A boost for GPs and patients

For the past 20 years family doctors have been striving to improve family medicine for the sake of the patients, the country and the profession. One of the greatest achievements was the success of the Malta College of Family Doctors. The college has been striving to raise the academic status of family medicine and the crowning success was that family medicine is now on par with the other specialities.

This requires that members participate in continuing medical education and the large number of doctors attending these activities attest to the wish of the majority of practicing family doctors to further improve their professional competence. Unfortunately, there will always be a nucleus of people who stay on the fringe and never participate. These cannot now claim foul when events overtake them.

It was with a sense of pride of ownership that I read the consultation document on reform in primary care. And I am sure this feeling will be shared by my colleagues, especially within the Association of Private Family Doctors, who have worked solidly to provide background knowledge, attended meetings and conferences. This is evidence that the profession is behind any reform that delivers the optimum care our patients deserve.

This document is not re-inventing the wheel: What has not worked in other countries need not be repeated here but our particular culture and customs require that, whatever the final version, this must have a "local flavour".

The "overall aim to reposition primary care to the centre of our healthcare system" is logical and is as it has always been - until the devastating upheavals of the 1970s.

How could we not agree to enhance equity, promote quality and excellence or safeguard sustainability?

Looking at the section The Patient Perspective (3.2) there is nothing we can disagree with and most of the items are already in place in the private sector. Where there are gaps and room for improvement we are ready to comply.

There is no doubt that to provide all that the document proposes requires that family doctors roll up their sleeves and get on with it. Gone are the days when the patient (and the doctor) were satisfied with primitive 19th century pharmacy backroom facilities, with basic instruments, no record keeping and not keeping up to date. We have to move away from the idea that anything goes. However, this carries a price and probably a change in how we value our health. Everything in medicine is expensive whether it is a stethoscope or simple electrocautery. But, at least, we know that we give value for money.

We know for a fact that several family doctors were keeping back from investing in their practices until the government decided on the direction it would take. The launch of this document will certainly encourage many to move forward. The proposal that tax incentives will be made available will certainly encourage improvements.

All will agree that without a political commitment no country-wide change is possible and the minister is really sticking his neck out in proposing this reform. Others in the fairly recent past were not lucky.

We can only hope that doctors who happen to be politicians will not now once again put spokes in the wheels to maintain their comfortable status quo. Our patients - their constituents - deserve better.

I was pleased to see that the minister wishes for a "high level of consensus and agreement" and how could it be otherwise when sooner or later we are all patients?

Improving healthcare is a non-political issue and if everybody works together this will guarantee that subsequent governments will improve further on what is already in place.

We have been criticised for being paternalistic in our relations with our patients. Frequently, however, it is the patient who requests that the doctor decides on his behalf. It is now high time for patients to be empowered to promote their own health and participate in decisions affecting their health and well-being. The publication of this document with the request for constructive criticism is one such opportunity, which I hope will not be lost.

A consultation document is not a fait accompli and it is to be hoped that suggestions will be offered on the one hand and clarifications made where necessary.

The vast majority of people in Malta and Gozo already do have a personal relationship with a family doctor, to whom they refer to, even if for a reference for a new job. The model being proposed is that every person in Malta will identify one doctor whom they will call "our family doctor". This has wide-ranging benefits for the patient because medical reports will be channelled to this doctor. This family doctor will be even more the patient's advocate when accessing hospital care and, not least, will be able to find out what is happening when the patient has been to hospital.

The access to medical records (with all the due data protection procedures) is something all family doctors have been asking for. The possibility to request investigations without the patient (and frequently an accompanying relative) having to waste several mornings to go to a consultant at Mater Dei Hospital is something that will save the country money, less wasted time all round, less hassle, less delay and, most importantly, less worry for the patient. Not to mention a more efficient use of the hospital consultants' time and, thus, the reduction in outpatient waiting lists.

There will be savings too, which will benefit the country as a whole. We all have to play our part if the health service is to be sustainable. Unnecessarily repeated investigations are already being flagged through the hospital IT system but when the patient accesses public health through one doctor, this fragmentation and lack of continuity is avoided. If Malta's health bill rises we all have to fork out more or, worse, do without.

The devil is in the detail and it is obvious that there is room for improvement: For example we know that ladies sometimes prefer a lady doctor and a method will have to be found to share such a patient's care while keeping to the "registering with one family doctor" principle. A mechanism needs to be in place to cater for patients whose doctor is not available - abroad or indisposed. Yet another is how to make best use of the health centres and the valuable resource in the highly-qualified medical practitioners working there and without killing their motivation.

I looked to see what would happen to the people who need support and cannot afford private medical care. It is to be noted that a safety net has been provided for such persons as well as those with chronic disease. After all, this is what equity is all about.

The Association of Private Family Doctors is a 100-strong group of experienced family doctors all ready and eager to improve their practices. We will certainly continue to give our input so that, once launched, what is working well is retained and what is not can be improved. Only thus will the reform be a success.

Dr Azzopardi is president of the Association of Private Family Doctors.