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This study examines a paper hand-held record and a shared electronic health record in an Australian tertiary hospital healthcare maternity setting and the role that both types of records play in facilitating integrated care among healthcare providers. A qualitative research design was used where five focus groups were conducted in two phases with 69 hospital healthcare providers. In total, 32 interviews were also carried out with general practitioners. Transcripts were analysed using qualitative content analysis. Three key themes were identified: (1) selective use of records; (2) records as communication of care; and (3) negativity about the use of records. This study demonstrates that healthcare providers do not effectively share information using either a paper hand-held record or a shared electronic health record. Considering a national commitment to e-health innovation, a multi-professional input, organisational support and continuing education are identified as crucial to realising the potential of a maternity shared electronic health record to facilitate integrated care.

The paper hand-held record (PHR) has been used extensively in general practice (GP) shared care management of pregnant women, and recently, the first Mater Shared Electronic Health Record (MSEHR) was introduced. The aim of this qualitative study was to examine women’s experiences using the records and the contribution of the records to integrate care. At the 36-week antenatal visit in a maternity tertiary centre clinic, women were identified as a user of either the PHR or the MSEHR and organised into Phase 1 and Phase 2 studies respectively. Fifteen women were interviewed in Phase 1 and 12 women in Phase 2. Semi-structured interviews were used for data collection, and analysed using qualitative content analysis. Four main themes were identified: (1) purpose of the record, (2) perceptions of the record; (3) content of the record, and (4) sharing the record. Findings indicate that the PHR is a well-liked maternity tool. The findings also indicate there is under-usage of the MSEHR due to health-care providers failing to follow up and discuss the option of using the electronic health record option or if a woman has completed the log-in process. This paper adds to an already favourable body of knowledge about the use of the PHR. It is recommended that continued implementation of the MSEHR be undertaken to facilitate its use.

Evidence indicates that general practice-based multidisciplinary teams can offer a means of addressing some of the key issues currently facing Western health systems, especially workforce and chronic disease management. Elements of team-working have been addressed in research and policy initiatives both overseas and in Australia, yet some important aspects of primary health care multidisciplinary team-working still remain unclear in the Australian context. This discussion paper has been developed by the Australian General Practice Network (AGPN) to raise awareness of and promote thought on four questions relating to multidisciplinary team-working that AGPN considers important but that, as yet, have not been fully addressed. (Except where indicated, it is not a position statement about AGPN's views on this matter.) Questions considered are: Who is in the team? What makes a successful team? How should teams be funded in Australia? Who coordinates the team? Each question broadly considers what is already known about the area through purposeful literature reviews of the published and grey literature, current policy impacting on the area, and suggested areas for policy development in the context of Australian general practice and primary care.

Following an extensive process, spanning nearly two years, the Salvation Army Crisis Services was funded to establish and operate a primary health service in St Kilda for injecting drug users in accordance with guidelines set out by the Victorian Department of Human Services. On 1 September 2004, Access Health was officially opened in a large building adjacent to Crisis Services and the primary Needle and Syringe Programs Locked in Crisis Services. In this paper, we seek to provide an insight into the initial establishment phase of a primary care facility designed to meet the health needs of a particularly vulnerable population. It outlines early trends in client need and the service response developed to meet these needs. It also touches upon the relationships that service management has pursued, the structure of the service, and the processes that have been put in place to address the (relatively few) teething problems that have arisen in the facility's first months of operation. In doing so, it provides insight of relevance to all practitioners who encounter the issues that marginalised and vulnerable clients with complex needs often bring.

In this paper, whānau Māori highlight how a Kaupapa Māori-centred intervention (the Harti Hauora Tamariki tool, hereafter Harti tool) has improved interactions with health services. The Harti tool is undergoing a randomised control trial (RCT) at Waikato Hospital in New Zealand. As part of the RCT, the authors engaged in a series of qualitative interviews with whānau members of tamariki Māori (children aged 0–5 years) admitted to Waikato Hospital’s paediatric ward. Whānau who met at least one criteria for New Zealand’s domains of deprivation were included. Using a Kaupapa Māori approach to the study, participants shared their views on barriers and facilitators to accessing health resources and primary care services. The interviews conducted highlight how the Harti tool, when administered in a culturally appropriate and respectful manner that prioritised relationship-building, enabled better connection to healthcare services. Prevalent in our analysis were connections to wider determinants of health and ways to reduce existing health inequities. To conclude the paper, how the Harti tool has enhanced feelings of being in control of health, with the potential to reduce the likelihood of a hospital readmission, is highlighted.

In this paper, whānau Māori highlight how a Kaupapa Māori-centred intervention (the Harti Hauora Tamariki tool, hereafter Harti tool) has improved interactions with health services. The Harti tool is undergoing a randomised control trial (RCT) at Waikato Hospital in New Zealand. As part of the RCT, the authors engaged in a series of qualitative interviews with whānau members of tamariki Māori (children aged 0–5 years) admitted to Waikato Hospital’s paediatric ward. Whānau who met at least one criteria for New Zealand’s domains of deprivation were included. Using a Kaupapa Māori approach to the study, participants shared their views on barriers and facilitators to accessing health resources and primary care services. The interviews conducted highlight how the Harti tool, when administered in a culturally appropriate and respectful manner that prioritised relationship-building, enabled better connection to healthcare services. Prevalent in our analysis were connections to wider determinants of health and ways to reduce existing health inequities. To conclude the paper, how the Harti tool has enhanced feelings of being in control of health, with the potential to reduce the likelihood of a hospital readmission, is highlighted.

Evaluation of programs and determining its challenges to improve and implement reforms is essential in a healthcare system. A primary healthcare program was conducted since 1984 in Iran and faces various challenges after several decades of its life. The aim of this study is to evaluate Iran’s primary healthcare program and determine its challenges and weaknesses. In the present systematic review study, the published articles related to Iran’s primary healthcare were searched and collected from Iranian databases (SID, Magiran, Noormags and Irandoc) and international databases (Pubmed, Scopus, Web of Knowledge and Google Scholar). The Iranian grey literature was also explored. In total, from 336 papers identified, 25 papers were deemed relevant after the step-by-step review of articles and removal of non-related articles. The results of this study show that primary healthcare in Iran has different challenges and weaknesses. Most of these challenges and weaknesses relate to the structure and process of primary healthcare. The Iranian primary healthcare system has achieved many successes in community health promotion, but today, because of social, economic, political and environmental changes, it does not meet the needs of the people; therefore, this system requires structural reforms.

