There are significant challenges for the primary health workforce in its supply, its distribution among metropolitan, regional, rural and remotes areas, and its changing roles.61 Workforce models implemented in primary care commonly involve a mix of substitution, delegation, enhancement, innovation and supplementation.16,62 Most new models have focused on increased access to a broader range of primary health care providers, such as practice nurses and allied health staff.16 These models reflect the changing models of care within the primary health system.
Emphasis in workforce models where there is a broader range of health professionals has been on defining these roles individually, rather than on the way staff work as part of a team.16 Given the evidence that team-based approaches to areas such as chronic disease management have demonstrated better clinical outcomes and improved quality in general practice, a key element for workforce development should be teamwork.42,51
One of the ultimate tests of the GP Super Clinics Program will be seen in terms of recruitment and retention of clinicians to work under this model of care. The question is - will GPs and allied health staff want to work in multi-disciplinary primary care environments such as those offered by GP Super Clinics?
In these very early days it appears that the answer may be yes. The results from this evaluation indicate clinicians of all disciplines and students have a high level of professional satisfaction working under this model. This is not to be underestimated in terms of a retention factor. Opportunities for teaching, training and research were also cited as factors impacting on recruitment and retention. Indeed, examples have been provided where GP Super Clinic Directors are being contacted by clinicians who want to work under this model. In combination with positive patient experiences of these models of care, and students being trained in these GP Super Clinics, these may be more telling long-term factors in driving reforms in primary care than a raft of other initiatives.
If the answer to the question is yes, this also has significant implications for the rhetoric of some of the professional organisations representing medical and other disciplines regarding GP Super Clinics. The representation of GPs is challenging with diversity in views, values and philosophies.63 This diversity often relates to economics, ideology and the role of government in general practice.63 Hence it would not be expected that there was universal agreement with or support for the GP Super Clinics Program. However, if the answer to the question regarding willingness to work in GP Super Clinics is yes, and it aligns with patients views about their experiences with health care suggested by this evaluation, then maybe it is time to review responses to new models of health care delivery, in the context of patient and clinician experiences.
16McDonald J, Cumming J, Harris M, Powell Davies G, Burns P. Systematic Review of Comprehensive Primary Care Models. Sydney: Australian Primary Health Care Research Institute;2006.
42Pearce C, Phillips C, Hall S, et al. Following the funding trail: Financing, nurses and teamwork in Australian general practice. BMC Health Services Research.11(1):38.
51Otoole TP, Cabral R, Blumen JM, Blake DA. Building high functioning clinical teams through quality improvement initiatives. Quality in Primary Care.19(1):13-22.
61Douglas K, Rayner FK, Yen LE, Wells RW, Glasgow NJ, Humpreys JS. Australia’s primary health care workforce — research informing policy. Medical Journal of Australia. 2009;191:81-84.
62Sibbald B, Shen J. Changing the skill-mix of the health care workforce Journal of Health Services & Research Policy. 2004;1:28-38.
63Coote W. General practice reforms, 1989–2009. Medical Journal of Australia. 2009;191(2):58-61.