Integration of General Practitioners with Hospitals and Community Health Services: A Qualitative Examination

Abstract

A series of focus groups was conducted with general practitioners (GPs), community health workers, hospital staff and consumers to examine the issue of integration of general practice within the wider Australian health system. Groups were held in various urban and rural locations to provide coverage of urban and rural conditions. The groups had representation from managerial as well as service provider staff and included GPs, hospital discharge planners, and emergency department staff, and from community health staff, nurses, physiotherapists, mental health workers, occupational therapists, and educators. Agreement was widespread that enhanced integration would confer benefits to patients, GPs, other health professionals, and to the health system generally. However, the health system was seen to be limited in its ability to integrate services. General practice, as small business working within the public health system, had different procedures and methods of remuneration than other health system components. Barriers to integration included structural, procedural and organisational factors, and included communication difficulties, variability in the roles and expectations of various service providers, and resource allocation and methods of funding. It is necessary to examine the barriers to integration more closely within the context of each type of service, to investigate effective ways of overcoming these barriers, and to describe and quantify the benefits that might arise from increased integration.