Monday, 25 December 2017

More value for primary care

Xavier Bayona

A British Parliamentary report on primary health care in the National Health Service (NHS) was published at the end of April 2016. This report reflects the most relevant aspects of primary care such as the experience of care (satisfaction, accessibility, labour conflict and quality), new models of care, the construction of a new work team and financing. As you read the report, leaving aside some differences that exist between the primary care model of Great Britain and ours, the first thing that stands out is the ability they have to make a self-critical assessment and publish it. In our environment, it’s quite uncommon for self-critical assessments that engage and align professionals, managers and politicians in the improvement of services to be published.

I will not comment on the whole report, it’s not the purpose of this post, but I will highlight some aspects, due to the great parallelism existing with our health system. It’s unquestionable that primary care is where the largest and most important number of contacts of citizens with the health system is made, which, as in our country, have made the best of being national health systems with universal coverage. In this sense, with CatSalut data, the population served in the BCN Health Region in 2014, stood at 74% (fraction of the reference population that has been treated at least once in the last year). For those who are not used to this data, it means that 74% of the population has at least once contacted their doctor or nurse. Another important fact of the report of the Health Region is that of those who contact, do so an average of more than 7 times in a year with their team leader. But although this previous data gives an idea of ​​care pressure, above all it explicitly points towards a possible opportunity in organizational management and to start facing it, we must answer the following question: " Is it necessary that patients visit more than once every two months of the year?"

The difficulty in obtaining an appointment with the primary care professionals is a cause for concern for many citizens, especially for those who work from Monday to Friday. In situations experienced as non-delayed for the citizen, the response of the primary care team in our environment is very agile, but unfortunately in a very high percentage of occasions the answer is not given by the reference professionals. The problem in the access is fundamentally for the scheduled appointments (previous appointments concerted not urgent) that in a very high percentage are more than three days, mainly in urban surroundings. At this point there are internal organizational measures (not dependent on funding or the environment) of the primary care teams that when applied, improves accessibility: quote from the consultation the days of less pressure, use non-contact consultation tools, work closely and as a team with the rest of the health and non-health professionals...

Accessibility is the guarantee of equity and the basis of the operation of the public health system, because the barriers to access always penalize the same population groups: Not only those with fewer resources and the sickest, but also the people who live in rural areas, the dependents, women over 65 years of age and children, who have a more vulnerable social and health situation. In the attached figure you can see in a schematic way the quality measures defined to evaluate the quality of the health system that I have extracted from a document of the Junta de Andalucía.

The Conceptual scheme for the Evaluation of the Results and Quality of the Public Health System of Andalusia. 2012.

Despite the above, there’s hope as we can see everywhere innovative experiences that have shown that they improve citizen’s accessibility and provide great satisfaction to professionals and citizens; experiences that are aimed at giving value to all professionals working in primary care, health and non-healthcare. 

One of the major problems we have in common with the primary care of the NHS to resolve from the standpoint of political commitment and management effectiveness, is to carry out policies that facilitate training, development and strategies to retain professionals in primary care and in the community, specialists in primary and community care working in multidisciplinary teams with the aim of giving a more integrated and helpful health care. This is achieved by improving the tools that facilitate non-contact communication (between professionals and citizens), active presence in universities, with agencies that facilitate and enhance safety and quality and unfailingly improving funding. 

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