Primary health reform

I will only question Stephen Spiteri's contribution Strengthening The Healthcare System (December 24) in a non-rhetorical way by asking: How? This because the government was undecided about the contents of the primary health reform consultation document even before it went to print.

Just like him, I have never had any misgivings about "a registration system... whereby patients, through the family doctor, will be able to access medical services and care, as well as medical records and history, in an individualised and personalised manner". Not so very many other colleagues, who insist that the role of electronic patient records must not shift from a primary care clinician's instrument to a tool to control them, thus strongly objecting to the consultation document's statement: "the expectations and needs of patients should be measured against deliverables and performance indicators created to monitor the performance of the care providers under this scheme" (3.2).

Many others are realising that these primary care proposals will be excluding them from serving their private patients fully simply because they happen to be contributing so much in other sectors. Suffice it to refer to Reform In Primary Care, by Pierre Mallia (The Malta Independent, December 16): "Many doctors have to work part-time to make ends meet. We have seen that many have maintained a government employment. But what about the hundreds of doctors who do company work (?)... Take our department of family medicine, for example, which has full-timers and part-timers. It would be ridiculous either way to have doctors working within such a department without seeing patients as well."

It seems that the penny did finally drop, many comprehending that these proposals will be wiping out the flexibility a small island state should thrive on.

Dr Spiteri said that "Registered patients will be means tested and those who are eligible will be able to have the services of their preferred family doctor for free". I can only repeat what I wrote on December 7: "As in the one-off energy allowance for households, it is not enough to only protect the worst off with the energy benefit or pink form. Are households earning €150 weekly and, hence, not pink card holders not also our concern?"

He also wrote that "The health centres will still be functioning and with improved services for free!" How health centres will be functioning is anybody's guess as is also the case on whether patients of family doctors who don't register will be discriminated against. On this point, I heard the Health Parliamentary Secretary spell out two diametrically opposite proposals in less than 24 hours.

Dr Spiteri is very much aware that the charge for a GP home visit of an established clinic in the south is already at €25 with public health centres still providing this service for free. If the latter is done away with there will no doubt be a decrease in equity in basic primary healthcare provision. And if anybody thinks free primary health was a socialist idea, think again. The government's own website describes the history of medicine thus: "The British opened the first Berġa, or government dispensary, or Farmacia Dei Poveri in Valletta, on April 14, 1832 with the aim to reduce the very big number of patients from the central hospital."

But the government must now shoulder its responsibility for allowing the Faculty of Medicine at the University of Malta to persist in demanding such high qualifications for medical students, less than 14 per cent of whom opt for general practice (2003 surveys, British Journal General Practitioners).

I must conclude by sharing a statement made in the most recent issue of the local newspaper-post Synapse by Francesco Carelli, a GP who is also professor of family medicine at the University of Milan: "We feel like a social worker, priest, marriage counsellor, educator, substitute mother... leaving us to wonder why we have acquired all these roles. But the social worker has interminably long waiting lists, psychologists and therapists are expensive..."

Much too often it is said: Go to your GP, he/she always has time. Aesop's fable The Goose That Laid the Golden Eggs easily comes to mind!