Family medicine confined into an individualistic practice

88% of the demand for assistance requires some kind of coordination

If we glimpse at the memories of the primary care centres, we will notice they all attach great importance to the number of visits, especially family doctors, in the sense that the more visits, the less waiting time. Unhappy with this, I have clicked on the primary care document of the AQuAS Results Centre, one of the most advanced evaluation systems in the world, and I have observed that, in addition to efficiency, data on effectiveness, quality, and value practices and information technology development are collected. The indicators of adequacy warrant separate mention since they are the only ones that, although indirectly, give an estimate of the collaborative work of the primary care teams, implying that if the preventable hospitalizations and the number of multi-medicated patients are in low levels, should be an indicator that in that team there is some form of integrated model of clinical work.

Despite this last annotation on the adequacy, what surprises me is that even today, in the evaluative models of primary care, elementary components such as community work, the integral evaluation of complex patients, the individualized plans developed are not considered jointly, networking and service integration. The message from the decision makersn is clear: we hire you to visit all patients who request it, community work and coordination, on the other hand, is a voluntary matter.

The new plan of the English NHS puts the focus on teamwork in primary care

The NHS of England has published (January 2019) a long-term plan of which, King's Fund analysts such as Richard Murray, highlight the emphasis placed on teamwork in primary care, considering that, as they say, the 88% of the clinical practices of family doctors are part of processes that require the collaboration of other professionals. Translated to the Spanish system, given that the English ones is not the same, this would mean that the individualized physician-nurse population allocation is slowing down the integrated approach to people's health problems.

The English plan features primary care based on teams, rather than individualities, also with the incorporation of support professionals such as administrative, pharmacists, physiotherapists, etc. To make this change happen, the plan foresees governance structures at the local level that promote networking of leading teams with other facilities in the same territory such as mental health, public health or community social work, in what they call "integrated care systems".

The English advise against the internal fragmentation of primary care marked by an overly individualistic practice of family doctors and, for this reason, they advocate the creation of territorial governance models that favour the integrated management of all the services acting in community. According to them, the future of primary care goes through: more team working, more networking and more community and integrated vision of people's health problems.

Jordi Varela

Editor