Chapter2 General practice and its place in primary healthcare

2011 ◽  
pp. 25-34
Keyword(s):  
General Practice ◽  
Primary Healthcare

scholarly journals Financial viability, benefits and challenges of employing a nurse practitioner in general practice

2015 ◽  
Vol 39 (2) ◽  
pp. 205 ◽  
Author(s):  
Christopher Helms ◽  
Jo Crookes ◽  
David Bailey
Keyword(s):  
General Practice ◽  
Nurse Practitioner ◽  
Primary Healthcare ◽  
Case Reports ◽  
Models Of Care ◽  
Careful Consideration ◽  
Scope Of Practice ◽  
Financial Viability ◽  
Practice Nurses

This case study examines the financial viability, benefits and challenges of employing a primary healthcare (PHC) nurse practitioner (NP) in a bulk-billing healthcare cooperative in the Australian Capital Territory. There are few empirical case reports in the Australian literature that demonstrate financial sustainability of this type of healthcare professional in primary healthcare. This case study demonstrates that the costs of employing a PHC-NP in general practice are offset by direct and indirect Medicare billings generated by the PHC-NP, resulting in a cost-neutral healthcare practitioner. The success of this model relies on bidirectional collaborative working relationships amongst general practitioners and NPs. PHC-NPs should have a generalist scope of practice and specialist expertise in order to maximise their utility within the general practice environment. What is known about the topic? NPs represent a growing workforce of highly trained and educated advanced practice nurses that aims to improve access to timely and affordable healthcare for underserviced populations. Recent legislation has allowed for greater exploration of innovative models of care using NPs in Australian primary healthcare. What does this paper add? This case study provides practical information on the financial and logistical implications of employing an NP in a bulk-billing general practice. It demonstrates the broad capability of this workforce in Australian primary healthcare, and gives an overview of the facilitators and barriers to their use in private practice. What are the implications for practitioners? Employment of a PHC NP in general practice requires careful consideration of the direct and indirect benefits associated with the complimentary care they offer. NP access to the Medicare Benefits Schedule is severely restricted, which impairs their ability to achieve a full scope of practice and may contribute to increased health system costs and inefficiencies. There are opportunities for integration and facilitation of this emerging role in general practice with existing nursing workforce. Further research into this evolving area would be of benefit.

scholarly journals Low Back Pain in Primary Care: A Description of 1250 Patients with Low Back Pain in Danish General and Chiropractic Practice

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Lise Hestbaek ◽  
Anders Munck ◽  
Lisbeth Hartvigsen ◽  
Dorte Ejg Jarbøl ◽  
Jens Søndergaard ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Low Back Pain ◽  
Back Pain ◽  
Sick Leave ◽  
Primary Healthcare ◽  
Healthcare Sector ◽  
Detailed Knowledge ◽  
Low Back ◽  
Chiropractic Practice

Study Design. Baseline description of a multicenter cohort study. Objective. To describe patients with low back pain (LBP) in both chiropractic and general practice in Denmark. Background. To optimize standards of care in the primary healthcare sector, detailed knowledge of the patient populations in different settings is needed. In Denmark, most LBP-patients access primary healthcare through chiropractic or general practice. Methods. Chiropractors and general practitioners recruited adult patients seeking care for LBP. Extensive baseline questionnaires were obtained and descriptive analyses presented separately for general and chiropractic practice patients, Mann-Whitney rank sum test and Pearson’s chi-square test, were used to test for differences between the two populations. Results. Questionnaires were returned from 934 patients in chiropractic practice and 319 patients from general practice. Four out of five patients had had previous episodes, one-fourth were on sick leave, and the LBP considerably limited daily activities. The general practice patients were slightly older and less educated, more often females, and generally worse on all disease-related parameters than chiropractic patients. All differences were statistically significant. Conclusions. LBP in primary care was recurrent, causing sick leave and activity limitations. There were clear differences between the chiropractic and general practice populations in this study.

Benefits of simulated General Practice clinics in the preparation of medical students for primary healthcare

2019 ◽  
Vol 30 (5) ◽  
pp. 275-281 ◽  
Author(s):  
Karryn Lytton ◽  
Torres Woolley ◽  
Roy Rasalam ◽  
Susan Gorton ◽  
Paula Heggarty
Keyword(s):  
General Practice ◽  
Medical Students ◽  
Primary Healthcare

Presenting primary care teams to the public: a qualitative exploration of general practice websites

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697049
Author(s):  
Helen Anderson ◽  
Joy Adamson ◽  
Yvonne Birks
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Nurse Practitioners ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Patient Choice ◽  
Healthcare Team ◽  
Sufficient Information ◽  
The Public ◽  
Professional Groups

