Handbook Positive Health in Primary Care

General medicine in the Netherlands is under pressure. How long will the currently provided health care remain sustainable? In the future, things will only get worse. With an increasingly ageing population, insufficient numbers of care professionals and costs that are too high. The concept of Positive Health facilitates taking a different look at disease and health. It leads to holding alternative conversations with patients, in a way that is more solution-oriented and stimulates self-management. Positive Health focuses on meaningfulness rather than on today’s more dominant medical-analytical approach to patients. The concept offers a solution for things that are currently stagnating in health care in the Netherlands. With more attention being paid to lifestyle, leading a meaningful life, and citizen initiatives that promote community outreach and self-reliance as important elements in the application of Positive Health in general practice.

This chapter sketches the historical development of the thinking on health. Where people, in the past, thought about health in terms of balance, this was subsequently replaced by medical-analytical thinking. Since then, this perspective has been broadening again, as expressed, for example, in the World Health Organization’s definition of health from 1948. However, the WHO definition is formulated in a static way. Over the past decade, a Dutch initiative led to a proposal for a new description of health, based on resilience and personal control. This formulation has been further elaborated into the Positive Health concept, with six dimensions that are in line with how patients perceive their own health. At its core is a meaningful life. The chapter discusses how the care provider of the future will be trained as a T-shaped professional. These professionals combine knowledge on disease (vertical bar of the T) with a broad health-oriented vision of humankind (horizontal bar of the T). A paradigm shift is taking place in the thinking on health care: from thinking in terms of disease-control to thinking in terms of resilience.

This chapter briefly describes the organisation of primary care in the Netherlands, the tasks of general medical practices and the way those are financed. For the Dutch population, general practitioners are, generally, the first point of contact with the health care system. General practitioners in the Netherlands have a strong position in the health care system. The gatekeeper function in referrals to secondary care, patient enrolment at general medical practices, and the involvement of general practitioners in out-of-hours services all play an important role in this respect. Dutch general practitioners provide a wide range of care and are in a key position as care coordinators. Compared to other countries, the average time per consultation at the surgery hour is short, in the Netherlands, while the number of registered patients per practice is relatively large.

This chapter deals with the relationship of Positive Health with the recently established core values of primary care in the Netherlands and the options general practitioners have for fulfilling their task. The described trends in primary care, from our perspective, can be summarised in two main developments that influence the content of general practitioner work and patient contact. The first development concerns changes in the continuity of primary care, with less personal contact with the same general practitioner, but the care is more person-oriented. The second concerns the primary care workload, which has undeniably increased. This chapter also discusses the contribution of Positive Health to the identified trends and the core values of primary care (person-oriented, medical generalist, continuous and together).

This chapter is about the organisation of the general medical practice and the role of the various team members. How to successfully incorporate Positive Health in your organisation? The key message is that it is not enough to see Positive Health as a clever trick to apply; for example, by instructing your team members to fill out the spider web questionnaire. Everyone in the practice needs to be convinced of Positive Health contributing to the realisation of the core values of their practice. Only in this way can Positive Health be part of the organisation, which is needed for working methods to really change. But how to do that? Changes in working methods are considered by drawing up a vision and mission for the general medical practice. The time management matrix appears to be very useful, for this purpose. This chapter discusses how to introduce Positive Health, how Positive Health could be implemented in practice and how to ensure the team remains motivated to work with Positive Health.

Taking health as a starting point, with people and the local community in central position, what does this mean for the roles and tasks in primary care? What is important for people to be able to live together in a healthy way in their community? With Positive Health as a common language, local residents appear to be taking more control of their community. Informal care, citizens’ initiatives and other community and prevention initiatives can be of greater significance for general practitioners than is currently recognised. Although care providers are used to look for medical solutions, many health care questions do require a broader answer. There are many possibilities for patients to take better care of their own health on the one hand, while making use of social and lifestyle services in the community, on the other. Integrated cooperation in local communities is crucial, in this respect. Knowledge of community networks that relate to the health care questions of their patients may support general practitioners. It is not without reason that the new core value of ‘together’ and core task of ‘care coordination’ have been added to the core values and core tasks of primary care. For more information, background and short videos about the subjects in this chapter, see the QR code at the end of this chapter.

For care innovation and disruption, there are challenges along the way to achieving a real shift in health care. Implementation of Positive Health requires a number of preconditions, and it is important that Positive Health is included in the Dutch Government’s National Policy Document on Public Health. The Institute for Positive Health (iPH) contributes to the further development of the Positive Health concept, in the areas of policy, practice, research and education, and looks at how Positive Health relates to other broad health concepts and working methods. The concept of Positive Health is also subject to criticism. Also from that perspective, there is ongoing attention for the further substantiation and scientific value of Positive Health. Further embedding Positive Health in general medical practices and beyond may also contribute to designing meaningful care. Positive Health, therefore, should become an essential element of the training and education of future care professionals.

Positive Health is a concept with a proven track record, on a small scale, and may be an answer to global health problems. Based on experiences in Positive Health in the Netherlands and with respect to transition management, three phases can be identified: inspiration, implementation and embedment. The tips included in this handbook appear universally applicable, looking at best practices and experiences in the Netherlands and, on a smaller scale, also in Belgium, Japan and Iceland. There are similarities in relation to the process and differences in the method of implementation. The culture- and country-specific themes vary, such as the organisation and infrastructure of care per country, business organisation culture (bottom up/top down), and having a group-oriented or individual focus. In the various countries where experience has been gained with Positive Health, there are differences as to for which target group Positive Health was first implemented. It is important that the concept can be aligned with existing initiatives and level of urgency, and that people in a leadership role embrace Positive Health to further the implementation in their country. We are working hard on further implementation research and effect. In the Netherlands, we started with primary care, but, over the course of time, the Positive Health method has been widely disseminated (e.g., to youth, social domain, mental care, public health, sustainable employability, hospital care and elderly care). Although, within Europe and beyond, primary care takes on many different forms, at its core, primary care is for care providers to assess what their patients need, and that always starts with a good conversation (i.e., the alternative dialogue). If reading this book has inspired you, and you would also like to start working according to the Positive Health concept, think of which health issues Positive Health could help to solve, and start with gaining experience in applying the alternative dialogue model. Forming coalitions of the willing will further develop cooperation, within the general medical practice as well as the local community, region and country.