With both main political parties committing themselves to keeping the national health service free of charge at the point of delivery, a sound business and financial model must underpin the operations of every sector offered. With an aging population, pressures on our public health services will continue to increase and any administration has to constantly review the efficiency and effectiveness of the service.

It is therefore essential to consider the conclusions reached by the National Audit Office that has conducted a performance review of the primary healthcare sector that provides services to the community through nine health care centres. In his report, the Auditor General set out a number of key success indicators that determine whether these health centres are efficient and effective.

The first criterion of success is that operations related to the GP function render the relative service accessible and qualitative in terms of national primary health care objectives. According to a survey conducted by the National Statistics Office, over 95 per cent of the 769 participants were satisfied with GP services. However, one fifth of users across the nine health centres had the perception of long waiting time to access GPs during peak hours. Improvements are undoubtedly needed to make this service more user friendly by cutting waiting time.

Another objective of the NAO report was to determine whether organisational and administrative structures facilitate service delivery. It is rather worrying that the report found that, in 2014, 23 per cent of all persons who made use of the services of Mater Dei Hospital’s Accident and Emergency Department could have been dealt with at health centre level.

Also, most of these users were self-referred. The report rightly concludes that this phenomenon implies that patients, probably because they do not believe they would get effective services at the health centres, are bypassing them and going directly to Mater Dei, thereby increasing even more the pressure on our main public general hospital.

The third criterion of success defined by the NAO was that services provided are cost effective. In the executive summary, there is a statement that is written in rather obscure civil service language but the underlying reality that the Auditor General was exposing is worrying: “The strategic management of primary healthcare, including GP services, is constrained through operational information limitations which, at times, can limit policy development and potentially delay relative decisions. Implementation of measures outlined in policy documents are primarily driven by the availability of funds rather than a planned schedule of works.”

Put simply, the NAO is saying that, however well thought the strategy for making primary health centres efficient and effective, this strategy often fails because of lack of funds to enable implementation. This leads to the conclusion that for the primary healthcare service to deliver what it promises it needs a more realistic funding plan that will help professionals provide the quality of service the community expects.

Secondary and tertiary healthcare was always deemed a higher investment priority within Malta’s public health service. But, ironically, the underfunding of the primary healthcare sector is increasing pressure on public hospitals that already have to deal with a multitude of challenges to cope with public demand.

While there is no doubt that the GPs serving in the primary healthcare system are performing well, changes in the funding of this service are inevitable.

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