Workplace bullying in junior doctors: questionnaire survey.

Although the rate of hepatitis B immunisation of patients with chronic renal failure in the United Kingdom has improved in recent years, most renal units still fail to follow current guidance. Partial coverage is the norm, and outmoded regimens are still used. The shared care management of immunisation may be one solution, although this requires good collaboration between primary and specialist care. Strategies that may improve collaborative care are inclusion of immunisation in service agreements, definition of responsibilities for initiation of immunisation, follow up and evaluation of response, payment to general practitioners, and regular audit and shared feedback. The efficacy of the hepatitis B vaccine in end stage renal disease needs investigation to encourage its use in dialysis patients.