Trans and gender-diverse individuals experience poor mental health, and face significant barriers when trying to access appropriate mental health care. Most seek treatment from mainstream primary care services, who have an ethical duty to provide care to all. Primary care practitioners can ameliorate traumatic harms by identifying helpful strategies and avoiding inappropriate or harmful strategies. However, there is limited robust, culturally sensitive evidence informing clinicians about the appropriateness and efficacy of psychological interventions for trans and gender-diverse clients. This forum article argues that the epistemological and ontological frameworks underlying psychotherapies can impact the therapeutic relationship, and are therefore important factors to consider in primary care practice with trans and gender-diverse clients. Our paper synthesises selected psychotherapies into four clusters. Each cluster is accompanied by discussion of the potential or demonstrated benefits and limitations of the underlying framework, in the context of primary care with trans and gender-diverse clients. We also explore power dynamics in therapeutic relationships with trans and gender-diverse clients, and the challenges these factors pose to developing a shared understanding of the client’s needs and preferences. The article concludes with some practical considerations for managing these issues in primary care.

There is a growing population of people from refugee backgrounds settling in Australia. They have often been forced to flee from their homes in violent circumstances and may have spent many years in refugee camps with poor health support. There are multiple barriers to their effective access to health services. Community engagement with this community can be tokenistic and difficult to effect. This paper highlights the importance of developing a meaningful strategy for community engagement that is not ‘one-size-fits-all’, which is achieved over time. There is a rich resource available to health practitioners if engagement with refugee-background communities is managed according to the set of trauma-informed and structural principles outlined in this paper.

This paper examines the implications of the second sentence in Tudor Harts statement about inverse care – that its operation was strongest when exposed to market forces. In the Australian context, we briefly review some available evidence for inverse care in three groups – Aboriginal and Torres Strait Islander people and those living in remote and socioeconomically disadvantaged areas. We then discuss the extent to which these examples can be attributed to the operation of supply-and-demand within Australia’s hybrid fee-for-service system in general practice. Our analysis suggests disparities in workforce supply and the ability of disadvantaged groups to seek preventive and proactive care are critical factors. These, in turn, suggest the need to fund general practice to be responsible for proactive and preventive care of disadvantaged population groups alongside broader structural reforms in workforce, education and taxation.

Chronic disease identification and management is a significant issue in Australia, with general practice being the primary contact point for those at risk of, or living with, chronic disease. However, there is a well-described gap between guideline recommendations for chronic disease management and translation in the general practice setting. In 2018, a group of researchers, clinicians and software developers collaborated to develop a tool to support the identification and management of chronic disease in general practice, with the aim to create a platform that met the needs of general practice. The co-design process drew together core principles and expectations for the establishment of a technological platform, called Future Health Today (FHT), which would sit alongside the electronic medical record (EMR) management system within general practice. FHT used algorithms applied to EMR data to identify patients with, or at risk of, chronic disease and requiring review. Using chronic kidney disease as a clinical focus, the FHT prototype was piloted in a large, metropolitan general practice, and a large regional general practice. Based on user feedback, the prototype was further developed and improved. This paper provides a report on the key features and functionalities that participants identified and implemented in practice.

Background Almost half of Australian after-hours emergency department (ED) presentations are rated as ‘non-urgent’ by clinicians and are suggested to be managed by community-based services, such as general practice (GP). This paper reports patient reasons for presenting for medical care after hours, and reasons for selection of specific services across a health system. Methods A cross-sectional survey was conducted across the Australian Capital Territory. Patients voluntarily completed questionnaires in waiting rooms during the after-hours periods of one weekday and one weekend in 2019 at 28/51 extended hours GPs, 3/3 medical deputising services (MDS), 3/3 nurse-led walk-in-clinics (WICs), and 2/2 public emergency departments (EDs). Results Of 3371 presentations, 1992 patients completed a survey, with 58% from GPs (n = 1149), 16% from WIC (n = 317), 10% from MDS (n = 193), and 17% from EDs (n = 333). Most patients presented with self-rated new issues (n = 987, 49.5%) and were uncertain of the urgency of their issues (n = 723, 36.7%). Common reasons for presenting to WIC, MDS, and EDs included the problem occurring after hours, and patients concern about the issue. Common reasons for presenting to GP were related to personal preference for after-hours care. Conclusions Patients present to after-hours medical services for both perceived need and convenience. Most patients appear to be self-selecting after-hours services appropriately aligned with advertised services; except for GP patients who were attending after hours for care that is often non-urgent and could be seen in usual working hours. This study should be replicated to account for local health systems, and coronavirus disease 2019 (COVID-19)-related changes to health care.

Person-centred primary care is a priority for patients, healthcare practitioners and health policy. Despite this, data suggest person-centred care is still not consistently achieved – and indeed, that in some areas, care may be worsening. Whole-person care is the expertise of the medical generalist – an area of clinical practice that has been neglected by health policy for some time. It is internationally recognised that there is a need to rebalance specialist and generalist primary care. Drawing on 15 years of scholarship within the science of medical generalism (the expertise of whole-person medical care), this discussion paper outlines a three-tiered approach to primary care redesign; describing changes needed at the level of the consultation, practice set up and strategic planning. The changing needs of patients living with complex chronic illness has already started a revolution in our understanding of healthcare systems. This paper outlines work to support that paradigm shift from disease-focused to person-focused primary healthcare.

The study aimed to explore Indigenous narrative accounts of healthcare access within qualitative research papers, to better understand Indigenous views on culturally safe healthcare and health communication represented in that literature. A systematic literature review of peer-reviewed academic qualitative studies identified 65 papers containing Indigenous respondents’ views on accessing healthcare. Analysis included all Indigenous voice (primary quotations) and author findings describing healthcare access across these studies. Healthcare communication, or ‘talk’, emerged as a key theme. Indigenous clients valued talk within healthcare interactions; it was essential to their experience of care, having the power to foster relationships of trust, strengthen engagement and produce positive outcomes. By mediating the power differentials between health professionals and Indigenous clients, talk could either reinforce powerlessness, through judgmental down-talk, medical jargon or withholding of talk, or empower patients with good talk, delivered on the client’s level. Good talk is a critical ingredient to improving Indigenous accessibility and engagement with healthcare services, having the ability to minimise the power differentials between Indigenous clients and the healthcare system.

