Factors enhancing and inhibiting the development of primary medical care in community health centres.

This study examined factors inhibiting and enhancing the development of primary medical care within community health centres. Nine centres with medical services, representing a range of financial administrative arrangements and a spread of locations, were selected for investigation. A modified version of the Community Health Accreditation and Standards Project (CHASP) review process was developed to look at areas of health service functioning. Effective internal management and a shared ethos were the strongest predictors of favourable outcomes overall. Salaried, as opposed to fee-for-service, financial arrangements led to better outcomes in most function areas, although salaried arrangements in themselves were not sufficient to produce good outcomes. All centres that performed well had community management structures, but the presence of such structures did not always guarantee good outcomes. The educational background and experience of the doctors had no effect. The study confirmed that primary medical care within community health centres represents a viable, alternative model of general practice in Australia and identified some factors that could strengthen it further.