Interorganisational and interprofessional partnership approaches to achieve more coordinated and integrated primary and community health services: the Australian experience

Abstract

Improving collaboration and coordination in primary and community health is a national priority. Two major approaches have been taken: strengthening interorganisational and interprofessional collaboration. This paper reviews current and emerging models of partnerships: divisions of general practice and primary care partnerships (organisational models); and collaboration between general practitioners with practice nurses and with allied health professionals (interprofessional models). The models are reviewed in terms of the governance and formalisation of the partnership arrangements and the level of collaboration they achieve. The organisational models have had different purposes and taken different forms, the ‘hub and spoke’ model of divisions and decentralised ‘network’ relationships of primary care partnerships, both of which have broadly achieved their aims. Interprofessional collaboration involves a complex mix of allegiances and interests that influences the level of collaboration that is achieved. A combination of approaches is needed to achieve more coordinated and integrated primary health care. The implications for several current policy debates are discussed: the establishment of local integrated and comprehensive primary health care centres, regional level primary care organisations and alternative payment mechanisms.