Challenges of the general practitioner's role in integrated primary health care: a qualitative study of trainees in a reform-oriented network in Northern Italy.

backgroundIntegrated primary health care (PHC) is essential for efficient, equitable healthcare, especially amid rising chronic conditions and an aging population. It ensures coordinated care across services, with GPs as key gatekeepers. Yet, European systems face obstacles like service fragmentation, workforce shortages, inadequate funding, digital barriers, inconsistent policies and poor integration across services.

objectiveThis study explores the perspectives of trainee doctors in Northern Italy on the challenges of integrated PHC and suggests best practices to enhance integrated care and GP training.

methodsThis is a qualitative study using semi-structured remote interviews, analyzed using data-driven thematic analysis. Eligible participants were regional and university-based trainees.

resultsTwelve participants (7 F, 5 M, aged 25-49y, 8 regional and 4 university-based trainees) were recruited. All shared a good understanding of integrated PHC challenges, such as managing patients with chronic conditions and limitations of the digital infrastructure for interoperability across primary, secondary, community, and social care services. They noted that service fragmentation, increased patient access to online health information and remote consultations have shifted patient expectations and disrupted traditional primary care dynamics, making it more challenging for GPs to promote integrated care. Rural areas are facing shrinking local health services, lack of staff and reduced capacity to provide integrated care comparable to urban settings. Participants emphasized the importance of team-based care and the need for both bottom-up initiatives (e.g., self-initiated collaborations with local care providers) and top-down support mandated by policy, such as dedicated regular meetings during office hours and clinical governance initiatives. They shared examples of good practices that could be incorporated in future policies, such as on-call secondary care specialists available for phone consultation to prevent unnecessary referrals. Participants also highlighted the importance of quality standards in GP training and the need to develop competencies in effective team-based working.

conclusionsThis study highlights key challenges and actionable solutions proposed by GP trainees to improve integrated care and training, offering insights relevant to health systems beyond Italy. Although based on more engaged and reform-minded trainees, this calls for more research on this group of future primary care professionals, who may be key to informing interventions to improve integrated PHC.