Abstract
Background This study aimed to synthesize policy recommendations for future planning in family physician training and effective primary care cluster policy implementation with regards to actual needs and responsive to the situation Methods Situation review and value chain analysis were done in 8 primary care clusters in Central, Eastern, Southern, and Bangkok Metropolitan areas in 2018. A national survey in all 13 health services areas was deployed during the second and the third trimesters of 2018 in order to assess major stakeholders’ perceptions and opinions; including administrators, academics, and family physicians, on national primary care cluster policy implementation as well as the performance and roles of family physician in their settings. The data from primary and secondary sources were analyzed and policy recommendations were synthesized accordingly. Results 213 subjects were participated in the study. 50.7% was female, and median age was 38 years (range 24-84 years). Regarding performance and roles, all groups of the stakeholders indicated that expectable performances of family physicians had not been achieved yet in accordance with 6 performance dimensions of Royal College of Family Physician of Thailand. For primary care cluster policy implementation, there were significant hurdles from frequent changes in policy contents, unclear messages, incongruencies with community situation, rigid specifications, lack of positive retention strategies on healthcare personnel, misunderstanding and acceptance problems among healthcare professionals as well as community, imbalance between demand and supply, lack of policy advocacy at local areas, and problems in family physician training system including trainers, trainees, and related resources. Policy recommendations 1) The Ministry of Public Health should allow those in local areas to propose their own operation plans as well as appropriate and feasible performance indicators. 2) The Ministry of Public Health should modify their policy contents by allowing any physicians to perform as family physician without the necessity to train in family medicine program. 3) The Ministry of Public Health in collaboration with the Royal College of Family Medicine of Thailand and other related Royal Colleges should develop self-directed learning system for the physicians and other health professionals to gain knowledge and experience in family medicine. 4) The Ministry of Public Health in collaboration with the Royal College of Family Medicine of Thailand and other related Royal Colleges should discontinue their diverse approaches in family medicine training, and preserve only a standard training program. Moreover, they should develop specialty training programs that are in needs for the society such as longterm care, elderly care, etc. 5) The Ministry of Public Health should develop networking system in the local areas that can effectively link specialists with family physicians by using “Shared care and responsibility”.
