A focus group study on primary health care in Johannesburg Health District: “We are just pushing numbers”

Abstract

Objectives: South Africa is striving towards a strong primary healthcare system. Since 2007, departments of family medicine have been established in Gauteng to improve quality of care through improved access to doctors, the coordination of health services and better referrals. There have been anecdotal difficulties around clinical quality, the role of the increasing number of doctors and the value of family medicine as a new speciality in Johannesburg since these changes. This study aimed to explore Johannesburg stakeholder views on clinical priorities, the role of doctors and family medicine in primary care.Design: The study design comprised qualitative focus group discussions.Setting and subjects: Groups of nurse clinicians, clinic managers, senior managers, doctors and interns within the Johannesburg Health District.Outcome measures: The content was thematically analysed and a model developed.Results: There were nine focus groups, with 6-13 participants per group. Addressing staff burnout and poor management were viewed as clinical priorities in primary care. Discussing the role of doctors reflected deep conflict between doctors and nurses. Nurses and managers expected doctors to help to "push the queues". It took some time for further roles, such as helping with referrals, training, research and administration, to emerge. There was initial confusion and tension when participants were asked about family medicine. However, its role was seen as useful.Conclusion: Nurses appeared to suffer from burnout and resented the increasing burden placed on them with regard to primary care in Johannesburg. There appeared to be confusion with respect to the role of doctors, with doctor-nurse conflict and poor teamwork. This may threaten attempts to re-engineer primary health care in order to increase the presence of doctors at clinic level. The discipline of family medicine can make a difference, but reorganisation of the system is required.Peer reviewed.

Insights of health district managers on the implementation of primary health care outreach teams in Johannesburg, South Africa: a descriptive study with focus group discussions

“…Whether leadership training is enough to address the current culture is moot. The relegation by managers of doctors to clinical curative work and the poor use of clinical associates is of concern [47–50]…”

Emerging role of family medicine in South Africa

“…Yet, this is arguably short sighted. Senior African government officials and academics engaged in a recent study on family medicine in Africa see a strong leadership role for family physicians in primary health care, although principally based at district hospitals 17–19. Their leadership is expected mainly through managing clinical referrals from juniors and clinical governance (including training and supporting the primary healthcare team in the district, including clinics) 17–19.…”

“…Senior African government officials and academics engaged in a recent study on family medicine in Africa see a strong leadership role for family physicians in primary health care, although principally based at district hospitals 17–19. Their leadership is expected mainly through managing clinical referrals from juniors and clinical governance (including training and supporting the primary healthcare team in the district, including clinics) 17–19. These stakeholders suggest a team-based approach, which includes family physicians, to proactively care for defined communities, as primary care practices, in the long term, but stakeholders in South Africa appear hesitant for family physicians to take a leadership role in current nurse-driven primary healthcare clinic systems 17–19…”

Insights of private general practitioners in group practice on the introduction of National Health Insurance in South Africa

“…The public primary healthcare (PHC) system is ‘nurse-driven’ with doctors in a marginal role, ostensibly because of shortages of doctors and a GP bias against early post-apartheid public health reforms. 2 , 3 Full-time postgraduate training in family medicine only started in 2008 with family physicians focused on public service district hospitals. Key stakeholders in SA see family physicians as critical to the district health services (DHS), with a growing focus on team-based family practices and community-oriented primary care.…”