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Table 5 Summary of contextual factors by caseDomain and description

From: Context matters for primary health care access: a multi-method comparative study of contextual influences on health service access arrangements across models of primary health care

 

Case and PHC model

1 - Traditional

2 - GPSC

3 - GPSC

4 - GPSC

5 - HealthOne

6 - Community Health

History and Initial Conditions

 Funding arrangements (All cases had access to FFS via GPs and other eligible services, and to nurse incentive payments)

Rental from co-located services

Rental from co-located services, other grants

Other grants

Rental from co-located services, other grants

Rental from co-located services, other grants

Broad range of grants

 Business model (FP – for-profit; NFP-not-for-profit; PPP-public/private partnership)

FP (privately owned)

NFP

FP (privately owned)

PPP (university, hospital, LHN)

PPP

NFP

Agents

 Size (no. of equivalent full-time (EFT) staff) (small ≤ 20; medium ≥ 21 < 35; large ≥ 35)

Small

Medium

Large

Large

Medium

Large

 GPs (no. of EFT)

5 GPs, EFT 3.5

5 GPs, EFT 2

12 GPs, EFT 4

23 GPs, EFT 7

5GPs EFT 3

9GPs, EFT 5.4

 Workforce (District of Workforce Shortage)

(Changes to GP workforce availability in last 5 years)

No (recent increase -oversupply)

No (well serviced)

Yes (shortage)

No (recent increase - oversupply)

Yes (shortage)

No (oversupply)

 Governance (Board of Management representation: e.g. GP/LHN/PHC network and/or university representative/s)

GPs only

University, GPs

CEO is owner and primary decision maker

LHN, University

LHN, PHC network, GPs

Independent board members; external to case LHN, LGA, other managers

 Stability (Recent changes to structure, governance, workforce)

Instability (workforce leadership)

Stable

Stable

Instability (management and governance structures)

Stable

Instability (management structures)

Local fitness landscape

 ASGC-RA Remoteness index (Major City; Inner Regional; Outer Regional)

Major City

Major City

Inner Regional

Inner Regional

Inner & Outer Regional

Major City

 Local government area (LGA) population [41]

64,000

25,000

76,000

100,000

13,000

107,000

 IRSADa (LGA): Decile

5

8

9

6

7

9 (practice population has lower socio economic status)

 Links with LHN/acute health services (distance to acute hospital, co-located specialist clinics/community health services)

< 20kms, none

<  1 km, many LHN clinics

Site A < 28 km, Site B <  12 km, no LHN clinics

<  500 m, some LHN clinics

<  1 km, most community health services

< 5kms, one LHN clinic

Regional and global influences

 Service culture (referral to other providers within the service, relationship with LHN staff)

Strong informal referral culture

Strong referral networks in and across services

Communications in and across service have improved

Instability has made ‘whole of service’ culture difficult

Strong referral networks in and across services

Allied health and medical siloes impair communication

  1. a Index of Relative Socio-Economic Advantage and Disadvantage IRSAD: (based on LGA). The lowest 10% of areas are given a decile of 1 and the highest 10% a decile of 10