title: Assessment of the impact of family physicians in the district health system of the Western Cape, South Africa.
abstract: BACKGROUND
  In 2007, South Africa made family medicine a new speciality. Family physicians that have trained for this new speciality have been employed in the district health system since 2011. The aim of the present study was to explore the perceptions of district managers on the impact of family physicians on clinical processes, health system performance and health outcomes in the district health system (DHS) of the Western Cape.
  
  
  METHODS
  Nine in-depth interviews were performed: seven with district managers and two with the chief directors of the metropolitan and rural DHS. Interviews were recorded, transcribed and analysed using the ATLAS-ti and the framework method.
  
  
  RESULTS
  There was a positive impact on clinical processes for HIV/AIDS, TB, trauma, noncommunicable chronic diseases, mental health, maternal and child health. Health system performance was positively impacted in terms of access, coordination, comprehensiveness and efficiency. An impact on health outcomes was anticipated. The impact was not uniform throughout the province due to different numbers of family physicians and different abilities to function optimally. There was also a perception that the positive impact attributed to family physicians was in the early stages of development. Unanticipated effects included concerns with their roles in management and training of students, as well as tensions with career medical officers.
  
  
  CONCLUSIONS
  Early feedback from district managers suggests that where family physicians are employed and able to function optimally, they are making a significant impact on health system performance and the quality of clinical processes. In the longer term, this is likely to impact on health outcomes.
authors.affiliation: Division of Family Medicine and Primary Care, Stellenbosch University. meyer.esme@gmail.com.
authors.forename: Meyer
authors.initials: M
authors.lastname: Swanepoel
authors.forename: Bob
authors.initials: B
authors.lastname: Mash
authors.forename: Tracey
authors.initials: T
authors.lastname: Naledi
mesh_terms: D018672:Community Health Planning; D006801:Humans; D007407:Interviews as Topic; D010819:Physician's Role; D010821:Physicians, Family; D036301:Qualitative Research; D011787:Quality of Health Care; D013019:South Africa