BackgroundIncreasing demand and expanded primary care provision, coupled with a reduced GP workforce present challenges for primary care. New workforce models aim to reduce general practitioner workload by directing patients to a variety of alternative clinicians. Concurrently, the principle of patient choice in relation to healthcare providers has gained prominence. It is, therefore, necessary to provide patients with sufficient information to negotiate access to appropriate primary healthcare professionals.AimTo explore how practice websites present three exemplar healthcare professional groups (GPs, advanced nurse practitioners [ANPs], and practice nurses [PNs]) to patients and the implications for informing appropriate consultation choices.MethodQualitative thematic analysis of a sample of general practice websites. 79 accessible websites from a district in England were thematically analysed in relation to professional representation and signposting of the three identified professional groups.ResultsInformation about each group was incomplete, inconsistent and sometimes inaccurate across the majority of general practice websites. There was a lack of coherence and strategy in representation and direction of website users towards appropriate primary healthcare practitioners.ConclusionLimited and unclear representation of professional groups on general practice websites may have implications for the direction of patients to the wider clinical healthcare team. Patients may not have appropriate information to make choices about consulting with different healthcare practitioners. This constitutes a missed opportunity to signpost patients to appropriate clinicians and enhance understanding of different professional roles. Potential for websites to disseminate information to the public is not being maximised.

scholarly journals Providing care to refugees through mainstream general practice in the southern health region of New Zealand: a qualitative study of primary healthcare professionals’ perspectives

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e034323
Author(s):  
Lauralie Richard ◽  
Georgia Richardson ◽  
Chrystal Jaye ◽  
Tim Stokes
Keyword(s):  
General Practice ◽  
New Zealand ◽  
Primary Healthcare ◽  
Healthcare Delivery ◽  
Health Sector ◽  
Community Support ◽  
Specific Patient ◽  
Health Region ◽  
Healthcare Needs ◽  
Southern Health

ObjectiveTo explore the perspectives of primary healthcare (PHC) professionals providing care to refugees through mainstream general practice.DesignQualitative exploratory design with semistructured interviews subjected to inductive thematic analysis.Setting and participantsNine general practices enrolled in the Dunedin Refugee Resettlement Programme, in New Zealand (NZ)’s southern health region. Participants included nine general practitioners and six practice nurses.ResultsThree analytical constructs were identified: relational engagement with refugees, refugee healthcare delivery and providers’ professional role shaped by complexity. Building meaningful relational connections involved acknowledging refugees’ journeys by getting to know them as people. This was instrumental for the development of an empathetic understanding of the complex human trajectories that characterise refugees’ journeys to NZ. Participants encountered challenges in providing care to refugees with respect to time-limited consultations, variable use of interpreter services, fragmentation of care between agencies and need for improved health infrastructure to ensure a fluid interface between PHC, secondary care and community support services. The current business model of NZ general practice was perceived to interfere with value-driven care and discouraged tailoring of care to specific patient groups, raising concerns about the ‘fit’ of mainstream general practice to address the complex healthcare needs of refugees. Meeting the needs of refugees across the social determinants of health involved a lot of ‘behind the scenes work’ particularly in the absence of shared information systems and the lack of well-established referral pathways to connect refugees to services beyond the health sector. This led to providers feeling overwhelmed and uncertain about their ability to provide appropriate care to refugees.ConclusionsThis study provides rich context-specific findings that enhance PHC responsiveness to the needs of refugees in NZ.

scholarly journals Remaking Practices in the Redesign of a Primary Healthcare Program

2017 ◽  
Vol 12 (1) ◽  
pp. 36-41
Author(s):  
John Rule ◽  
Roger Dunston ◽  
Nicky Solomon
Keyword(s):  
General Practice ◽  
Professional Learning ◽  
Primary Healthcare ◽  
Data Gathering ◽  
Practice Change ◽  
Design Data ◽  
Community Healthcare ◽  
New Ways Of Working ◽  
Healthcare Program ◽  
Liaison Nurse

Objective: To develop a detailed account of changed practices in everyday work in the redesign of a primary healthcare program. Design: The research aimed to produce layered and rich descriptions of the complex and multidimensional remaking of health practices. Empirical data was gathered through ethnographic methods including; interviewing, self-reporting, observation and shadowing. The subjects of the research were involved as active participants in the research design, data gathering and analysis. Setting: HealthOne was a New South Wales government attempt to provide a local and responsive model to improve chronic disease management in primary and community healthcare settings. We report specifically on the HealthOne program implemented in a suburb of Western Sydney. Main outcome measures: The research did not aim to evaluate the program but to uncover instances of professional learning though identifying changes in professional practice. These were noted and observed by the researchers and research participants or through reflexive conversations with the program planners, healthcare workers and the research team. Results: Drawing on the work of a number of learning and practice-based theory writers, particularly those using a socio-material approach, we describe how practice change has occurred and how work practiceshave been remade at this site - especially in the role of the General Practice Liaison Nurse (GPLN). Conclusions: The research demonstrated the potential for new categories and practices of health work to emerge; this was especially seen in the work of the GPLN but also extended to new ways of working through General Practitioners and community health networks. Abbreviations: GP – General Practitioner; GPLN – General Practice Liaison Nurse. 

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