General practitioner networks matter in primary health care team service provision
Lucio NaccarellaThe Australian Health Workforce Institute, The University of Melbourne, 200 Berkeley St, Carlton, Vic. 3053, Australia. Email: l.naccarella@unimelb.edu.au
Australian Journal of Primary Health 15(4) 312-318 https://doi.org/10.1071/PY08071
Published: 26 November 2009
Abstract
Australia is undergoing significant primary health care policy reforms in response to concerns about quality of care, increasing burden of complex and chronic diseases, and workforce shortages. Governments are encouraging multidisciplinary teamwork between general practitioners (GP) and other primary health care service providers. Essential elements of teamwork have been addressed in policy initiatives, yet important dimensions of the way GP develop and use their work-related relationships in their practice remain unrecognised. This paper draws upon a doctoral thesis that explored the types and the qualities of GP work-related relationships. A qualitative research methodology combined with a relational perspective was used. Data were collected from a pilot, main and a validation study. Fifty interviews were conducted, including: GP, clinic staff, service providers, support organisation personnel and policymakers. A complex web of interdependent work-related relationships exist between GP and other health care providers. Four main types of GP work-related relationships emerged: clinical problem solving, obtaining metaknowledge, obtaining legitimisation, and validation. Key qualities of GP work-related relationships included the nominated providers’ competence, accessibility, goodwill, honesty, consistency and communication styles. A validation study verified research findings. The research provides evidence that the nature of GP work-related relationships have implications for other practitioners who need to work with GP. The findings challenge the current primary health care policy emphasis on using structural reforms such as prescribed service delivery processes and financial incentives to encourage teamwork.
Additional keywords: general practice, multidisciplinary teamwork, primary care, relationships.
Acknowledgements
The research reported in this paper was part of a doctoral thesis supported by a NHMRC Postgraduate Primary Health Care Scholarship. I acknowledge the continual support of my three supervisors, Dr Jane Sims, Professor Pip Pattison and Associate Professor Rae Walker.
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