Background The impact of colonisation, dispossession and marginalisation on the health of Aboriginal and/or Torres Strait Islander peoples (hereafter respectfully referred to as Aboriginal people) is well documented. Aboriginal people continue to practice traditional healing, and in recent years have initiated numerous community-based healing programs around Australia. The Closing the Gap policy has also resulted in numerous community health programs. Despite these program and policy responses, Aboriginal people continue to experience persistent health disparities. The role of Aboriginal Elders in shaping Aboriginal health has yet to be a focus of research attention. This paper reports on a study that examined the contributions of Elders to the healing of Aboriginal people in a remote Tasmanian community. Methods Our co-designed participatory action research methodology was undertaken with eight community Elders. Results Analysis of qualitative data derived through interviews and yarning circle discussions revealed an emerging theme of community healing; with Elders undertaking a suite of therapeutic practices, and promoting cultural values to strengthen Aboriginal identity, community cohesion and connections to Country. The Elders identified healing as an essential process in response to intergenerational trauma, racism and marginalisation. Conclusions The findings inform policy stakeholders to consider the wisdom and voice of Elders in addressing Aboriginal community healing.

The COVID-19 pandemic has challenged the mental health of communities worldwide, with the triple pressures of financial insecurity, lockdowns, and worry about the infection. Australia rapidly deployed resources to protect the mental wellbeing of the community through supplementing existing services, supporting at-risk groups, investing in social supports, embracing technology, and supporting the health workforce. This paper describes the Australian Government’s investment in mental health during the COVID-19 pandemic in relation to the 10 priority areas identified in Australia’s National Mental Health Pandemic Response Plan.

Background The impact of Australia’s diverse population on the aged care sector has been acknowledged, with the Royal Commission into Aged Care Quality and Safety findings providing evidence of the importance of population diversity for consumer-directed and person-centred care. Similarly, the Aged Care Quality Standards and Aged Care Diversity Framework acknowledge the diversity of Australia’s ageing population and potential implications for equitable access to care and the ensuing importance of culturally appropriate and culturally safe care. This paper reports on the development of informational web pages and utilisation findings for use by the aged care workforce supporting diverse populations. Methods Content was created for the End of Life Directions for Aged Care website, based on rapid review findings relating to barriers and limitations for people accessing equitable care in the aged care and palliative care sectors. Results Website pages containing embedded links to useful content and resources for health professionals and care workers who work with older diverse adults are shown to be well received among users. Conclusions As Australia’s future population will age with increasing diversity markers, with implications for aged care and palliative care service provision, workforce access to up-to-date, relevant and evidence-informed information on best practice non-clinical support for individuals from diverse backgrounds towards the end of life promotes a person-centred care approach. Access data shows that the website content is being utilised increasingly over time and suggests that it is filling a gap in comprehensive and accessible end of life resources that have been missing from the Australian aged care and palliative care workforce.

Australia is facing a growing burden of knee and hip osteoarthritis (OA). To address this demand in northern New South Wales, a community health-based conservative OA joint management service was established in the Tweed Valley. This paper describes the design, implementation and initial evaluation of the service. Following the principles of clinical redesign, a diagnostic phase involving consultation with key stakeholders revealed several issues. OA patients could wait up to 9 months for review by orthopaedic specialist following GP referral and received limited information on how to conservatively manage their conditions. GPs were constrained by short consultations and had limited knowledge of the latest recommendations for the conservative treatment of OA. GPs also highlighted the limitations of outdated fax systems for communication, noting their preference for secure electronic messaging. Based on these findings, the Tweed Knee and Hip Arthritis Service was established. For patients not on a waiting list for surgery, the service provides evidence-based conservative management for knee or hip OA involving standardised assessment, education, exercise, self-management strategies and regular review. An analysis of a foundational cohort of patients demonstrated improvements in a suite of validated and standardised measures for pain and function, with improvements seen as early as 1 month and sustained for 6 months. The study findings support the introduction of integrated conservative OA management models of care directly available to primary healthcare providers.

Despite the best efforts and commitment of oral health programs, there is no evidence that the current surgical output-based model of oral health care is delivering better oral health outcomes to the community. In fact, Australian evidence indicates the oral health of the community could be getting worse. It is now well-understood that this traditional surgical model of oral health care will never successfully manage the disease itself. It is proposed that a health-promoting, minimally invasive oral disease management model of care may lead to a sustainable benefit to the oral health status of the individual and community groups. The aim of this paper is to describe such a model of oral health care (MoC) currently being implemented by the North Richmond Community Health Oral Health (NRCH-OH) program in Melbourne, Victoria, Australia; this model may serve as a template for other services to re-orient their healthcare delivery towards health promotion and prevention. The paper describes the guiding principles and theories for the model and also its operational components, which are: pre-engagement while on the waitlist; client engagement at the reception area; the assessment phase; oral health education (high-risk clients only); disease management; and reviews and recall.

Surveillance of people’s health takes on an important meaning in the practice of public health because it allows monitoring of diseases and prompt response to change in proportions and rates at which diseases occur in populations. Improving health of populations requires establishment of an effective public health system. Population level data and analysis is critically important in government policy and program development and monitoring. Lack of or inadequate information about the health of populations leads to ineffective policies that may often attenuate health problems instead of solving them. Australia’s current oral health surveillance is mostly through ad hoc sentinel surveys, which lack recency in time. This position paper is to present the need for real-time oral health surveillance in Australia, which can be used to inform health decision-making in a timely manner.

