Health policy defines health systems and health care provision, including specifying the role of primary care. Primary care can be understood as the first contact-point between the health care system and the served population. In some countries, like in Germany, Primary Care Practice can function as the bridge between health policy and Primary Care Physicians (PCPs). Primary Care Practice is responsible for the implementation of the rules and regulations established in health policy and for bridging policy with the needs of PCPs.
When it comes to implementing new health policies, PCPs play a critical role as leaders of change. Their support can be instrumental in steering policy reforms, but they can also act as barriers to change. Resistance from PCPs may occur when they lack sufficient information about the new health regulations and policies proposed, when they don't see the need for reform, or when they have been excluded from the health policy development process. Therefore, it is important to engage and inform PCPs throughout the policy development process to ensure successful implementation and support.
Currently, shortages and maldistribution of health workforces in PHC is a challenge not limited to Germany, but to our global health systems. The work focused on Germany´s context highlights the urgent need to address the issues of workforce maldistribution and unattractive working conditions, particularly in rural regions, which has persisted for years and gendersensitivity design of primary care. Primary Care Practice has a crucial leadership role in ensuring a high performing primary care. To encourage and support the next generation of General Practitioner (GPs), Primary Care Practice must be ready to innovate and find solutions that go beyond current rules and regulations. Health care reform and new heath policies is paramount to improve and maintain health care delivery. With this comes the evaluation, monitoring of progress, managing of change, and communication in a dynamic environment in midst of multiple, often diverging stakeholder interests. The ability of Primary Care Practice to innovate is a predictor of the resilience of the health system and its capacity to adapt and cope with performance challenges necessary for the health system to achieve its purpose. Through applying HPSR and systems thinking, this work assessed the introduction of health reforms in primary care and the design and proposal of a new model of care focusing on a patient-centered, share-care approach in ambulatory settings, This work evaluated the level of acceptance and uptake of introduced reforms on task-shifting and task-sharing (vertical collaboration, amongst PCPs and non-medical personnel), which addressed shortages of GPs in Germany, as well as evaluated the distribution of gender and labor wastage amongst health workforce in Mexico and exploring interprofessional collaboration (horizontal collaboration amongst PCPs). From these analyses, it was possible to identify challenges and opportunities for greater participatory methods, such as co-designing a new provision model of collaborative patient-centered-shared primary care by GPs and Gyns for women over 50 years that included a new financing mechanism. Beyond scientific publications, the communication strategy of these projects included policy briefs, fact sheets, briefs, and full policy reports to inform stakeholder groups who presented results at multiple national and international conferences as well as project specific meetings. It is crucial to understanding target groups and their power-relationships before formulating health policy recommendations for innovating Primary Care Practice in Germany. The introduction of a new health policy reform should be accompanied by a tailored information campaign. When evaluating health systems, the HPSR approach and systems thinking methods can bridge diverse paradigms of disciplines that can greatly aid in designing and introducing health policy reforms targeting PCPs to allow for participation and co-creation across all stakeholders.
The work has shown that the application of HPSR in the design and implementation of health systems research efforts are an effective method to assess and address primary care challenges and propose innovations to Primary Care Practice and health policy. HPSR and systems thinking takes into account the complexity of the real-life-context in which PCPs provide services, which allows for more concrete, impactful recommendations for policy and practice (such as those pertaining to task-shifting), the uptake of reforms, collaboration on policy formulation, new models of care, and remuneration that reflect the pulse of primary care. Applying these approaches to Primary Care Practice can contribute to closing the gap between health policy and the practitioner’s realities in primary care service delivery, ultimately improving the function of health systems in upholding patients’ health. The higher specificity of the formulated solutions and the responsiveness of policy and practice to the pressing challenges of PCPs and patients facilitates the uptake of relevant, timely and needed reforms. HPSR has shown promise as a valuable tool for driving change and innovation in Primary Care Practice. It offers a suitable theoretical and methodological framework for the adoption of research findings by policymakers, PCPs, and society as a whole. By bridging the gap between policy regulations and the realities faced by PCPs and patients, HPSR has the potential to effectively translate research into tangible improvements in healthcare delivery.
