Transforming primary care: scoping review of research and practice

PURPOSE: The purpose of this paper is to reflect on research evidence and practice experience of transforming primary care to a more integrated and holistic model. DESIGN/METHODOLOGY/APPROACH: It is based on a scoping review which has been guided by primary care stakeholders and synthesises research evidence and practice experience from ten international case studies. FINDINGS: Adopting an inter-professional, community-orientated and population-based primary care model requires a fundamental transformation of thinking about professional roles, relationships and responsibilities. Team-based approaches can replicate existing power dynamics unless medical clinicians are willing to embrace less authoritarian leadership styles. Engagement of patients and communities is often limited due to a lack of capacity and belief that will make an impact. Internal (relationships, cultures, experience of improvement) and external (incentives, policy intentions, community pressure) contexts can encourage or derail transformation efforts. PRACTICAL IMPLICATIONS: Transformation requires a co-ordinated programme that incorporates the following elements – external facilitation of change; developing clinical and non-clinical leaders; learning through training and reflection; engaging community and professional stakeholders; transitional funding; and formative and summative evaluation. ORIGINALITY/VALUE: This paper combines research evidence and international practice experience to guide future programmes to transform primary care.