We are delighted to have been invited to guest edit this special issue of the Australian Journal of Primary Health and to bring you 13 papers looking at aspects of the rhetoric and reality of e-health in relation to primary health. We were pleased to see the enthusiastic reaction from authors to the call for papers and have thoroughly enjoyed reading the submitted papers and guiding them through the reviewing and revision processes. In developing the special issue, several things have been foremost in our mind. First, what exactly is e-health, and is it different from telehealth, information and communication technologies (ICT) for health, online health and other terms? The World Health Organization (WHO) defines e-health as the use of information and communication technologies for health, with e-health innovations including electronic health records, computer-assisted prescription systems and clinical databases, ICT-supported clinical care, online health information for the general public and scientific information for professionals, platforms for publishing and disseminating health alerts and supporting administrative functions (World Health Organization 2006). The papers in this special issue reflect awide understanding of e-health and cover topics including health professional training to use online health systems, issues around access and equity for consumers, and electronic records and management. The papers cover areas such as maternity care, dentistry, general practice, mental health, cancer care, chronic disease, nursing and community health. Second, we were keen to develop this special issue in light of the techno-optimism that we feel prevails within some parts of government and of the health professions in Australia in relation to e-health, and which is not always balanced by a critical perspective of who actually benefits, or of unintended consequences of its introduction or expansion. Australia’s national E-Health Strategy (Australian Health Ministers Advisory Council 2008) envisages ‘a safer and more sustainable health system that is equipped to respond to emerging health sector cost and demand pressures’, and it sees this being achieved by changing the way information is accessed and shared across the health system. This means that interactions with the health system by consumers, care providers and healthcare managers will increasingly be through electronic means. In particular, the Strategy notes the ‘potentially important role e-healthmayplay in deliveringAustralians a higher quality, safer, more equitable and more efficient health system’ and that ‘e-health should be considered a means to potentially address the ever-increasing costs of Australian health care’ (Australian Health Ministers Advisory Council 2008, p. 23). Australia’s national E-Health Strategy has substantial goals, including that by 2018 (i.e. in just 5 years from now) up to 20% of consultations will be by electronic consultation or telehealth capability, and over 90%of care providerswill be using standards compliant systems for patient, clinical and practice management that support e-health priority solutions such as the electronic transfer of prescriptions, test orders/results, referrals and event summaries. It also envisions that by 2018, 50% of consumers will be actively accessing and using a personal Electronic Health Record tomanage their health and interact with the health system. The Strategy sees ‘latent capacity in the system represented by consumers themselves playing a more active role in the protection and management of their personal health outcomes’ (Australian Health Ministers Advisory Council 2008, p. 1), although it does not detail how all consumers will be up-skilled and resourced to be able to this. Similarly, Australia’s E-Mental Health Strategy (Department of Health and Ageing 2012) focuses on mainstreaming the provision of online health information and online support services for consumers and carers, seeing these as widely accessible (but with little acknowledgement of the inequities in technical Internet access by geography and socioeconomic status across Australia, or of how social/cultural and educational barriers to successful Internet use can be overcome to provide e-mental health that is truly accessible by all). The Strategy also outlines the need for training of the mental health workforce to provide services in these ways. TheNational E-health Strategy sees the approach as threefold: (1) to improve the quality and safety of the Australian health system(and thereby reduce avoidabledemand forhealth-care services) through improved data and monitoring, access to decision support tools for care providers and up-to-date consumer information and knowledge sources at the point of care; access to better quality datasets of treatment effectiveness; automatic monitoring of individual care; and access to timely and comprehensive data for more effective health surveillance and management.

This paper explores the role of the General Practitioner Liaison Nurse (GPLN) in improving integration and coordination of services within Primary Health Care. This position can play a major role in care coordination and cultural change. The GPLN within HealthOne Mt Druitt (HOMD) identifies patients’ needs and facilitates communication, case conferencing and care coordination between health and other providers. The priority areas of children and their families at risk or with significant unmet needs, and chronic aged and complex care, were identified as target areas. This paper focuses on the GPLN within the chronic aged and complex care service model. The GPLN within HOMD was able to improve coordination and integration of services for patients of the facility. Activities included organising multidisciplinary services and addressing psychosocial issues. Patients and community health staff identified the importance of the role for improving coordination and integration of services. Decision and policy makers saw the position as vital to the implementation, operation and sustainability of HOMD.

Health promotion professionals often work with community organisations and voluntary associations, including churches and church-affiliated organisations, to reduce health inequities within communities. How voluntary and church-affiliated organisations form intersectoral relationships and partnerships, and the challenges they face in doing so, has been well researched. However, there is a need to investigate further the extent to which local churches collaborate or form partnerships with other actors, such as government, peak bodies and welfare organisations. This paper reports a Victorian-based mapping exercise of partnerships and funding involving document analysis of the annual reports from 126 organisations and 35 interviews conducted with church-affiliated organisations and local churches. The discussion begins with the exploration of the nature of, and the reason why churches partner with other sectors. The paper also examines funding sources and partnership pathways that churches access to undertake the activities and programs they conduct. Interview themes highlight the value to churches of the sharing of expertise and resources, the provision of support to communities, a shared ethos of social justice and the empowerment of vulnerable populations. The findings about the extent to which local churches are involved in partnerships across society, and the extent of public and private funds they draw on to provide resources and assistance to local communities, indicate that churches are now a key player not just in welfare provision but also in health promotion activities. The findings contribute to the understanding of church activities in relation to health promotion and will assist organisations who may be potential partners to consider their collaborative efforts in the health promotion field.

There is a paucity of research into the development of intersectoral collaborations designed to support early childhood development in rural communities. Drawing on findings from a qualitative study conducted in three small rural communities in Tasmania, this paper will examine community-based intersectoral collaborations involving government and non-government organisations from the health and allied health, education and community service sectors. The paper analyses the process of developing intersectoral collaborations from the perspective of early childhood health and wellbeing. The specific focus is on collaborations that build family and community capacity. Findings indicate that three groups of factors operate interdependently to influence collaborations: social capital, leadership and environmental factors. Each community has different leadership sources, structures and processes, shaped by levels of community social capital, and by environmental factors such as policy and resources. Effective models of early childhood development require strong local and external leadership. Rural communities that are able to identify and harness the skills, knowledge and resources of internal and external leaders are well positioned to take greater ownership of their own health and wellbeing. The paper provides guidelines for developing and enhancing the capacity of rural communities at different stages of collaborative readiness.

Refugees can experience problems accessing and utilising Australian primary health care services, resulting in suboptimal health outcomes. Little is known about the impact of their pre-migration health care experiences. This paper demonstrates how the Afghan pre-migration experiences of primary health care can affect engagement with Australian primary care services. It considers the implications for Australian primary health care policy, planning and delivery. This paper is based on the international experiences, insights and expert opinions of the authors, and is underpinned by literature on Afghan health-seeking behaviour. Importantly, Afghanistan and Australia have different primary health care strategies. In Afghanistan, health care is predominantly provided through a community-based outreach approach, namely through community health workers residing in the local community. In contrast, the Australian health care system requires client attendance at formal health service facilities. This difference contributes to service access and utilisation problems. Community engagement is essential to bridge the gap between the Afghan community and Australian primary health care services. This can be achieved through the health sector working to strengthen partnerships between Afghan individuals, communities and health services. Enhanced community engagement has the potential to improve the delivery of primary health care to the Afghan community in Australia.

