Primary healthcare is set to be revolutionised through new reforms that will focus on the relationship between patients and their family doctor.
Under the proposals, general practitioners will be able to access their patients' medical records and test results, prescribe some free medicines and make appointments for out-patient services and day care procedures.
"We felt the need to build on the patient-doctor relationship which can give us the best results," Social Policy Minister John Dalli said yesterday as he launched a reform that has been in the making for 20 years.
The 49-page document, which was launched yesterday at the start of an eight-week consultation period, highlights the need to create seamless and coordinated quality care services.
Patients will be able to register with a family doctor, who will be the first point of contact for all their medical needs. The doctor will direct them to further treatment if this is needed.
In future, family doctors will be entrusted with assisting national screening programmes and health promotion initiatives, for which they will be paid by the government.
Although registering with a doctor is free, patients will continue to pay for visits. However, there will be a means-tested mechanism to identify those who cannot afford to pay.
Moreover, people with chronic diseases, who currently go to health centres for follow-up care and repeat prescriptions, will be able to get the service from their family doctor, with the visit subsidised by the government.
The document states that family doctors "should" provide round-the-clock coverage for their registered patients, though the authorities recognise that they would only be able to do this if they set up group practices. Health centres are being transformed into hubs for primary and secondary care interventions. The government is envisaging three or four health centres in Malta and another in Gozo that will serve as a one-stop shop for community care, also equipped to carry out minor day surgery.
District health centres (bereġ) will also provide support services to hospitals, family doctors and the community.
This reform is expected to relieve the pressure on Mater Dei's Emergency Department and slash long waiting lists for other hospital services.
"We have a very good hospital but it is being used for primary, secondary and tertiary care, leading to inefficiencies and waiting lists for out-patient appointments," Health Parliamentary Secretary Joe Cassar said.
However, doctors are already objecting to the fact that those working in health centres will not be allowed to enter the registration system, although they can still continue doing private practice.
"It is completely unacceptable that they are being excluded," Medical Association of Malta president Martin Balzan said, before he had read the report.
He said the government should have first "put its house in order" by changing public community care before delving into the private aspect of the system.
The government is calling on patients and health workers to take part in the consultation process, with feedback to be received until January 31.
Suggestions can be sent to primarycare.mhec@gov.mt or by calling 188.
Some of the measures up for consultation
Non-urgent patients who go to hospital's emergency department without being referred may be sent back to either the regional health centre or their doctor.
The government will be helping family doctors equip themselves with the necessary technology to access patient records.
Part-time doctors or those working reduced hours will only be able to work within the system as part of a group practice.
The government is proposing that each doctor has a minimum of 300 registered patients.
Family doctors or group practices will be able to benefit from tax incentives designed for capital and other innovative incentives.
The government is also expected to start discussions with the insurance sector to mainstream insurance medical coverage for the entire population.