Primary health UK doctors warned about turning people away from emergency dept
In the UK, Malta’s primary health reform vision to curb casualty drop-ins, is given short shrift by healthcare think tank
Matthew Vella
Malta’s primary health reform could be heading in the wrong direction if it discourages patients with minor ailments not to turn up at Mater Dei’s emergency department.
A UK government-commissioned report by the Primary Care Foundation has warned NHS chiefs that vulnerable people who “for cultural, personal and socio-economic reasons, will almost always turn to the emergency department for their care will effectively be denied access to the health service... These are the very people that it is vital the NHS delivers care to. Trying to redirect them elsewhere may well mean they do not receive it at all.”
Malta’s policymakers believe less patients should drop in at Mater Dei’s emergency department for minor ailments, and seek primary health assistance from their family doctor and private GPs. The reform is aimed at improving primary care away from the general hospital, and to reduce the burden on waiting lists.
Back in 2008, the government launched a campaign urging patients to drop in at A&E only if “they were sure” it was an emergency. Now its primary health reform document advocates the registration of patients with private GPs, who would then be responsible to refer them to secondary care unless they assist to any minor ailment themselves.
The UK report questions assumptions in the NHS that up to 60% of patients who attend casualty departments could be diverted to GPs.
The report suggested only between 10% and 30% of A&E patients had conditions regularly seen in general practice and that the main driver to use GPs has been to reduce costs, although no assessments had been made about real savings.
The report says: “There is good evidence that the majority of patients choose the correct level of care. A few do not and it is always a risk to plan for the few rather than the many.”
The study said that locating GPs in emergency departments could improve patient care but it found little evidence that the approach cut costs or unnecessary hospital admissions.
The UK’s Department of Health is now set to ask NHS managers to look again at plans to shift a huge volume of A&E work to GPs in polyclinics and urgent care centres, as part of their mandated efficiency savings.
Dr David Carson, joint director of the Primary Care Foundation, said: “We were surprised to find there was no evidence that providing primary care in emergency departments could tackle rising costs or avoid unnecessary admissions.”
Malta’s reform has come under severe criticism by Nationalist MP Jean-Pierre Farrugia, who earlier this week turned down a post to be parliamentary private secretary. Farrugia claimed the primary health reform had been fully influenced by the private doctors’ lobby, and warned he would vote against any healthcare bill. His opposition forced the government to reconsider aspects of the policy.
According to the health ministry’s reform document, there are 149 full-time family doctors apart from other public sector doctors with their own private practices. A survey carried out by the Association of General Practitioners also shows that 82% of family doctors agree with a primary healthcare system that establishes GPs as the primary gatekeepers.
Other MPs have however expressed their full support: Nationalist MP Stephen Spiteri says improving the care that family doctors can give to patients within the community can go to great lengths at reducing the burden on general hospitals.
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