The oral health of older people living in residential aged care facilities has been widely recognised as inadequate. The aim of this paper is to identify barriers to effective engagement of health-care providers in oral care in residential aged care facilities. A literature review was conducted using MEDline, CINAHL, Web of Science, Academic Search Complete and PsychInfo between 2000 and 2013, with a grey literature search of government and non-government organisation policy papers, conference proceedings and theses. Keywords included: dental/oral care, residential aged care, health-care providers, barriers, constraints, and limitations. A thematic framework was used to synthesise the literature according to a series of oral health-care provision barriers, health-care provider barriers, and cross-sector collaborative barriers. A range of system, service and practitioner level barriers were identified that could impede effective communication/collaboration between different health-care providers, residents and carers regarding oral care, and these were further impeded by internal barriers at each level. Findings indicated several areas for investigation and consideration regarding policy and practice improvements. While further research is required, some key areas should be addressed if oral health care in residential aged care services is to be improved.

Children and adolescents in rural Australia experience poorer health and educational outcomes than those in urban areas. This paper presents findings from a qualitative study exploring the role of primary health care registered nurses (RNs) working in the School-Based Primary Health Care Service in Broken Hill, far west New South Wales. The Service integrates health district-employed RNs with school learning and support teams to increase service access and improve health and education outcomes for students. The findings show that RNs used care navigation to reduce barriers to care by addressing healthcare candidacy with students and families. The RNs also linked schools, families and health and social care services, and facilitated intersectoral collaboration to improve the support provided to students experiencing health and developmental issues. Integrating health district-employed RNs with existing student support services is a promising approach to improving the health and education of disadvantaged students. This study provides individual- and system-level explanations of the role of the school-based primary health care RN and can inform the development of similar services elsewhere.

There has been a growth in Australian school-based nurses to address the inequities confronted by vulnerable students and school populations. Failure to address inequities can be evidenced in intergenerational poverty, poorer health and educational attainment and diminished life opportunities. School-based nurses are ideally located to advocate for public health policies and programs that address social determinants that detrimentally affect the health of school populations. However, school-based nurses can confront professional and speciality challenges in extending their efforts beyond individual student advocacy to effect change at the school population level. Guidance is required to redress this situation. This paper describes public health advocacy, the professional and speciality advocacy roles of school-based nurses and the barriers they confront in advocating for the health of school populations and strategies that can be used by key stakeholders to enhance school-based nursing public health advocacy efforts. School-based nurses who are competent, enabled and supported public health advocates are required if we are to achieve substantial and sustained health equity and social justice outcomes for vulnerable school populations.

Background The COVID-19 pandemic continues to exert a significant toll on the Australian primary healthcare system. Although wellbeing challenges faced by hospital-based healthcare workers are widely discussed, less is known about the experiences of general practitioners (GPs) during the initial phases of the pandemic. This paper reports qualitative survey data from Australian GPs, examining their workplace and psychosocial experiences during the initial months of the pandemic. Methods An Australia-wide, cross-sectional, online survey of frontline healthcare workers was conducted in 2020. A qualitative approach using content analysis was utilised to examine responses to four free-text questions from GPs. Results A total of 299 GPs provided 888 free-text responses. The findings reveal that general practice was overlooked and undervalued within the pandemic response, resulting in negative impacts on GP wellbeing. Four themes were identified: (1) marginalisation of GPs; (2) uncertainty, undersupported and undervalued in the workplace; (3) isolation and disrupted personal lives; and (4) strategies to support GPs during times of crises. Key concerns included poor access to personal protective equipment, occupational burnout and poor wellbeing, insufficient workplace support, and conflicting or confusing medical guidelines. Conclusions Primary healthcare constitutes an essential pillar of the Australian healthcare system. This study presents the many factors that impacted on GP wellbeing during the COVID-19 pandemic. Enabling GP voices to be heard and including GPs in decision-making in preparation for future crises will enhance the delivery of primary care, reducing the burden on hospital services, and help sustain a safe and effective health workforce long term.

Mental health disorders among women during the perinatal period are common and cause significant morbidity, yet precise reasons why some women develop depression during this period, and others do not, are, as yet, unknown. Pregnancy may burden populations of women differently, and sociological variables, such as finances, social position, interpersonal resources; and extreme events, the coronavirus disease 2019 (COVID-19) pandemic for example, may be as significant as biological determinants. However, current treatment for depression remains focused on the individual woman as the main agent for change. Incorporating a systems-wide approach to diagnosing and treating perinatal depression by addressing structural and systemic determinants may be a more effective way to treat this illness. In this paper, we explore social determinants of health and their correlation with clinical depression in the antenatal period. We also investigate broader, society-wide interventions that may reduce this significant morbidity among women of reproductive age, in both developed and developing nations.

The genesis of this issue of the Australian Journal of Primary Health occurred in October 2013, at the inaugural Onemda VicHealth Koori Health Unit’s writers retreat at the Mount Eliza Business School (Victoria, Australia). At this gathering, Aboriginal andTorres Strait Islander academics fromuniversities acrossAustraliametwithnon-Indigenous researchers, editors and writers, all invested in the process of writing together. Over the courseof the retreat, communitypeoplehadachance to reflect and write up theirwork, and students and academics hadopportunities to build capacity together by participating in workshops, joint exercises and walks along the beach. Over dinner, we discussed the multiple ways in which we promoted health and well-being and what is possible through the active engagement of culturally sensitive researchers with people invested in community, innovations, capacity building and shared experience. What we quickly identifiedwas that there is no simple term to expresswhat we mean by ‘health promotion’. We know health is a universal human aspiration and a basic human right. We know there are people acrossAustralia, includingmembersofourAboriginal and Torres Strait Islander communities, who may never achieve good health. We also know that there are many of us working to address the inequitable distribution of social determinants.Health promotion, we determined, is a complex interactive function of the ideas one has absorbed from others; others, in turn, whose ‘own’ ideas are a complex interactive function of the ideas they have absorbed, and so on. For some of us, such complexity is hard to tie down on a page through the act of writing. However, through the creative process of writing together, we identified some papers that we thought were worthy of publication so others could learn about the successes being discussed at this gathering. We are grateful to Ms Kate Silburn from La Trobe University (Melbourne, Vic., Australia) for putting us in touch with the editorial team at the Australian Journal of Primary Health. We also want to acknowledge the farsightedness of this team in dedicating a journal issue to health promotion with and by Aboriginal and Torres Strait Islander people. In the pages of this special issue youwill see health promotion represented as a synthesis of people with their families and communities, people with the natural world, people transforming their service delivery systems, building capacity within their organisations and changing the way mainstream communities interact with Aboriginal and Torres Strait Islander people. Others have developed key educational, practice-orientated and clinical tools and resources to engage people with their own and their community’s health and well-being. Other papers articulate the capacity of developments inAboriginal andTorres Strait Islander people’s health promotion work to inform and strengthen health promotion efforts targeted at other population groups. All work represented in this special issue of the Journal has been undertaken by people who are committed to the work of health promotion, to its social purpose and to concepts of social justice andequity for all. Importantly,manypapers start fromastrengthsbased position. A clear message from authors contributing to this special issue is that for too long Aboriginal and Torres Strait Islander people have been described as having problems that are toobig and complex to be solvedwithin communities themselves. Aboriginal and Torres Strait Islander people are starting to write back against these descriptions, changing the collective story of Aboriginal and Torres Strait Islander communities from one of deficit to one of strength and resilience. This ‘writing back against the deficit position’ is in itself a health promoting exercise, a call to which culturally sensitive researchers are starting to respond. If there is one behavioural change that wewouldwant as a result of this compilation it would be that researchers do not in the first sentence focus on our disadvantage; rather, we want them to focus on what is possible through a process of self-determination and of co-creating health and well-being. We took the responsibility of co-creating health andwell-being seriously. First, participants at thewriters retreat in Mount Eliza developed a call for papers and sent the invitation to participate through our networks. The editorial team, made up of Indigenous and non-Indigenous academics, maintained a strong commitment to ‘two ways together’. Second, we invested in a peer-review process that saw each paper reviewed by at least one Aboriginal and/or Torres Strait Islander reviewer and at least one non-Indigenous reviewer. This meant the review process supported the authors of the articles with both academic and cultural rigour. Finally, we are delighted that there are first-time authors in this issue of the Journal. Although health promotion work is innovative and inspiring, many Aboriginal and Torres Strait Islander people are employed in chronically underresourced contexts, are time poor and are not actively encouraged and supported to showcase their work in academic journals. We are proud that there are a high proportion of practice and innovation papers in this special issue of the Journal. We remained true to the principles in Indigenous scholarship to

