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Workshop D Wyeth Schorr Our workshop shared with the others a great concern that the energy from this excellent and very productive meeting not be dissipated, but be har- nessed in the service of nurturing existing COPCs and encouraging their spread. It was felt that some mechanism the precise attributes of which were not defined very clearly should be supported or created or exploited or captured to perform a variety of functions. First, such a mechanism should define systematically the objectives of COPC against which performance of COPCs generally and COPCs indi- vidually can be measured, particularly in relation to outcomes and effec- tiveness. Secondly, this mechanism should facilitate communication and mutual assistance among existing COPCs, among nascent ones, between existing ones and nascent ones, between potential COPC providers who are now in training, and also among communities that might feel a need for a COPC model if they knew enough about the concept tO want to utilize the ap- proach. Thirdly, this mechanism should help institutions training health profes- sionals to develop curricula that are relevant to COPC or its components, especially by: . providing health professions with greater skills in epidemiology and in management; . encouraging joint training of a variety of health professionals; and . helping health training institutions provide a more compelling and 289

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290 PART III: WORKSHOP DISCUSSION SUMMARIES attractive role model of valued primary care providers, operating at a high level of skill, competence, and dedication. This suggestion was made recognizing that changing medical education is not a sufficient, although probably a necessary, condition for achieving the kind of change that is needed. Fourthly, the group agreed that this new and continuing mechanism might also explore the possibility of making inroads on some of the broader problems affecting the future of COPC, including the problem of modifying financial arrangements, to assure payment for a full range of health services and health professionals, and the financing of health profession education in ways that make primary care a more attractive option. Lastly, this mechanism should provide technical assistance to operating COPCs in several very specific ways: 1. Provide expertise to help COPCs collect epidemiologic data about the occurrence, distribution, and determinants of health and disease in the community and to assess the efficacy of the interventions used. 2. Actually provide some of the epidemiologic information that may have been collected by another agency or group. (It was felt that some further sorting Out was needed about the kinds of epidemiologic investi- gation that could be most appropriately done directly at the COPC level and what could come from a regional or perhaps even a national level.) 3. Help COPCs to deal with the discrepancy between how the com- munity and providers perceive both needs and demands. 4. Help COPCs forge better links with other agencies and services. 5. Create a support system that will do more than the individual COPC can do so that the health providers working in COPC settings remain and work productively and happily over time. Such a support system can provide stimulus, sanction, and a sense of being part of an effort that has great significance in attempts to improve the health of the families and com- munltles t ney serve.