Interprofessional collaboration and learning in primary care

Van Bokhoven: “Dutch GP care is an international best practice for accessible and efficient care. We should really be careful about that. But the solo GP as we know it from the past no longer exists. A lot is changing in GP care, and at a rapid pace. More care is being transferred from the hospital to primary care, there are long waiting lists, staffing challenges exist both in the practices and communities, the demand for care is increasing due to an ageing population, patients have ever-higher expectations and there is also room for improvement in terms of content. In short, the practice needs to adapt. This is why innovation, which we engage in both in the department and within the Living Lab, is important”. 

Van Bokhoven: “Strong collaborative teams in the community are vital for innovation in primary care. GPs are key players in building such teams. They are often the first point of contact and have a broad view of the patient’s life context. They also hold a unique position, as unlike other organizations, they cannot refuse patients due to a lack of staff or resources. Moreover, GPs act as gatekeepers to hospital care. Yet general practitioners are often not fully aware of the role they have. They sometimes take charge in a hierarchical way, even though they do not want to be hierarchical. But leadership is different from being ‘in charge’. For the leadership needed in the community, GPs are well equipped because they have been in a neighborhood for a long time, are broadly and academically trained and can therefore think transcendently. We also know from research that the presence of the GP in innovation is crucial because innovation then gets off the ground faster and more successfully”. 

Van Bokhoven: “My chair is titled Interprofessional Collaboration and Learning in Primary Care. Interprofessional means that all relevant players in the patient’s care network (like home care, physiotherapists, dementia case managers, occupational therapists, pharmacists), and the patient themselves work together. Each brings their own background and training, but they jointly develop a care plan aimed at delivering personalized, appropriate care. In a multidisciplinary consultation (MDO) with healthcare professionals, we examine how to organise care around a particular group, for example elderly people in a vulnerable position, as efficiently as possible. What makes sense for them? What information should we collect about these patients? And if a patient wants to stay at home for as long as possible, what is necessary for that? Coming to a shared definition of the problem, with the patient involved, is key to guiding diagnosis and treatment. Yet in practice, this is difficult. Particularly in complex cases, professionals often assume what is best for the patient. At the same time, we also see the tension when the patient's role becomes too much of a client role. We need to define what is good enough, and what truly contributes to the quality of care. If we are talking about staff shortages, we can’t afford to spend all our time making care more patient-friendly - it’s simply unsustainable”.

Van Bokhoven: “Of course, there is already a lot of cooperation in healthcare, but we also often see everyone doing their own part, or acting one after the other. And while everyone thinks it's important, everyone also sees that it doesn't always go well. I hear GPs say: ‘all day long we do nothing but work together’. I then cite as an example the physiotherapist with whom a GP collaborates a lot. On the side of the physiotherapist, you see that they hesitate to give feedback to the GP, fearing they might no longer receive referrals client. And vice versa, you see that the GP, if things are not going well with a physiotherapist, does not enter into the conversation but refers to someone else next time. When you talk about interprofessional cooperation, it's also about these kinds of situations. We study how to improve them. Interprofessional learning is about (prospective) healthcare professionals having to learn with, from and about each other, with both disciplines being open to each other's perspective and speaking each other's language. This is quite different from telling during training what the tasks of another discipline are”.

Van Bokhoven: “Our faculty was originally founded with a strong focus on primary care. That’s still visible in CAPHRI, which integrates everything from direct patient contact to health systems organization. That really is a strength of Maastricht. And next to this we also have the various Living Labs. The educational aspect is also strong in the faculty. Thanks to the intensive cooperation with institute SHE, for example, we can immediately translate research we do in our department into education, and vice versa. It is also in our DNA that we work across disciplines. We do not offer a block of ‘general medicine’, but make thematic education together with different disciplines, both from first and second line. For example, on abdominal complaints.

In GP training, the idea of interprofessional collaboration and learning can also be found, especially in the third year when junior doctors are already more experienced and work in a general practice for a full year. They then also really work with colleagues in the community. How they build a relationship with those colleagues - and how that sometimes goes wrong - we are also investigating. Until now, doctors in training to become GPs were often only assessed by the trainer with whom they work in the practice. But why pick up feedback only from that GP? Why not also from the community nurse, the physiotherapist or the pharmacist? And when it comes to musculoskeletal care, why shouldn't the junior doctor learn some of the musculoskeletal research from the physiotherapist? 

When it comes to improving general practice, one aspect is beyond question: we must preserve the way this care is organized in the Netherlands. We must continue to safeguard the strength of primary care - the small scale, knowing people personally and in their context.”

Text: Eline Dekker
Photo: Joey Roberts

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