcohol treatment agencies was carried out in order to enquire about client characteristics and the broad features of the treatment service received by clients on a specific day (4 December 1996). A total of 728 agencies were eligible for the census and the overall response rate was 41 %. When the effects of response bias were examined, correcting for under- and over-representations of different types of agencies made very little difference to findings. A rough estimate from the census is that 10,000 individuals were seen for treatment or advice regarding an alcohol problem on census day in the UK. Treatment services are dominated by the non-statutory sector, which accounted for almost two-thirds of all clients seen on census day. Despite demographic changes in drinking patterns over the last 10-20 years, the ‘typical’ client attending treatment services is still a middle-aged man and the client sample as a whole showed evidence of major social disadvantage and dislocation. Compared with national figures, the sample showed an over-representation of ‘Irish’ clients in English agencies but there was no under-representation of other ethnic groups. The most common category of staff providing treatment was ‘counsellors’, and the complaint most often presented by clients concerned ‘psychological well-being’. Twenty-eight per cent of clients were recorded as being in residential treatment. The most common form of treatment received was therapy or counselling on a one-to-one basis, which accounted for two-thirds of clients receiving some form of psychosocial treatment. The majority of clients in detoxification (60%) received it as in-patients. Forty-two per cent of treatment episodes were estimated to have lasted for more than 3 months and 18% had continued for over a year. The most commonly cited use of other services was for Alcoholics Anonymous (AA), although AA was mentioned in relation to only 9% of all clients. Excluding cannabis, 85% of clients were recorded as having no illicit drug use. Suggestions are made as to how the response rate and other features of the census could be improved if the exercise were to be repeated.

A treatment version of the Readiness to Change Questionnaire (the RCQ[TV]) was developed among a sample of 263 clients attending treatment for alcohol problems. The psychometric properties of this new instrument were shown to be adequate for research and clinical purposes, although further work is needed to strengthen the internal consistency and test-retest reliability of the Contemplation scale. It was not found possible to include a Preparation or a Maintenance stage in the RCQ|TV| and subjects are therefore allocated to Precon-templation. Contemplation or Action stages of change. Significant relationships were found between allocated stage of change and level of alcohol consumption, items measuring motivation to change drinking habits, length of time in treatment and whether or not the subject has previously received treatment for an alcohol problem. Subjects allocated to the Contemplation stage at initial assessment were less likely to show a good treatment outcome at six months follow-up than those ...