GPs and other primary health care providers - a case of square pegs and round holes?

Malcolm R. Masso, University of Wollongong

M. R. Masso (2007). GPs and other primary health care providers - a case of square pegs and round holes?. General Practice and Primary Health Care Research Conference: Working Together, Sydney, 23-25 May.


Objectives To identify themes emerging from three evaluations examining the role of general practitioners and other primary health care providers. Methods This presentation draws on the lessons learnt from evaluations of three programs to improve primary health care for patients with a terminal illness, including two national programs, involving 15 projects across all states of Australia. All projects were in rural areas and 12 involved allocation of funding to divisions of general practice. Developing closer working relationships between GPs and other primary health care providers was a major focus. Strategies included formal governance structures, educational programs, case conferencing, teleconferencing, dissemination of information and development of formalised arrangements and protocols. Findings were interpreted within the framework of Leutzs five laws for integrating health services with particular reference to the definition of integration and the idea that you cant integrate a square peg and a round hole. Principal Findings Leutz distinguishes between three levels of integrationlinkage, coordination and full integration. Findings indicate the work of GPs tends to involve linkage and, to a lesser extent, coordination, whereas the work of other health providers involves coordination and, to a lesser extent, integration. In general, projects sought to bridge the gap between these ways of working without understanding the difference. Discussion The findings suggest that improving integration of GPs with other primary health care providers is akin to integrating a square peg with a round hole, rather than recognising, and accepting, the value of each. Implications Projects are a legitimate strategy to achieve changes in practice but are less likely to achieve the desired change without an understanding of the different roles of primary health care providers, including GPs.