Health professionals' perspectives on service delivery in two Northern Ireland communities

This research builds on the findings of an ethnographic study of health ine qualities in two small, rural communities in Northern Ireland. Through furt her analysis of existing data, this second study aimed to explore health pr ofessionals' perspectives on issues of service delivery relevant to governm ent policy on primary care. Anthropological fieldwork was conducted for two consecutive 4-month periods during 1995 and 1996 in one predominantly Cath olic and one predominantly Protestant town. To preserve confidentiality, th e locations have been given the pseudonyms, respectively, of Ballymacross a nd Hunterstown. Research tools included fieldwork journals and a fieldwork diary, meetings with key informants, tape-recorded interviews, group discus sions, participant observation and use of secondary material such as census data, local newspapers and community health profiles. interviews with 15 h ealth workers revealed that there was not a coherent approach to achieving health gain, little collaborative enterprise and minimal interaction betwee n the different professional groups. The National Health Service (NHS)-empl oyed primary care professionals, more than local community workers, appeare d to be demoralized, exhausted and suspicious of the business-orientated he alth service. In this respect, the primary care-led NHS appeared not to be working. It is concluded that a shared health agenda should be developed by NHS-employed primary care professionals and local community workers to cre ate a health-inducing environment at community level. This needs to be comp lemented by the establishment of formal mechanisms for inter-agency working at local, professional and government levels.