Rethinking primary healthcare

"Asociety that fosters an environment that is conducive to persons attaining their maximum potential for health and well-being."

This is the vision established in 2007 of the Health, the Elderly and Community Care Division of the Ministry for Social Policy. This vision was chosen because the health sector in Malta wants to foster the development of health and healthcare provision at the community level.

In order to achieve this vision, we need to embark upon radical but sustained change within primary care. This sector has developed, over the years, in a fragmented manner with little, if no, integration between the private and public primary care systems. There is little communication and interaction between the private family doctor and the public sector, while there is lack of continuity of the patient's care as he moves from one sector into another. A small country such as ours, with our limited resources, cannot continue to afford or sustain this duality and dichotomy.

We need to produce a system where the patient is cared for, primarily, in the community, closer to his or her home while having access to an extensive array of community services and, if medically necessary, to hospital care also. This can only be achieved by pooling our resources together and by utilising both the well-developed private primary care sector as well as the strengths of our health centres.

It is being proposed that the private family doctor would work in synch and closely with the health centres and hospitals while the public system would both complement and, more importantly, support the family doctor in caring for his/her patients. Only through these synergies can we hope to achieve a comprehensive primary care and community service that our population deserves and demands in this day and age.

Healthcare provided at primary level is not only curative but focuses upon the more important and lasting aspects of prevention, health promotion and screening for early disease. The family doctor, who is a specialist in his own right, together with other primary care and community health professionals, are best placed to provide these non-curative services. This paradigm shift is sorely needed if we are to improve our health status at a population level. International literature shows that investment in primary care is translated in improved health results, higher patient satisfaction and reduced overall healthcare spending. Hence, it directly contributes towards the improvement of the health of the population and towards the long-term provision and sustainability of healthcare.

Through the recent launch of the consultation document on strengthening primary care, the government is putting forward its proposals and ideas of how all the above may be achieved. It is an ambitious project that would, if implemented well, change the face of how patients are cared for in the community.

We are proposing a registration system where each eligible person in Malta identifies a family doctor of his or her choice and this relationship is both formally recognised as well as supported by the government. This personal healthcare system will then be the key for the family doctor to offer the best of care to his/her patient with the direct support of the government.

Some would argue that the government can still offer support in the absence of such a registration system. While this may be true to a limited extent, only a registration system would allow for the full development of the service and for the launching, in the future, of government-driven and -supported nation-wide initiatives like screening programmes (such as cervical screening), health prevention campaigns (targeting, for instance, diabetics and those suffering from hypertension and cardio-vascular disease) and health-promoting initiatives to deal with national "burdens" such as obesity and smoking.

My appeal for all involved is to view this in an objective manner, keeping the national, and not personal, interest, at heart. I am certain that, through a process of constructive dialogue and consensus building, we will achieve our common aims of providing the best primary care services to our population.

Dr Cassar is Parliamentary Secretary for Health.