Teamwork in primary healthcare

The main aim of the reform in primary care services is to provide the necessary framework to bring about a change in the way care is being offered. The services provided under the personal primary healthcare system mark a departure from the traditional methods of healthcare delivery from a curative to a preventive and health promotion model.

The different areas of expertise and skill mix of the primary healthcare team (PHCT) would ensure that the patient receives more comprehensive healthcare within the community closer to where s/he lives. The function and complexity of such a team is in continuous evolution. The make-up of primary care teams can vary widely but the contribution of each player is pivotal for a more integrated patient care. Such developments have shifted the emphasis from the solo GP providing isolated care to a multi-disciplinary team approach.

The reform document encourages the voluntary setting up of group practices. To this end, the government is ready to offer fiscal and other types of support towards capital infrastructure investment in premises and equipment so that GPs may further develop and improve their practice. Furthermore, the government will be assisting group practices in the engagement of clinical, administrative and auxiliary staff.

The GP is the key player in the primary healthcare system and may often assume leadership of the PHCT. GPs are primarily responsible for the provision of comprehensive and continuing medical care to the patients and are in the best position to advise and, hence, to be responsible for the coordination of all the health and social care needs of patients registered with his/her practice. They have a gate-keeping role between the primary and secondary sectors and, hence, ensure the best possible utilisation of primary and secondary healthcare.

Although in Malta care provision is usually offered by a GP in solo practice, the setting up of group practices in other countries has been frequently documented as a positive experience. Practices have become a hub for local clinical leadership and patient-led service evaluation and consequent redesign, allowing them to plan and develop multi-disciplinary case management within community settings. In other countries these practices are contributing to the shift in care from the secondary to the primary sector with positive results in health outcomes. The skill mix of such a practice would permit delegation of certain procedures to staff specialised in other disciplines such as healthcare assistants. This facilitates the more effective use of the time of all the professionals involved, eventually allowing more time for personal, professional or practice development purposes such as attending conferences or setting up new services.

The complexities of running a group practice have increased in recent years with the consequence that the role of a practice manager is vital to the smooth running of most surgeries. His/her duties would involve managerial responsibilities such as the supervision and training of administrative and clerical staff, arranging duty rotas and financial/resource procurement and management.

There are several grades of specialisation within primary care nursing, based upon the qualifications and experience of the individual. The different categories relate to the individual's ability to practise autonomously, make clinical decisions and account for his/her own practice and trainees under his/her charge. Practice nurses may participate in certain clinics and assist the GP with immunisations and minor surgery procedures. These practice nurses may not only carry out these and other traditional nursing duties but may perform more specialised roles such as providing vaccinations and immunisation services, involvement in first contact care, chronic disease management, promotion and implementation of preventive services.

Healthcare assistants and health visitors can also make a significant contribution to the delivery of general practice services to patients. In addition, counsellors have a role in treating psychosomatic conditions such as chronic pain and fatigue and assist patients in smoking cessation, tackling obesity and coping with terminal illness.

The role of administrative staff would surely help make the group practice more efficient. This is also accompanied by the role of several other primary care professionals who have extensive contact with the practice but are not normally considered permanent members of the group practice, among which are community nurses, midwives, community pharmacists and allied health professionals.

The personal primary health reform being proposed is based on the premise that the provision of primary care by group practices would be a positive step in the provision of integrated patient care in the community. The team approach would be an innovative experience for the different professionals to work together in the primary setting, each member contributing in a special way to the well-being of the individuals and the whole population.