Roles in the new organizational models of primary care : between care and management

The World demographic trend is evolving: the average age of the population is increasing and it is predicted to keep growing in the future. This implies an exploding demand for healthcare systems: an older population needs more healthcare services, especially because elderly tend to incur long term conditions (e.g. chronic diseases, often characterized by comorbidity). Healthcare systems are seeking solutions for this new context, offering patients the best services while controlling expenses. In this realm, primary care gains importance. In fact, it is expected to provide care for chronic patients in the most cost-effective way: it avoids hospitalization, it manages symptoms and check-ups, and reduces the average costs. However, in order to respond to the new needs, primary care can no more be carried out by practitioners working alone, but through multi-professional teams. Signals of movements towards the development of these collaborative arrangements have emerged in countries all around the world. In 2012 the Balduzzi decree pushed Italy toward this direction, defining primary care organizations (and not general practitioners alone) as the basis for new primary care models. These models imply an increased organizational complexity, which has to be managed by the physicians. Thus, General Practitioners (GPs) are required to hold a new role alongside the clinical one: the role of managers. In order to fulfill the new responsibilities, GPs have to handle managerial competencies. However, the literature is not rich in terms of the competencies needed and how/if they are taught within training programs. The objectives of this work are as follows: 1st, to map the features of the new primary care organizations, especially in Europe and Italy; 2nd, to define the managerial skills required by GPs in these new organizations; 3rd, to investigate the current training for practitioners on these competencies. To reach its goals, the thesis is based on a literature review and on seven in-depth case studies conducted to explore the Italian models of primary care organizations, and to collect information about the managerial competences needed by professionals involved, to confirm or deny what has emerged by literature analysis