Reform aims to reduce pressure on health service
Parliamentary Secretary Joe Cassar.
Family doctors would be given a much more important role in both treatment and prevention under a reform of primary health care about to be proposed by the government.
The reform, due to be unveiled and opened for consultation in the coming weeks, will propose a registration system through which all patients would choose a family doctor to guide them in all their medical needs.
"We have patients who go to their family doctor for small things but when something worries them they go directly to a specialist. We are totally against this culture because specialists see patients through their specialisation, while family doctors have the expertise to see patients eclectically," parliamentary secretary for health Joe Cassar told The Times.
The current system, he said, was making waiting lists longer as people sought appointments they did not necessarily need. This situation could easily be avoided if patients first saw their family doctor, who might in turn direct them to the right specialist for further investigations, he said.
By way of example, he said 70 per cent of patients who attended the orthopaedic outpatients department suffered from low back pain but not all needed to be seen at hospital and many could easily be treated within the community.
Moreover, when a patient had to be urgently seen to, a family doctor could ensure this took place through a simple phone call.
"The family doctor will be the patient's first and last point of contact, and can follow the patient through all his or her needs."
This would also provide doctors with access to patients' medical records, something the Association of Private Family Doctors has long been calling for and which was promised in the Nationalist Party's pre-election manifesto.
He said the new system would revolve around the patient: "At the moment the patient is not at the centre. The reform will give the patient the key to his primary care."
Although some 70 per cent of patients who use primary health care services see their private family doctor, Dr Cassar said the government was not planning to do away with the health centre doctor service.
Patients who do not want to pay for a GP visit will still be able to go to health centres, which will be restructured. Their role, and even location, will closely analysed during the consultation process with the aim of improving the service.
Dr Cassar said the role of family doctors would go beyond treatment. In cases of high blood pressure, for example, they would be instrumental in picking up those who needed treatment before their condition deteriorated.
"We need to move away from treatment when the problems could be prevented. This is the quantum leap we need to make," he said.
Dr Cassar said screening programmes, including those for cervical and colon cancer, could also be done by family doctors as opposed to breast screening which required mammography equipment.
He said the reform would need all the stakeholders to be on board for it to be successful. It would not, however, be a hasty process and the required culture change would take time to be implemented.
No new healthcare fees are being recommended. A document leaked by Labour leader Joseph Muscat just before June's European Parliament election had recommended a fee for vaccine services and the removal of the health centre doctor service but it had been turned down by Cabinet.
Dr Cassar insisted everything was up for consultation, which had to be thorough and involve all stakeholders. "We first need to agree on the principles before entering into the details."
This is the fourth time the authorities have attempted to start a consultation process on primary health reform since 1988.
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J. Tonna
Oct 6th 2009, 21:48
I agreed with the most of the PS's suggestions.
What I don't know is: 1. If a patient is not satisfied with the Dr he was registered with, will it be easy to change him/her? Some Drs are taking the habit of not visiting you at home after certain hours. Everybody knows that you can feel sick at any time of the day or night.
2. Naturally if we go to a private Dr we will have to pay him. Now if one goes just to check his blood pressure why should he be charged as if he requested a full check up?
3. "Some test could be done by the family Dr." Will this always be against payment?
4. Some go to a Summer residence and their Family Dr. might not like to visit him there, should he have a Dr for Summer and a different one for Winter?
5. It was mentioned that our Medical history will be available online for Drs to check with, when will this be available?
A Cassar
Oct 6th 2009, 15:57
@Gerard Cassar
This is not interference!!! The government offers a service, a no service should be abused of. Just like any other social service, free health care should be offered only to whoever needs it. Specialists are there only for specialist care. If you want to see a specialist for something a GP can deal with go ahead, but don't expect me to pay for it!!
@Criss Camilleri
Just check the meaning of community in the dictionary please
Gerard Cassar
Oct 6th 2009, 15:05
Is this interference in mattersof health. Shall we not be able to seek the services of a specialist in private without a recommendation of our private family doctor?
And who will chose the specialist? The private family doctor?Of course we trust our family doctor and his advice is appreciated, but a patient could have another opinion about whom to consult as a specialist. Human beings are subject to cabal. Since seeing a private specialist is done against money, it is common knowledge that money creates problems!
maria delicata
Oct 6th 2009, 15:04
I hope that the right people are chosen for the consultation process and that involves services users and NGO's.
Dr Wilfred Galea
Oct 6th 2009, 14:58
The Malta College of Family Doctors and Association of Private family doctors as well as innumerable local national conferences have been encouraging policy makers to give more importance to facilitate a proper, patient oriented primary care system in Malta for the past 21 years at least. Indeed it's encouraging to see positive moves in this direction.
There will be obstacles of course by those who are either afraid of change or those who do not want change for their own reasons. At the end it is the patient that benefits at the end of the day.
Dr Wilfred Galea
Oct 6th 2009, 14:57
It's about time that policy makers give Primary Care the importance it deserves. Unfortunately the present setup does little to facilitate continuity of care which is a crucial element. There are numerous studies which support such a system. Studies by Barbara Starfield and many others clearly show that Primary Care Oriented Countries have fewer low birth weight infants, lower infant mortality, especially postneonatal, fewer years of life lost due to suicide, fewer years of life lost due to “all except external” causes, higher life expectancy at all ages except at age 80. Moreover many other studies done WITHIN countries, both industrialized and developing, show that areas with better primary care have better health outcomes, including total mortality rates, heart disease mortality rates, and infant mortality, and earlier detection of cancers such as colorectal cancer, breast cancer, uterine/cervical cancer, and melanoma. The opposite is the case for higher specialist supply, which is associated with worse outcomes.