Background Low back pain is the leading worldwide cause of years lost to disability and the problem is worsening. This paper describes and demonstrates the scholarly development and contextual refinement of a primary care program for acute low back pain in Sydney, Australia. Methods Hybrid theoretical frameworks were applied, and co-design was used to contextualise the program to the local healthcare setting. Results The program was developed in four stages. In stage 1, the scientific evidence about management of acute low back pain in primary care was examined. In stage 2, stakeholders (patients and clinicians) were consulted in nationwide surveys. Data from stages 1 and 2 were used to design an initial version of the program, called My Back My Plan. Stage 3 involved the contextual refinement of the program to the local setting, MQ Health Primary Care. This was achieved by co-design with primary care clinicians and patients who had sought care for low back pain at MQ Health Primary Care clinics. In stage 4, a panel of Australian experts on clinical care for low back pain reviewed the contextualised version of My Back My Plan and final amendments were made. Conclusion My Back My Plan has been developed using an innovative scholarly approach to intervention development.

Background Rising health costs and health inequity are major challenges in Australia, as internationally. Strong primary health care is well evidenced to address these challenges. Primary Health Networks (PHNs) work with general practices to collect data and support quality improvement; however, there is no consensus regarding what defines high quality. This paper describes the development of an evidence-based suite of indicators and measures of high-quality general practice for the Australian context. Methods We reviewed the literature to develop a suitable framework and revise quality assurance measures currently in use, then reviewed these in three workshops with general practitioners, practice managers, nurses, consumers and PHN staff in western Sydney. We used a descriptive qualitative research approach to analyse the data. Results A total of 125 evidence-based indicators were agreed to be relevant, and 80 were deemed both relevant and feasible. These were arranged across a framework based on the Quadruple Aim, and include structure, process and outcome measures. Conclusions The agreed suite of indicators and measures will be further validated in collaboration with PHNs across Australia. This work has the potential to inform health systems innovation both nationally and internationally.

This paper examines commitments to address health inequities within current (2008–11) Australian government initiatives on health promotion and chronic disease prevention. Specifically, the paper considers: the Council of Australian Governments’ ‘National partnership agreement on preventive health’; the National Preventative Health Taskforce report, ‘Australia: the healthiest country by 2020’; and the Australian Government’s response to the taskforce report, ‘Taking preventative action’. Arising from these is the recent establishment of the Australian National Preventive Health Agency. Together, these measures represent a substantial public investment in health promotion and disease prevention. The present paper finds that these initiatives clearly acknowledge significantly worse health outcomes for those subject to social or economic disadvantage, and contain measures aimed to improve health outcomes among Indigenous people and those in low socioeconomic status communities. However, we argue that, as a whole, these initiatives have (thus far) largely missed an opportunity to develop a whole of government approach to health promotion able to address upstream social determinants of health and health inequities in Australia. In particular, they are limited by a primary focus on individual health behaviours as risk factors for chronic disease, with too little attention on the wider socioeconomic and cultural factors that drive behaviours, and so disease outcomes, in populations.

Australia and New Zealand both have large populations of people with limited English proficiency (LEP). Australia’s free telephone interpreter service, which is also used by New Zealand through Language Line (LL) but at a cost to the practices, is underused in both countries. Interpreter guidelines warn against the use of family members, yet the lack of uptake of interpreter services must mean that they are still often used. This paper reviews the literature on medical interpreter use and reports the results of a week-long audit of interpreted consultations in an urban New Zealand primary health centre with a high proportion of refugee and migrant patients. The centre’s (annualised) tally of professionally interpreted consultations was three times more than that of LL consultations by all other NZ practices put together. Despite this relatively high usage, 49% of all interpreted consultations used untrained interpreters (mostly family), with more used in ‘on-the-day’ (OTD) clinics. Clinicians rated such interpreters as working well 88% of the time in the OTD consultations, and 36% of the time in booked consultations. An in-house interpreter (28% of consultations) was rated as working well 100% of the time. Telephone interpreters (21% of consultations) received mixed ratings. The use of trained interpreters is woefully inadequate and needs to be vigorously promoted. In primary care settings where on-going relationships, continuity and trust are important – the ideal option (often not possible) is an in-house trained interpreter. The complexity of interpreted consultations needs to be appreciated in making good judgements when choosing the best option to optimise communication and in assessing when there may be a place for family interpreting. This paper examines the elements of making such a judgement.

This paper discusses the methodological framework and perspectives that were used in a larger study aiming at examining the experience of working life among female Aboriginal health care workers. Currently, the voice of Aboriginal women who work in the Australian health system has not received much attention. In comparison to other occupations and backgrounds, there is virtually no literature on Aboriginal woman health care workers despite 15% of health care and social service industry employees in Australia being Aboriginal. In this study, we selected female participants because of the fact that of these 15% of health workers in the Victorian health system, 76% of them are women. This paper outlines some of the barriers in researching Indigenous communities. These barriers were overcome in this study by framing the research in feminist theory, decolonising theory, empowerment and by employing the photovoice method. The photovoice method was used because it is relatively unobtrusive and has the capacity to be empowering. All data was extrapolated from the participants’ own narratives that were prompted by the photographs they had taken. The data produced were rich descriptions and narratives that were oral as well as visual. Finally, the article discusses the experience of using the photovoice method from the researcher and participants’ perspective.

