An attempt to assess integration between general practitioners and other health care providers in New Zealand in 2015

Abstract

Integrated Family Health Centres became prominent in planning for future general practice in New Zealand particularly following the 2008 election. The Royal New Zealand College of General Practitioners (RNZCGP) is the organisation that trains and sets standards for general practitioners in New Zealand. In 2015 a question on integration was included in its annual workforce survey of members. The College sought to ascertain from general practitioners the nature and extent of integration currently existing with other health care providers. Integration with other doctors or with registered or enrolled nurses was specifically excluded as this is almost universal in NZ general practice. Respondents were asked "Do healthcare providers other than doctors and registered or enrolled nurses work in your practice, share your premises, share patient records with you or work with you in a virtual integrated practice? For example do you work with a Nurse Practitioner, Practice Assistant, Physician Assistant, Midwife, Pharmacist, Physiotherapist, Medical Laboratory Technician or Phlebotomist, Psychologist or Psychotherapist, Occupational Therapist, Dietician, Podiatrist, Speech Language Therapist, Social Worker, Counsellor or any other health related practitioner?" Those who said yes were then asked to select the relevant interactions in a matrix of fourteen professions and seven types of interaction. The survey was conducted in March and April 2015. A link to the electronic survey was emailed to 4576 fellows, members and associates of the College and the Division of Rural Hospital Medicine. We received 2486 usable responses giving a response rate of 54.3%. 2228 respondents stated that they were currently working in New Zealand in general practice. The age profile of respondents largely mirrored that of the recipients of the survey. Female respondents were slightly over represented among respondents comprising 47% of those emailed the survey but 53% of respondents. The majority of respondents (67%) indicated that they worked with other health care providers. Respondents from larger practices and rural practices were more likely to report doing so, as were younger GPs, recent graduates and GPEP 1 teachers. The most frequently reported relationship was with pharmacists. Thirty one percent (603) of the 1965 respondents who provided information on whether they "worked with other providers" reported that they worked with pharmacists in some way. Free-text entries in this question reveal that general practices are also integrating with a wide variety of provider types additional to those listed. The most frequent type of integration reported was working in the same building or premises (45% of all instances of integration) followed by working in the same practice (23%), sharing patient records (12%) and participating in joint practice meetings (7%). The pattern of responses indicated that some respondents had interpreted the question and in particular the types of interaction differently to what had been intended. This limited the conclusions that could be drawn from the data.