Reform aims to reduce pressure on health service

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.