COMMUNITY NURSING

Community Nursing

Community Nursing

Primary care or primary health care?

Traditionally in Australia, the emphasis has been on 'primary care' rather than 'primary health care'. General practice in Australia is founded largely on the 'primary care' model and arguably, 'primary care' is a subset of 'primary health care'. 'Primary care' has been commonly considered to be a client's first point of entry into the health system if some sort of active assistance is sought. Drawn from the biomedical model, primary care is practised widely in nursing and allied health, but general practice is the heart of the primary care sector. It involves a single service or intermittent management of a person's specific illness or disease condition in a service that is typically contained to a time limited appointment, with or without follow-up and monitoring or an expectation of providerclient interaction beyond that visit.

While the terms have been used interchangeably, they generally represent two different philosophical approaches to health care. This in turn can disguise the transformative potential of strategies and approaches that can make the fundamental changes necessary to improve health status outside the traditional domain of health, that relate to broader social determinants of health.

Secondly, the structures, funding mechanisms and practices of the primary care sector in Australia in 2009, centred as they are upon the providers (largely general medical practitioners) and the management of disease and injury are not always compatible with notions of comprehensive primary health care.6

Another way of viewing the differences between the primary health care that is the norm in Australia in 2009 in comparison to international models of primary health care being promoted is by seeing them as 'selective primary health care' versus 'comprehensive primary health care'. The following table highlights the differences.

Importantly, nurses and midwives recognise improving health through primary health care can only be achieved by placing health in its social, cultural, political, economic and environmental context. Its success comes from having the community and its citizens as drivers of the broader national policy; as well as of their own health and any care they may require as individuals. The health and wellbeing of the local community of which a person is a member is seen as a critical factor in a person being able to reach their full potential as a human being - the essence of the approach to primary health care promoted by Aboriginal and Torres Strait Islander peoples.

The vision of nurses and midwives for primary health care in Australia

This vision outlines the values, principles and aspirations for the development of a comprehensive primary health care strategy across Australia. It contains elements that are not universal features of health and health care in Australia at the present time. It is acknowledged there are unique and innovative exemplars of primary health care teams who are attempting to achieve this vision; and in some instances have been doing so for a number of years. They continue, however, to have significant structural impediments preventing them from realising their ...