Community participation is considered important in primary health care development and there is some evidence to suggest it results in positive health outcomes. Through a process of synthesising existing evidence for the effectiveness of community participation in terms of health outcomes we identified several conceptual areas of confusion. This paper builds on earlier work to disentangle the conceptual gaps in this area, and clarify our common understanding of community participation. We conducted a research synthesis of 689 empirical studies in the literature linking rural community participation and health outcomes. The 37 final papers were grouped and analysed according to: contextual factors; the conceptual approach to community participation (using a modification of an existing typology); community participation process; level of evidence; and outcomes reported. Although there is some evidence of benefit of community participation in terms of health outcomes, we found only a few studies demonstrating higher levels of evidence. However, it is clear that absence of evidence of effect is not necessarily the same as absence of an effect. We focus on areas of debate and lack of clarity in the literature. Improving our understanding of community participation and its role in rural primary health care service design and delivery will increase the likelihood of genuine community-health sector partnerships and more responsive health services for rural communities. Refereed/Peer-reviewed

Partnerships bring actors together to make horizontal connections between organisations. This has proven to be an effective model at the local level in Ireland. This paper explores possibilities for local partnerships to come together through a network to make vertical connections to national policy processes. It is written as a practice and innovation paper by the national coordinator of the Community Partnership Network in Ireland. A review of current practice and expectations of the Community Partnership Network indicates there has been greater success in providing support to members compared with impacts from strong vertical connections. This experience is common for a range of local actors in the community development sector in Ireland who find that there are insufficient meaningful connections between local and national institutions. This limits the opportunity for transfer of knowledge from the local level to inform national policy. Going forward, the notion of network advantage is explored as a means to make the necessary vertical connections. It is proposed that the outcomes from a network should cover the dimensions of: joint value creation, mutual capacity development and collective engagement with decision makers. There is real opportunity to apply this in Ireland as the three networks representing local development are about to merge into a single representative body for what are now local integrated development partnerships. Thinking about network advantage also provides possible application for creating stronger vertical linkages between local partnerships in Victoria, Australia and bodies at the state level, including the Victorian State Government.

Partnershipsareessentialforreformoftheprimaryhealthcare system in Australia according to discussion papers produced in 2008 by the reform initiatives. Building on the foundation of patient–provider relationships, partnerships are needed between health care providers, between governments and between health and other sectors. Partnerships will feature in the regional structures that are being proposed to develop, resource and network private, public and state-based primary heath care services. This paper considers the potential for Divisions of General Practice to undertake the role of these regional structures. Whileprimary healthcareinAustraliadeliversagreatdeal of value, reform is needed to address considerable inequities in care and outcome, as well as many current and future pressures. Years of tinkering at the edges of the system have resulted in an increasing proliferation of narrowly targeted programsandfundingarrangements,andgrowingcomplexity

This paper focuses on the use of a partnership self-evaluation tool in local health partnerships in Australia. Partnership tools are intended to be used across all phases of partnership development and are typically delivered in the form of a self-administered survey. Survey questions are designed to encourage members of local partnerships to reflect on their progress to date and, if necessary, to reorient future activities to satisfy objectives and desired outcomes. In this paper we argue that without a broader surrounding framework of partnership development and appropriate assistance in administering partnership tools, the potential benefits of self evaluation in local partnerships may be restricted. We base these comments on a study of the use of a partnership self-evaluation tool as part of a broader chronic disease initiative in 17 communities across regional Australia during 2008. Although participants reported favourable outcomes from being involved in the local partnerships, and some found the tool to be of benefit, only 8 of the 17 partnerships actually used the self-evaluation tool. The reported reasons for non-use related primarily to: (1) lack of time; (2) perceptions that it was too early to ‘evaluate’ the partnership; and (3) difficulty in administering the tool. These barriers to use indicate that participants may have been unaware of the potential of the tool to assist in partnership development over time. Partnership participants may require more preparation to use partnership tools in a way that can secure high quality sustainable local health partnerships.

This paper outlines the background and progress to date of a project to improve the coordination of care for Aboriginal people with mental health and/or alcohol and other drug problems living in the Eyre Peninsula region of South Australia. The project responds to recommendations from previous research by this team in this area, and has been running since 2004. Working with a wide range of health and human service providers, we explored issues that improve or hinder coordination of care and identified useful strategies. Some of these have already been implemented through the project: e.g. interagency cross-disciplinary training in response to shared needs, and lobbying for after-hours telephone help. Other strategies are still in progress: e.g. implementing a uniform triage and referral system and improving information sharing within Port Lincoln Aboriginal Health Service. The paper reflects on our experience of conducting Aboriginal health service research using a participatory action oriented approach, and discusses the challenges in providing effective and well coordinated rural and remote mental health/alcohol and other drug care in the context of complex health and social needs of Aboriginal people.

This paper reports a pilot study examining the feasibility, acceptability and sustainability of a multidisciplinary case conferencing model in residential aged care. The model was developed through a consultation process and then implemented in 31 case conferences over a 6-month period between May and October 2008. This paper explores the feasibility and acceptability of model implementation, the experience of the facility staff, general practitioners and residents/family carers and the perceived sustainability of the model in clinical practice. It shows that although there was a degree of confusion around the concept of multidisciplinary case conferencing, implementation of this partnership model significantly improved communication between health workers, facilitated interaction between staff and family carers, and provided a focus for reflecting on individual residents’ health needs.

This paper addresses the question: "What is the current situation for Aboriginal primary health care services in relation to continuous quality improvement (CQI) in clinical care and what is needed for sustainable practice to be achievable five years from now?" The paper describes a number of recent CQI initiatives that evolved within an accountability framework, the origins of which are based on a top-down government approach to performance measurement. Over the last decade there has been a shift to a more negotiated approach and most recently to an emerging agenda that focuses more on systems to support CQI at the primary care coalface. Further development should aim to capitalise on the synergies between different CQI-related initiatives and effectively align quality improvement with performance measurement. Principles of CQI and key challenges for the future are identified.

