Doctors give different diagnoses of reform

The proposed reform in primary health care has elicited drastically opposed reactions from two doctors' organisations.

The Association of Private Family Doctors welcomed the proposed measures, which would give its members more power to treat patients in the community.

But the Medical Association of Malta said the proposed reform needed a significant number of changes to be acceptable to all in the medical profession.

"This is work in progress," MAM president Martin Balzan said, adding that the government should have first sought consensus among medical professionals before publishing the document for public consultation.

The reform, unveiled on Saturday, proposes a system through which patients will register with their chosen private family doctors. These will be able to access the patient's medical records and test results, prescribe some free medicines and make appointments for outpatient services and day care procedures. Family doctors will be the patients' first point of contact and will direct them to further treatment if needed.

But the MAM has taken exception to the fact that doctors working with the government will not be allowed to register within the system. Dr Balzan said it was also completely unacceptable that doctors would be expected to provide a round-the-clock service, even though the authorities pointed out that health centres would continue to offer free services all day and night.

His stand differed from that of the president of the family doctors' association, Anthony Azzopardi, who, in The Times on Monday, praised the reform.

"How could we not agree to enhance equity, promote quality and excellence or safeguard sustainability," he wrote, adding that the reform called on doctors to roll up their sleeves for work.

Dr Azzopardi was unable to give more comments and referred The Times to Wilfred Galea, one of the association's founders, who also sang the praises of the proposed reform.

"For the first time we saw an official acknowledgment and endorsement of the importance of family medicine in Malta," he said, adding that family doctors were specialised in their profession and not a jack of all trades.

Dr Galea, who is no longer on the association's council, stressed the importance of continuity of care, which was being pushed by the reform.

He said that allowing doctors to prescribe or change the doses of free medicines would put family doctors in a better position to manage their patients, while saving time.

"It is very apolitical, objective and took a lot of time to compile," he said, adding that similar systems had been successful in other countries.

Dr Galea insisted some changes were necessary but he did not see any problems.

Another family doctor, Nationalist MP Jean-Pierre Farrugia, has already declared he would not take part in the system.

Writing in The Times, also on Monday, Dr Farrugia expressed concern that doctors might raise their fees substantially. He asked whether the necessary technology would be in place before family doctors were expected to book outpatient appointments and day care procedures. Dr Farrugia said the document did not encourage family doctors to work in underprivileged areas either.

Questioned about Dr Farrugia's comments, a spokesman for the Health Parliamentary Secretariat said this was the start of a wide consultation process and not the start of the reform's implementation.

"The government is open to receive any type of idea, suggestion or recommendation to improve or possibly change the proposals as presented," the spokesman said.

He added that Health Parliamentary Secretary Joe Cassar would be holding separate meetings with doctors' associations in the coming weeks and inviting all doctors to send in their suggestions, ideas and recommendations.

The public is also invited to contribute in the discussion by sending an e-mail to primaryhealth@gov.mt or primarycare.mhec@gov.mt or by phoning the helpline 188.

The Labour Party is criticising the reform, saying it was spelling the end of free healthcare. Labour health spokesman Michael Farrugia said the fact that people would be discouraged from using health centres and the need for a ticket of referral with the patient footing the bill for the family doctor's visit equated to the introduction of healthcare payments and went against Prime Minister Lawrence Gonzi's pledge that his government would not introduce any healthcare fees.

He said the PL would have expected the government to publish the report within the context of the Budget speech to allow scrutiny during the Parliamentary debate.

"Labour is analysing the implications of the document, which also includes long-overdue measures, will consult and follow the reactions to this new government policy. Labour will base its approach on its key principle that properly-managed healthcare services can and must remain free," Dr Farrugia said.