Monday, 11 December 2017

8 future proposals for primary care

Primary care is the key to the good running of the health system and therefore it must be promoted, protected, improved and, above all, invest in it. Many countries are immersed in renewal processes of their primary care and, therefore, we must be attentive to the contributions we receive, especially those in the United Kingdom, where primary care is very similar to ours. In an earlier post, I reviewed a paper by the Royal College of General Practitioners that provided an insight into the role of family physicians in 2022, and in this same direction I have a report from a committee of experts of the National Health Service Primary Care Workforce Commission), which has developed a set of reform proposals aimed at strengthening the future of primary health care, broader than the previous one which was limited to a corporate vision.

8 proposals that we can benefit from

Some of the proposals in the report are very specific to the English model, such as those referring to General Practitioners' working circumstances, quite different from those of family physicians in our country. Others, on the other hand, should be noted, since the general environment of primary care is very comparable; I have chosen eight proposals that can be suitable for us:

1. More communication with patients. In this sense, the document makes two very specific proposals: a) a good triage based on the demand should direct people to the type of professional that best fits their problem; this would mean, for example, that physicians would have more time to better meet the more complex clinical needs, and b) patients should be given an email address from their care team to efficiently answer their most frequently asked questions.

2. More multidisciplinary teams. Doctors and nurses should be free of bureaucratic burdens and, for this reason, administrative and para-medical professionals staff must be increased (the document does not specify this point too much). The motto would be: we don’t need more doctors or nurses but we need that health care professionals devote all their working hours to add value to the health of people instead of engaging in admin jobs that don’t correspond to them.

3. More community nurse work. The systems must invest more in nursing home work that guarantees the services on a continuous basis 24 hours a day and 7 days a week. English experts believe that only this way could avoid the unnecessary hospitalizations of many elderly people with diverse fragilities and chronic disease.

4. More functions for pharmacists. Both community pharmacists and clinicians should play a more important role, especially in issues as worrisome as the lack of adherence to medication or the poly-medication of older patients.

5. More integration of social services. In addition to deploying their own social services, primary care needs to have many more experiences of coordination and integration with community social services, both those managed by city councils and those of other providers.

6. More time for teamwork. The development of individualized therapeutic plans for patients with complex social and health needs requires that the professionals involved have the time to coordinate more than they do now.

7. More communication with hospital specialists. Primary care physicians and nurses must have an open communicative line with both specialists and hospitalization units. The communication channels can be diverse: the clinical history, the mail, the telephone, the remote meetings, etc. The current communicative barriers between primary care and the hospital make the matters worse.

8. More palliative services. Attention to the end-of-life episodes should not be confined to the last days of life, but should be extended to the care provided to people who have a reduced life expectancy. That is why we have to expand these services and offer them from the primary care with a real continuous care that includes nights and weekends.

Professor Martin Roland, President of the Primary Care Workforce Commission, explains that the reference point of the working group has been to develop proposals for the development of primary care that has provided quality and order to date, as well as guaranteeing accessibility to the system.

From my reading of the document I have extracted these 8 points that, in my opinion, can reinforce primary care services in the right direction and, at this point, someone will wonder where the money will come from in order to start the essential reform of primary care. My suggestion is that before we go to knock on the door of the Economic Adviser, whose answer, sadly, we can already guess, we could listen to the advice of John Wennberg, who says that if we dig into the waste of care for chronic patients in hospitals, we are sure to find the necessary funds to divert them in the right direction (of which Wennberg calls it Sutton's Law).

Jordi Varela

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