The role of the visiting doctor in primary care clinics

Abstract
The concept of doctors visiting clinics to support primary health care is well established by the role that these doctors should play is not clear, and varies from area to area.

As an approach to understanding the possible roles of visiting doctors in order to assist District Management Teams to produce job descriptions for such doctors, groups of clinic nurses in 2 districts in North West Province (Odi and Brits) were interviewed in focus groups. The question posed was, “What do you think about the role of the visiting doctor at your clinic?”

From the analysis, which was validated by participants from the groups, a number of key themes emerged. Many BENEFITS were identified which indicate that the role of the visiting doctor is a valuable one; benefits were attributed to patients, clinic staff, the clinic as a whole, the hospital an the service. However, there are also NEGATIVE EFFECTS, which arose as side effects of doctors' visits, mainly centred around issues of relationship with staff and patients, and sub-standard medical practice, which serve as a warning to those involved. RELATIONSHIPS were identified as a central issue, which determines whether the visiting doctor's role is a negative or a positive one. A number of CONSTRAINTS AND CHALLENGES emerged which need to be addressed, by doctors, nurses and, especially, District Management Teams, as these are thought to be critical for the development of the service.

Across all the themes there emerged a series of CONTRASTS which on the one hand highlight the potential for improved health care where the visiting doctor's role is clearly understood and the doctor is functioning optimally, but on the other hand show the potential for harm and discouragement where the doctors' visits do not serve their purpose.

Recommendations to optimise the role of the visiting doctor, which emerged from the groups, included the involvement of administrators to address some of the constraints, orientation and training of doctors, developing respect as a basis for teamwork, and ensuring networking and co-ordination.