Community participation is regarded as one of the key pillars of primary health care.53 This is in part due to evidence of impact on the health of the communities and in part to notions of democracy and a civil society. In line with the GP Super Clinics Program objectives, the World Health Organisation (WHO) also emphasises the need for the primary health care sector to be responsive to local community needs through community participation and engagement.10 Similarly, a consensus process undertaken in Canada to determine attributes of primary care, identified a number of community-oriented dimensions including community participation, and responsiveness to the needs of the population.54
There is a range of evidence to support the impact of community participation in achieving clinical and population health outcomes.53 Despite this, community participation is considered one of the weakest strands in primary health care, requiring a strong policy and practice emphasis.55 Importantly, evidence exists for the impact of participation on disadvantaged groups nationally and internationally. For example, chronic disease programs for Aboriginal Australians were most successful with a high level of Aboriginal community engagement and effective communication at all levels, with flexibility to meet local needs.56 Strategies for enhancing capacity in community engagement for primary health professionals at local and national levels are strongly recommended.10,55
All of the GP Super Clinics had undertaken some form of needs assessment prior to commencing operations, as part of the application process and in contributing to the operational plan. Approaches included examining local population health data and health service activity, as well as general and specific consultation strategies.
Few of the GP Super Clinics have developed or implemented ongoing processes for community engagement. Given the stage of development, this is hardly surprising. However, opportunities for more strategic approaches to community engagement and community involvement in organisational governance are required if the GP Super Clinics are to meet local needs.
GP Super Clinic Directors appeared uncertain as to the approaches for community engagement, which could be applied in an ongoing and strategic manner. As Medicare Locals develop, there is potential for collaborative approaches to community engagement to support GP Super Clinics to meet local needs. Similarly, it would be expected that partnerships with local health services and potential for shared planning could be achieved. These approaches would be dependent on relationships between the GP Super Clinic Directors and these other health organisations.
Aboriginal and Torres Strait IslandersThere were some outstanding examples of engagement with the Aboriginal community. However, these were in the minority. Where these outstanding examples of engagement had occurred, they were simple, consultative strategies which were ongoing. The importance placed on engagement reflected a commitment of the Directors to addressing Aboriginal health in the local areas. While the GP Super Clinics Program emphasises the importance of engagement with the Aboriginal community, greater emphasis is needed on this important area at local levels. There are also opportunities for sharing strategies among GP Super Clinics which have not yet been realised.
10The World Health Report 2008: Primary care now more than ever. Geneva: WHO 2008.
53Bhatia N, Rifkin S. A renewed focus on primary health care: revitalize or reframe? Globilization and Health. 2010 6(13).
54Haggerty J, Burge F, Levesque J-F, et al. Operational Definitions of Attributes of Primary Health Care: Consensus Among Canadian Experts. Ann Fam Med. July 1, 2007 2007;5(4):336-344.
55Lawn JE, Rohde J, Rifkin S, Were M, Paul VK, Chopra M. Alma-Ata 30 years on: revolutionary, relevant, and time to revitalise. The Lancet. 2008/9/19/;372(9642):917-927.
56Liaw ST, Lau P, Pyett P, et al. Successful chronic disease care for Aboriginal Australians requires cultural competence. Australian and New Zealand Journal of Public Health.35(3):238-248