Matthew Vella The Medical Association of Malta has denounced a consultation document on a patient registration system, announced last Saturday, as “intrinsically flawed”, claiming there is no consensus on government’s plans.
A mandatory registration system for patients with a private GP is one of the hallmarks of the reform in primary health care. Under the proposed reform, the GP will be the first point of contact for patients who will channel their medical requirements, rather than referring them to Mater Dei Hospital.
For those patients who cannot afford even a private practitioner’s visit, they will be able to visit their family doctors free of charge. A reimbursement system will then be worked out for each doctor, based on the number of patients registered under his practice.
Doctors’ union president Martin Balzan however claimed the consultation process, to take place until the end of January 2010, will lead to “great and unnecessary confusion amongst patients” and that the plans will certainly go back to the drawing board.
“MAM finds it completely unacceptable that government employed doctors are excluded from the process of registration. It seems that the government is abrogating its responsibility to introduce an efficient public health service, where there is a personalized care,” Balzan said.
The reform also plans to have health centres turned into hubs for primary and secondary care interventions at regional levels, to serve as a one-stop shop for community care and specialised care for certain prevalent diseases and conditions. Patients who do not have urgent ailments and who go to Mater Dei’s emergency department without being referred there would be sent back to either the regional health centre or their doctor.
“The concept of regional hubs manned by doctors who know nothing about the patient is of very dubious validity as they will not be able to filter patients for accident and emergency. It is also completely unacceptable to expect private doctors to provide a 24 hour service, seven days a week to patients, if they are to be effective gatekeepers in the proposed system.
“While MAM has long prepared its position on the proposed reform it is ready to work with the authorities to find credible solutions to the current problems. MAM feels that the current document as “work in progress” needing a significant number of changes to be acceptable to all of the medical profession,” Dr Balzan said.
Under the proposed reform, clusters of district health clinics would be able to provide specific services and support to hospitals, family doctors and the community as a whole.
With the patient’s consent, the family practitioner would be able to access the patient’s medical records electronically. Moreover, the GP would be able to prescribe medicines from a pre-determined schedules and refer the patient to out-patient appointments and day-care procedures.
One of the problems identified in the current healthcare system was fragmentation and lack of continuity in patient care. Government says the reform would enable Mater Dei Hospital to perform its proper function as a tertiary acute care hospital, relieving the hospital from needless primary and secondary health work which could be done elsewhere.
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