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Health system 'should be based on primary care' - 5/12/2004

Health system 'should be based on primary care'
Cynthia Busuttil

"We have to convince the government to base its health system on primary care because this is better for people, both financially and also health wise" - Pierre Mallia.

A country's health system should be based on primary care, according to Pierre Mallia, president of the Malta College of Family Doctors.

Dr Mallia said that when it comes to family medicine prevention is a priority and the primary aim of the college is to maintain high quality and standards in family medicine.

Speaking to The Times, Dr Mallia said sometimes it was not the best thing for patients to go directly to a specialist when they had a problem. It was important for them to go to their family doctor. In Malta there was still a culture whereby people sought their family doctor.

"We have to convince the government to base its health system on primary care because this is better for people, both financially and also health wise," he said. Dr Mallia explained that primary care was all about prevention.

For the patient it is more cost effective, and quicker, if necessary tests can be done by the family doctor. But although a number of doctors have invested in equipment it often happens that patients have to be sent either to private clinics or to hospital for tests. Dr Mallia said there are certain tests that are not conducted at health centres but the wait for an appointment at the general hospital sometimes varies between six and eight months.

Such a problem could be overcome by the government seeking more cooperation with private family doctors. It is estimated that 30 per cent of new cases of hospital out patients could easily be dealt with in primary care.

Another significant achievement could be through group practices, where a group of doctors would pool in and work together. "There are enormous benefits for doctors, mainly because they could take time off while the others in the group take care of the patients," he said. Obviously, group practice depends heavily on trust between the members of the group, he added.

Because the practice of family medicine in Malta is different from abroad, Dr Mallia said the college was working to develop a diploma in this sector with the help of the United Kingdom's Royal College of General Practitioners (RCGP) and the Irish College. The diploma will be oriented toward the need of family practice in Malta.

Currently, doctors can obtain a degree from abroad through distance learning while the college brings over tutors to deliver talks. At the moment 15 doctors are reading for a Master's degree, another 15 for a diploma in women's health and 20 doctors have just finished their diploma in preventive medicine.

Dr Mallia explained that abroad governments ensure that people see the doctor of their choice either through the National Health System (NHS) or through private health insurance. In Malta, however, family practice is solely a private affair, with health centre doctors often referring patients to their private general practitioner.

Dr Mallia said the college strongly believes in continuous education for doctors and often holds talks on different issues.

More than 200 of the 300 odd general practitioners in Malta are members of the college.

The college will mark its 15th anniversary tomorrow and Dr Mallia said the college was working on creating its own membership system, which would be achieved by doctors through a certain qualification system. He said the aim was for the membership qualification system to be up and running by next year.

One of the college's future aims is for Maltese doctors to be eligible to join the RCPG international membership. In fact, this will be discussed during a visit to the United Kingdom by Dr Mallia in January. "That would mean that members of the local college would be able to apply for membership of the Royal College," he explained.

Dr Mallia said a decision has been taken to change the college's statute. A committee was appointed to hear ideas and will then make proposals as to what changes should be made. He said the plan is to have the new statute approved by an extraordinary meeting by the end of next year.

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