Working well 1: Differences between Aboriginal Community Controlled Health Services and mainstream general practice

This resource is part of a series of online 'Working Well' resources designed to assist GP Registrars and other health professionals working in Aboriginal Community Controlled Health Services (ACCHSs).

You will hear stories and perspectives from a range of people with experience of working in Aboriginal Health in one way or another. We hope this will help you in finding your feet as you contemplate working in ACCHSs in the future.

The resource can be used on your own, in a small group or with a Supervisor. Find out more information about how to use this resource or just click the 'Start' button to begin.

See the full list of Working Well resources.

This project has been funded by Northern Territory General Practice Education (NTGPE) with assistance from AMSANT and the Danila Dilba Health Service (DDHS). Many thanks to all the contributors.

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Working well 1: Differences between Aboriginal Community Controlled Health Services and mainstream general practice
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TOPIC A: Community control
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Working Well 1: Differences
Back TOPIC A: Community control
Back TOPIC B: Holistic approach
Back TOPIC C: Cultural safety
Back QUIZ: Check your knowledge
Back SUMMARY: Print or download resources
Working Well 2: The ATSIHP
Back TOPIC A: The role of the ATSIHP
Back TOPIC B: ATSIHP training
Back TOPIC C: Knowledge of community
Back QUIZ: Check your knowledge
Back SUMMARY: Print or download resources
Working Well 3: Challenges
Back TOPIC A: Finding your place within the team
Back TOPIC B: The cross-cultural environment
Back TOPIC C: Addressing complex patient needs
Back TOPIC D: Managing your own expectations
Back QUIZ: Check your knowledge
Back SUMMARY: Print or download resources
Working Well 4: Misunderstandings
Back TOPIC A: Lack of respect
Back TOPIC B: Different levels of knowledge
Back TOPIC C: Resolving misunderstandings
Back QUIZ: Check your knowledge
Back SUMMARY: Print or download resources
Working Well 5: Advice
Back TOPIC A: Get to know the community
Back TOPIC B: Work closely with the team
Back TOPIC C: Manage your own expectations
Back SUMMARY: Print or download resources
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Think about the focus question below and click on each of the staff members to listen to what they have to say about this topic.
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How does the level of community control of a health service affect the authority a GP has within that service?
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KEY POINTS AND ADVICE
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Community control

In mainstream general practice the doctors are in charge clinically and usually they own the practice or they may well own the practice or ... so they are in charge and they are in control, whereas in a community controlled service the clinicians are answerable to the board.

Clinicians are used to making, used to doing it their way and some clinicians find it difficult then to be able to conform to a set of standards that are being allocated to them by the health service itself.

I think that’s great and it’s great in an exercise in humility for clinicians to know that you know the people they are working with also have a capacity to be able to give them some direction via this sort of mechanism of community control.

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Community control

Community controlled health clinics are much closer to communities - they understand their population, their communities and the needs of the primary health care and other health care services that need to be delivered.

It also empowers Aboriginal people which is important ... another important aspect of community control is that Aboriginal people are in a position to make those decisions.

As opposed to, again, mainstream or government-run clinics where most of those decisions are determined by parliament or the government of the day.

Then, you know, bureaucrats and their staffers then employ those ... implement those programs from a government-priority perspective.

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Community control

There are a lot of differences in the way that the clinic was run compared to mainstream clinics that I worked in, and I think what’s important is everybody works as a team.

So, the clinic that I worked for was a really large organisation with over 100 employees and we start the day slightly differently there - so everyday there’s a meeting where all staff attend and it really feels like everyone has the chance to speak and make collective decisions on what happens at the clinic and decisions about how it’s run.

So, whether that be the transport driver or the Aboriginal Health Practitioners*, the receptionist - everyone’s involved in making decisions and I guess it seemed like everyone felt comfortable to have their say because there’s no sort of real hierarchical structure like you might get in other places where, you know, the doctor might be in charge and everyone else does what they say.

Yeah, so I guess the clinic runs a bit differently - so it’s a real sort of team care approach. You’re not a solo GP sitting in your office with patients coming and going all day.

*Note: Aboriginal and Torres Strait Islander Health Practitioners (ATSIHPs) are often also referred to as Aboriginal Health Practitioners (AHPs). The correct term to use is ATSIHP. Refer to: Difference between ATSIHPs, AHPs, AHWs and ACWs.

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Bruce Hocking
GP
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John Paterson
CEO AMSANT
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Sophie Lines
GP Registrar
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