Is there an ideal primary care team?

Jordi Varela
Editor

Have we ever heard that there are health centres in Finland that work as a multidisciplinary team, or that in Alaska there are groups of professionals who do admirable work with indigenous community health, or that in Scotland health and social services already they work in a very integrated way? And the question that comes to mind is: does the ideal primary care team exist?

To try to answer this question, a research group, which I have had the privilege of leading, from the Catalan Society of Health Management (SCGS), has developed a field study with 22 semi-structured interviews to primary care leaders and has reviewed 42 innovative projects that were submitted to a contest that had been called by the SCGS itself and, with this material, the research group has dared to define an ideal primary care team that exists in Catalonia, even though it's crumbled by the territory in various initiatives. The Observatory "Management Matters" of the SCGS has published the report, as well as a post with the executive summary of the work, of which I have dared to write down some highlights below.

The ideal primary care team

1) Manages the demand with follow-up guidelines developed in the light of the evidence, it has an algorithm of reasons for consultation per the competencies of its professionals, which have agendas with sufficient availability to respond to the eventualities of the day, without having to open spillway consultations and, in this framework, nursing management of demand is enhanced. Carefully analyse visit requests to channel them appropriately between face-to-face care and telematics.

2) Promotes multi-disciplinary teamwork through advanced organizational models based on population needs. It incorporates the profile of the clinical assistant, the auxiliary nursing care technician, the pharmacist and the social worker.

3) Take care of people with complex health and social needs with multidisciplinary teams that collaborate with municipal social services and maintain efficient contacts with long-term services in the territory.

4) Organizes the care of children counting on the development of nursing skills, the real availability of paediatricians, the collaboration of family doctors and the support of the referring hospital.

5) Fosters shared clinical decisions by specifically training doctors and nurses in the matter and counts on the opinion of patients in organizational matters, circuits and improvements of all kinds, through co-creation dynamics.

6) Maintains good connections with the entities, associations and public institutions of the territory, with which it prepares the map of health assets, an essential tool for the social prescription. It deploys a portfolio of community health promotion programs based on evidence and effectiveness. It creates a network with community pharmacies, which become allies in its strategies.

7) Incorporates mental health services, attention to sexual and reproductive health, physical therapy, dentistry, podiatry and nutritionist within the dynamics of the primary care team.

8) Develops right care working groups to promote value practices.

9) Offers a broad portfolio of diagnostic and therapeutic services and deploys telemedicine connections with the most common specialities.

10) Constitutes the backbone of the value chains of the most frequent clinical processes. It receives, periodically, the visit of the hospital specialists, with whom clinical sessions and training actions are held, as well as a space for patient consultations.

11) Offers first-hand information when a patient is admitted to the hospital, which allows them to contribute to the clinical decisions that are made during hospitalization, in addition to properly coordinating the discharge.

12) Creates a participatory and team climate strategy. It manages the talent of its professionals, prevents burnout, fosters positive leadership and, in terms of governance, tries to involve professionals as much as possible in fundamental decisions.

13) In the rural world, with isolated peripheral clinics, the primary care team elaborates a plan to gradually change the criterion of the presence of professionals, for that of proactive scheduling of visits, with an efficient telephone line for unscheduled demands.

14) In the event of reforms, the primary care team generates co-creation processes with professionals and patients and takes into account the new needs of individualized reception, offices with shared screens, multidisciplinary teamwork, telemedicine, remote care and community work.

Given that primary care seems disoriented we ought to observe what the most daring are doing at home, and the emerging picture is quite suggestive, isn't it?