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Integration or pragmatic coalition? An evaluation of nursing teams in primary care

Changing structures and organisations in primary care raise questions about the role and fit of traditional nursing disciplines. This paper discusses recent findings from an evaluation of integrated nursing teams. The study design used a mixed method approach measuring workload activity of health visitors, practice nurses and district nurses, through time diaries; and teamwork using the Primary Care Teamwork Questionnaire, in conjunction with semi-structured interviews exploring the views of key stakeholders and the nurses themselves. The main themes arising from the interviews are discussed, taking account of the findings from the assessment of workload and teamwork questionnaire. The key themes addressed are implementation of change, shifting role boundaries, communication and teamwork. The findings indicate that this type of organisational change is concerned predominately with structure, professional and organisational issues rather than patient care. In the teams studied the opportunity of integration led to a pragmatic coalition that encouraged its members to plan, execute and manage change by themselves, according to a vague definition rather than a patient focused agenda. In order to ensure a quality nursing service and avoid old historical rivalries this needs to be addressed as nursing teams are reconfigured in primary care groups.