Health care: All for one, one for all

The medical profession is not a job but a vocation, and those who practise within this field should practise "All for One" - "All" should facilitate the service to benefit the "One" - the patient. To this end the three doctors who now work to help at Mater Dei are following the creed of "Others before Self" and giving help to those in need and to the health authorities trying to manage ever-increasing demands as best they can.

Of the three doctors, two work at St James Hospital, including myself. Therefore we have not made matters worse in respect of the community by taking our services away from Primary Care but added more of our time to serve the community as a whole. I am a British doctor who have always served my vocation to the best of my abilities and put "Others before Self" in my whole medical career within the UK and now for the Maltese people.

To this end I have learned that it is no use complaining about medical manpower shortages - it exists in Malta, in both the state and private sector, within Europe and across the entire world. Wherever there is a need, there is always a shortage of skill to fill the gap. Therefore you cannot complain but try and identify remedies and release resources to lessen the problem.

To address the needs of patients to get medical advice, free at the point of contact, for those that cannot afford private medical insurance one could offer the management of polyclinics to an outside agency. This, however, could cause problems and resentments, therefore hindering a smooth transition in altered working practices.

Each medical provider has his own empire to protect whether it be Mater Dei, the private hospitals, private GPs or polyclinics, but for the good of the one patient and also to improve care to all let's set up another empire - to start from scratch - combining as much as possible of the old and what is good to benefit the present and improve for the future - now. But how?

Start small, offer an experimental service at one location and through proper audit - assessing cost, patients seen, outcome and satisfaction as a few parameters - see if it is worth expanding. I was a principal in general practice in England and initiated first-wave fund holding within our practice, bringing it from concept to reality for the benefit of our patients.

This system is my proposition to address the provision of "free at the point of contact" health care to those patients in need, trying to address the problems of patients attending Mater Dei for routine emergencies, second opinions and confirmation of appropriateness of treatment. This would then leave Mater Dei able to deal with the genuine emergencies the A & E Department which its professional staff are best trained to deal with.

A possible solution: An agency contract with the government to provide services for patients in their vicinity. For example within the postcode of Valletta and Sliema only.

Those with ID cards within these initial jurisdictions can present at the agency's address for free medical assessment.

On the agency's part, they have entered into an agreement to provide A & E and general practitioner services to this group of patients together with all ancillary back-up. This includes X-ray and laboratory investigations aiding the experienced medical practitioners to efficiently deal with common problems.

Through audit and review this system of funding is fine-tuned within the initial phase of development to ensure the provider of services is sufficiently remunerated and the government is getting value for money. On its success such units could then be expanded out into the community of Malta and Gozo, units being set up in other localities under the same model.

This can be a win-win-win situation for the government, the provider of services and most of all the patient, bringing a first class, free-at-the-point-of-delivery, health care system to the community of Malta and Gozo. "One" service for "All" patients.