Fig. 1

A model of GPs’ experiences of collaboration with CWS. This is a conceptual model describing the GPs’ main concerns regarding collaboration with the CWS, based on the concept of There’s a will, but not a way. The figure illustrates shifting stages of GPs’ experience with their patients in situations where the CWS become involved. The first stage describes the GPs’ familiar territory, providing health care to their patients, with an emphasis on whole-person care and often consisting of a long and extensive relationship with a patient. In the first stage, the CWS is not part of the care, but when they become involved with a patient or family on the GP’s list, the conditions change to the second stage. This is characterized as unfamiliar territory by the GP. Obstacles such as a one-way window of information flow and a closed door to dialogue help to perpetuate the GPs’ lack of knowledge of the CWS’ procedures and work methods, as well as direct information on what is happening to their patients. This leads to fragmented territory, affecting GPs’ possibilities to do their job, expressed as lost opportunities to help and missing pieces in the patient’s history