The objective of this study was to review physician attitudes, beliefs, knowledge and barriers towards adult patients who are overweight and obese. Electronic searches were carried out on PubMed, Medline and Embase up to July 2007. The search terms were built around 'obesity', 'physicians', and 'attitudes'. Only peer-reviewed full papers in English were included. Each paper had to directly investigate the attitudes, beliefs or barriers towards overweight and/or obese adults by physicians only. Forty-three studies met the inclusion criteria. Studies meeting inclusion criteria were reviewed by two authors. Evidence was fairly consistent across studies indicating that, in general, physicians feel qualified and well-equipped to manage and treat overweight and obese patients, yet overall do not feel successful. Knowledge about obesity is poor, with a lack of understanding of minimum BMI for obesity and the use of waist circumferences as a measure of obesity evident. There also appears to be a lack of knowledge about the treatment options available when treating obesity and their effectiveness. Furthermore, negative attitudes towards overweight and obese individuals are present, with many physicians categorising overweight and obese individuals as lazy, and that a key barrier in successfully treating obesity being lack of patient compliance and motivation. The study indicates additional training is necessary to educate physicians in regard to treatment options for obesity and to address the persistent negative attitudes towards obese patients.

An important role of divisions of general practice is to support general practice to build capacity for the delivery of quality care. The purpose of this paper is to discuss the National Primary Care Collaboratives Program and the impact this quality improvement initiative has had on building practice capacity to achieve improvements in the management of chronic disease. "The Collaboratives" are an international phenomenon, which, over the last three years, has been implemented in Australia and has achieved impressive results consistent with the success documented in other countries. This paper explores the key elements contributing to the success of the program and discusses the opportunities that have strengthened the ability of participating divisions to support general practice to deliver quality care.

The purpose of this paper is to describe the development and evaluation of the Victorian Aged Care Assessment Service (ACAS) quality improvement framework. The framework was developed in 2001 by a reference group consisting of ACAS managers and government officers, to enable ACAS to engage in a quality improvement process specific to its core areas of business. The framework comprises seven core business domains which are used by the ACAS for annual quality improvement planning and reporting. Using the qualitative methodology of thematic analysis, the ACAS Evaluation Unit has examined annual quality improvement reports submitted by the 18 Victorian ACAS teams from 2002-03 to 2006-07. The findings were used to revise the framework and the ACAS quality improvement reporting template. The number and range of ACAS-related quality improvement activities carried out in Victoria since the implementation of the framework demonstrates its effectiveness as a mechanism for capturing and centrally recording quality improvement activities in areas of core ACAS business. The paper concludes that the Victorian QI framework could be drawn on to develop a quality improvement framework for the Aged Care Assessment Program nationwide.

Quality improvement has recently become a key focus of the alcohol and other drug (AOD) treatment sector through initiatives such as accreditation, workforce development and the adoption of an evidence-based practice approach. While this attention on quality improvement is viewed as a much-needed change, a number of barriers to successful implementation of quality initiatives within the AOD sector exist. This paper discusses these issues, drawing from the research evidence and a case example examining accreditation and workforce development in the AOD sector in Victoria, Australia. The paper concludes that the recent focus on quality improvement within the AOD sector is a very desirable direction, but quality initiatives must be supported by an appropriate level of funding if they are to lead to improved outcomes for service users.

In rural Australia, models of primary health care are as diverse as the communities themselves. Differing facilities, health disciplines, individual providers, local contexts, funding models and reporting make measuring quality of care very difficult. This paper proposes that quality can be measured in three ways - through industry driven benchmarks, through consumer satisfaction, and through consumer and community decision-making. Further, this paper argues that quality of care needs to include a consumer domain. If consumers are able to influence how they receive support, care and/or treatment, they are more likely to receive appropriate services and interventions and have positive outcomes. A case study is presented to discuss how the three levels of quality are applied within a rural organisation, highlighting the challenges and effort required to sustain genuine community participation. The paper concludes with a discussion of these issues and the many challenges embedded in consumer-driven approaches to quality of care.

In this special edition of the Journal, we have brought together papers with the aim of contributing to primary health care reform in Australia. The papers will stimulate further debate and increase the evidence base through which policies can be informed. Does primary health care in Australia need reform? Are there fundamental problems with the health system demanding a reform response? The challenges confronting Australia's health care system over the next decade are real and well documented (Productivity Commission, 2005; Australian Medical Workforce Advisory Committee [AMWAC], 2005). They include the ageing population and longer life expectancies, the increasing prevalence of chronic illness and co-morbidity, heightened consumer expectations, advances in health technologies and shortages in the health workforce.

The short paper that follows is fundamentally about evidence-based practice. In Kuruvilla, Mays, Pleasant and Walt's (2006) terms it was an exercise in the application of research to service development and evidence-based practice. In Walter, Nutley, and Davies' (2003) taxonomy it resulted in a professional intervention, the development of which was led by research users seeking evidence to inform practice development. The team emerged out of a social network of individuals interested in partnership development issues (Kalucy, McIntyre, & Jackson-Bowers, 2007). The resulting paper was the foundation for a significant investment, by the Department of Human Services, in building capacity for partnership leadership in Victoria. The team that undertook this research-to-practice project consisted of three Primary Care Partnership (PCP) executive officers/managers, one of whom was also executive officer to the Statewide Chairs and Managers Group, a university researcher, and a final year undergraduate student working as a volunteer. The executive officer to the Statewide Chairs and Managers Group formed the team to explore broad issues of PCP development and to report to the chairs. The Statewide Chairs and Managers Group was the pathway through which the group's work would reach decision-makers. After a series of meetings to clarify the issues to be addressed, a developmental process for working with the chairs and managers was designed. The executive officers/managers were key to clear issue definition and appropriate process; the researcher to linking the issues to the partnership evidence base. The process relied on tapping the tacit knowledge of PCP managers and chairs and relating this to the relevant body of research. In this process implicit learning needs in regard to partnership leadership were articulated within a framework developed out of a complex research project undertaken with similar partnerships elsewhere. The university researcher on the team had a long history of research into partnerships and networks in the field of primary health care. The specific research project in question was a National Health and Medical Research Council-funded study of trust in the relationships between organisations in a Primary Care Partnership. The study of trust in a partnership is necessarily a study of partnership processes more generally. It was the general learning about partnership processes from this and related research that turned out to be so useful for the service system. The report of this work, that follows, was written in a form suitable for decision-making. It is not a research report but it is built on strong research-based frameworks that were "tested" in the local context. The recommendations are specific to PCPs in Victoria but will also be familiar to partnership workers elsewhere. The predicted effects of the recommendations are supported by research evidence.