Over the past few years, Malta has witnessed milestone developments in the organisation and delivery of healthcare services, culminating in the construction of Mater Dei Hospital, characterised mainly by significant investments in the establishment of optimal secondary healthcare services. It is evident that, now, as with the global trend, it is time to shift the focus to the primary care sector. The proposed personal primary healthcare service (PPHCS) reform appears to seek precisely that: address the clear need for changes or, more accurately, developments within the primary healthcare services in the country.
The proposed reform seeks to provide a cornerstone of future healthcare services delivery in Malta. In tandem with the services provided across the social policy and social security sectors, the proposed reform in the primary healthcare services seeks to provide a more comprehensive and collaborative service to members of the population that would, in turn, be characterised by maximal efficiency and effectiveness, rather than a fraction of the potential of either.
In seeking to synchronise primary healthcare services with secondary, tertiary and other social services, PPHCS is potentially the vehicle to bridging the gap between the provision of such various services, which to date are unfortunately plagued by incongruence, and thus, wastage, inefficiency and, more worryingly, compromised ineffectiveness at the point of service delivery to the client.
The long-term expected outcomes of the proposed reform in primary healthcare services largely comprise the establishment of an affordable healthcare system for all with better outcomes measured through health status of the population. The evidence suggests that, indeed, there is a correlation between primary healthcare and expenditure. The statistics derived from the United Kingdom and Spain illustrate that efficient primary healthcare systems secure a lesser per capita expenditure on healthcare services. It is against this backdrop that one may argue that the need for a reform in the primary healthcare services in Malta and, indeed, the content of the proposed reform cannot be dismissed.
Countries are arranged in three groupings according to the strength of primary care. The higher the score, the stronger is the primary care. Healthcare costs per capita have also been ranked with the higher the ranking (1 highest), the less the per capita cost.
The entitled/eligible persons for the reception of healthcare services in Malta and Gozo will be obliged to register with a medical doctor, who would have pursued a recognised established training programme in the respective field of practice. Initiatives to ensure the provision of and support for the relevant educational and training opportunities for medical doctors are being actively explored by all parties involved in the consultation process regarding the proposed reform. The medical doctor may be in independent full-time practice or also in part-time, independent or group practice.
Inter-disciplinary care is coordinated care for a particular condition provided by health professionals having different expertise. For instance, a person diagnosed as suffering from a chest infection by the family doctor could be referred to the physiotherapist. This coordination between different health professionals would offer better care resulting in a more rapid patient recovery.
The personal primary healthcare reform aims to provide an inter-disciplinary approach to care both in the health centres and in the private sector. To enhance this inter-disciplinary approach, the setting up of group practices in the private sector is being encouraged. A group practice is made up of two or more doctors together with a team of healthcare professionals that will include nurses, physiotherapists, occupational therapists and other supporting staff. It is felt that a group practice will encourage the different professionals to work in teams, thus offering a more efficient and widespread service.
The reform has been proposed and its details are being discussed through a thorough period of consultation with all parties involved.
An acceptable degree of consensus among the parties involved, across the providers and the consumers of healthcare, would need to be established before proceeding further. The proposed reform would need to be amended, tweaked and adjusted in the meantime in order to address this need for consensus.
Indeed, the sooner this is achieved the better it would be for all. The successful introduction of the reform would primarily enhance the provision and delivery of services to the patient in the community. This, in turn, would help release the pressure on secondary healthcare services, mainly on Mater Dei Hospital. In view of the critical over-demand for beds and services offered at MDH, this favourable aftermath predicted to follow the successful outcome of the reform is desperately awaited.
Supplementing the proposed organisation of GP services, the regional health centres would continue to offer a free walk-in GP service and urgent patient care on a 24-hour basis. The personal primary healthcare system is envisaged as a necessary tool to bring about a needed leap in quality in healthcare provided at primary level. This change has been expected for a very long time in Malta. This system would enhance access to more specialised healthcare and also to community care at a local level, closer to where the patient lives. This should translate into several benefits that will include better patient satisfaction and a better quality of life for the population at large.
The author is assistant lecturer at the Nursing Division, Institute of Health Care, University of Malta.