Integration of primary health services: being put together does not mean they will work together.
BACKGROUND
This paper reports on an Australian experience of co-locating a range of different primary health services into one building, with the aim of providing integrated services. It discusses some of the early challenges involved with moving services together and reasons why collaborative and integrated working relationships to improve the clients' journey, may remain elusive.


METHODS
Ethnographic observational data was collected within a GP plus site as part of day-to-day interactions between the research officer and health professionals. This involved observations of team processes within and across teams at the site. Observations were thematically analysed using a social anthropological approach.


RESULTS
Three main themes arose from the analysis: Infrastructural impediments to collaboration; Territorialism; and Interprofessional practice (IPP) simply not on the agenda. The experience of this setting demonstrates that dedicated staff and resources are needed to keep IPP on the agenda of health service organisations. This is especially important where organisations are attempting to implement new models of collaborative and co-located services. Furthermore, it shows that establishing IPP within newly co-located services is a process that needs time to develop, as part of teams building trust with each other in new circumstances, in order to eventually build a new cultural identity for the co-located services.


CONCLUSIONS
Co-located health service systems can be complex, with competing priorities and differing strategic plans and performance indicators to meet. This, coupled with the tendency for policy makers to move on to their next issue of focus, and to shift resources in the process, means that adequate time and resources for IPP are often overlooked. Shared interprofessional student placements may be one way forward.
Flinders Human Behaviour and Health Research Unit, Flinders University, Margaret Tobin Centre, Adelaide, South Australia, Australia. sharon.lawn@flinders.edu.au.
Sharon
S
Lawn
Andrea
A
Lloyd
Alison
A
King
Linda
L
Sweet
Lyn
L
Gum
D000554:Ambulatory Care Facilities / Q000458:organization & administration; D003149:Community Dentistry / Q000458:organization & administration; D003153:Community Health Services / Q000458:organization & administration*; D003156:Community Mental Health Services / Q000458:organization & administration; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003752:Dental Health Services / Q000458:organization & administration; D005160:Facility Design and Construction; D063025:Health Information Management / Q000458:organization & administration; D006801:Humans; D033183:Interdisciplinary Communication; D007400:Interprofessional Relations; D008511:Medicine / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D013021:South Australia; D018881:Suburban Health; D013731:Territoriality