Family doctors as healthcare coordinators. Matrix of family doctors' competences for unlocking health workforce potential - the case of Poland

Abstract

The article presents the results of the research on the competences of family doctors in the Polish healthcare system. According to the 2017 bill on primary health care (PHC) introducing integrated care to PHC, family physicians are obliged to coordinate the care delivered to their populations and to manage the PHC teams. First contracts on integrated care with the National Health Fund have been concluded in 2022. 
 The regulation evoked the necessity of redefining the role of family physicians in the healthcare system. Before that they were habitually deprived of chances to manage the care they provide. The author claims that their role should be perceived as managerial. It is crucial for patients and decision makers to understand family physicians' role in the system and properly manage the PHC workforce, especially when new professions and functions are being introduced to PHC. The regulation is not clear enough in regard to the definition of healthcare coordinator and leaves space to terminological inconsistency and, as a consequence, inadequate use of health workforce potential. The observations that led to designing the research were shared and consulted with the PHC community (focus group consisted of family doctors and PHC facilities’ staff members from lubuskie voivodeship). The research has been shared within academia (results of each stage of the research have been published and peer reviewed).
 The author has developed the matrix of family doctors’ competences to show the scope of competences they demonstrate. It is an ordered aggregation of competences classified according to the roles performed by family doctors in the healthcare system. It includes the indication of classified sources of formal requirements of those competences (in brief: sources of competences). One of the six roles presented in the matrix is a healthcare coordinator. Comparative text analyses have been performed to assess the relation between the range of family physicians’ and healthcare coordinators’ competences. 
 The results show that family physicians have a full set of competences, including managerial, to coordinate the care, which means that they are predisposed to play the role of healthcare coordinator. The author proposes a precise competence-based description of the role of family doctor as a healthcare coordinator. The author further suggests introducing a new function of healthcare coordinator’s assistant. 
 Since one of the sources of competences included in the matrix are WHO’s recommendations on competence clusters for coordinated care the results of this research may be found particularly interesting by international audiences. Especially when the shift towards integration of care is common for most of the healthcare systems and many of them are in preliminary stages of introducing the changes when comparing practice is of great value. 
 The research will be followed by qualitative study of family physicians’ experience in playing the role of healthcare coordinator. The aim of this study is to develop a framework for competence training for family physicians delivering coordinated care.