Countries with strong primary care have lower overall costs generally have healthier populations.
I suggest readers spend some time to have a look at this link http://pcpcc.net/content/primary-care-video-presentation-dr-barbara-starfield
Anthony Azzopardi
Oct 6th 2009, 14:29
As President of the Association of Private Family Doctors, I can confirm that we are on the same wavelength as the Hon Dr Jos Cassar. We are pleased that he has the courage to take the bull by the horns and to empower the point of first contact of the patient who is normally his or her family doctor. He can count on us.
At present where we succeed in getting through and obtain the required information on behalf of the patient, this saves him a day's work and the hospital yet another visit. Not to mention the peace of mind given to the patient. In an attempt to reduce Out Patient visits patients are told that No News is Good News in the sense that they will be contacted only if something is wrong. Yet this gives rise to plenty of stress int he patient until the next appointment, because "what if my results have not been seen?" At the moment we have to depend on the goodwill of our colleagues in hospital, These all try to help but it is the system which needs updating. Mater Dei should be for the sicker patient so he is seen sooner.
Criss Camilleri
Oct 6th 2009, 13:05
Dr Cassar stated; 'WILL BE TREATED WITHIN THE COMMUNITY' What exactly does he mean by this?
Ian C Ellul
Oct 6th 2009, 11:32
A major acheivement for the Association of Private Family Doctors. Well done.
Dr Victor Ceci
Oct 6th 2009, 10:42
At last it seems that what the Association of Private Family Doctors has been clamouring for since its inception is about to materialise, albeit belatedly. Kudos to The Hon Joe Cassar for sticking to his guns all throughout. This news actually reflects what the APFD has been pushing for all along. It is not true that family doctors simply want the facility to order more tests as was reported a few weeks ago in this same paper. Family doctors can and wish to do more if only they were allowed to by a primary health service plan that was properly thought out and implemented. The anxieties of at least some back bench doctor MPs should also be allayed by this news as rather than dismantling what exists at present the intention seems to be to complement what there is with something else that should truly put His Excellency The Patient at the core of primary health care.
Tony Abela
Oct 6th 2009, 10:39
"By way of example, he said 70 per cent of patients who attended the orthopaedic outpatients department suffered from low back pain but not all needed to be seen at hospital and many could easily be treated within the community."
I was always under the impression that unless through the Emergency Dept, nobody can have an appointment unless she/he has a written referal from a M.D.
Of course unless through the most popular manner when a person visitis a Consultant in his private clinic and he gets an outpatient appointment to carry the necessary tests at the State Hospital.
I hope the Hon Parliamentery Secretary is aware of the varoius ways to get through the back door.
I augur that he succeeds to eleminate abuses and then the Waiting Lists will get shorter quicker.
Dr. Victor Ceci
Oct 6th 2009, 10:12
At last it seems that what the Association of Private Family Doctors (APFD) has been clamouring for since its inception is about to materialise, albeit belatedly. Kudos to The Hon Joe Cassar for keeping his word all throughout. Cynthia Busuttil got it right this time and reported The Hon Cassar faithfully. The piece in today's paper actually reflects what the APFD has been pushing for all along, as opposed to what Ms Busuttil reported when she interviewed the president and vice-president of the association a few weeks ago. Family doctors can and wish to do more if only they were allowed to by a primary health service plan that was properly thought out and implemented. The anxieties of back bench government doctor MPs should also be allayed by this news as it would seem that rather than dismantling what is in place at present the intention is to restructure and complement what exists today by something else that should truly put His Excellency The Patient at the centre of primary health care.
tessa taylor
Oct 6th 2009, 10:11
At the moment my doctor does not receive any communication from my hospital doctor. I had a battery of tests at Mater Dei but my doctor had no access to the results and I had not received them either so could not inform him of the results. As a result I was prescribed medication by my doctor in good faith only to find on my next hospital visit that the drug prescribed was positively risky/dangerous in the light of the test results. In England, the doctor is automatically informed of the results of his referral, which are then put on the patient/doctor's medical records .Thus family doctors and hospital doctors are working together in the patient's best interest.
Mario Saliba
Oct 6th 2009, 10:10
This is good thinking both medically and politically but our health system is totally a taxation based universal health system and the perennial problem remains how it is going to be sustained with the increasingly costly diagnostic tools, new drugs, surgical procedures & aging population. This will demand a higher expenditure in order to maintain standards. To empower GPs we need to provide adequate reources and financial arrangements to compensate private service providers. Patient registration means a EMR system which will enable the GP to access hospital records including lab and X ray results, reduce unnecessary visits to Mater Dei. I agree that primary care is the hub through which patients are guided through the health care system (WHO< 2008) based on good doctor-patient relationship and continuity of care ( Azzopardi Muscat & Dixon, 1999). Our GPs are giving sterling service ( reflected in high patient satisfaction) in spite of the lack of resources. So go for it! We are waiting.
J.Borg
Oct 6th 2009, 10:09
Will this mean that we want be able to visit the doctor For Free at the health centres?????
C.Sammut
Oct 6th 2009, 09:53
May I suggest that the patient still retains the right to visit a consultant even if his gp or A&E won't refer him. I was diagnosed with muscular pain for years before I decided to just go to a consultant who diagnosed a need for gall bladder surgery.
Dr Francis Saliba
Oct 6th 2009, 09:40
Other important points in favour of more utilisation of the family doctor is that of continuity of treatment by the same doctor and the family doctors' more intimate acquaintance with the family medical history and its environment that both could have a bearing on diagnosis and treatment