Primary Health Care

Primary Health Care A comparison of the UK and Cyprus Systems of Health Savoula Ghobrial Nursing programme Coordinator University of Nicosia Savoula Ghobrial

Presentation Overview • Introduction • What is Primary Care - Definition of primary care • Overview of the UK Health System - Primary Care in the UK • Overview of the Cyprus Health System - Primary Care in Cyprus • Conclusions/Recommendations Savoula Ghobrial

Introduction • Primary care should be the linchpin of a well-designed health care system. • But it does not carry over into the organizational mechanisms best suited to pursuing or achieving this common objective. • Across the WHO European Region, primary care is delivered through a wide range of: • institutional, • financial, • professional • clinical configurations Savoula Ghobrial

PRIMARY CARE • Primary care is: • the term for the health services that play a central role in the local community including: • GPs • specialist practice nurses • pharmacists • dentists and midwives. • Every citizen should have the best possible access to these services. Savoula Ghobrial

What is primary Care? • Primary care describes community based health services that are usually the first, and often the only, point of contact that patients make with the health service. • It covers services provided by: • family doctors (GPs) • community and practice nurses • community therapists (such as physiotherapists and occupational therapists) • community pharmacists • Optometrists • dentists and • midwives. Savoula Ghobrial

Overview of the UK NHS Savoula Ghobrial

NHS Structure Savoula Ghobrial

Primary care in UK (in England) • State funded system… • Division into commissioners + providers of care • Commissioners – decide what care is to be provided • Must implement national guidance • NSF (National Service Frameworks) • NICE (National Institute for Clinical Effectiveness) guidance • Must meet Access Targets • 4 hours casualty • Same day and 48 hour access to a GP • 2 weeks suspected cancer • 13 weeks OPD, • 6 months to surgery • Inspection: • Healthcare Commission • Many health communities have large deficits…. Savoula Ghobrial

Primary Care Trusts • Primary care trusts (PCTs) are at the centre of the modernisation of the NHS and are responsible for 80 percent of the total NHS budget. • They are free-standing NHS organisation with their own boards, staff and budgets. • PCTs are monitored by their local SHA and are ultimately accountable to the Secretary of State for Health. Savoula Ghobrial

Primary Care Trusts • They work with other health and social care organisations and local authorities to make sure that the community's needs are met. • PCTs provide some care directly and commission services from others, such as NHS acute trusts and private providers, with decisions on providers increasingly informed by the choices which patients make themselves Savoula Ghobrial

PCTs are responsible for: • Developing programmes dedicated to improving the health of the local community • Deciding what health services the local population needs and ensuring they are provided and are as accessible as possible. This includes hospital care, mental health services, GP practices, screening programmes, patient transport, NHS dentists, pharmacies and opticians • Bringing together health and social care, so that NHS organisations work with local authorities, social services, and voluntary organisations Savoula Ghobrial

PCTs are responsible for: • Ensuring the development of staff skills, capital investment in buildings, equipment and IT, so that the NHS locally is improved and modernised and can continually deliver better services. • Every PCT is committed to achieving the maximum health improvement through prevention and other interventions. • This can include everything from ensuring that smoking cessation services are achieving high long-term 'quit' rates to ensuring that the primary care element of the targets of national service frameworks are met. Savoula Ghobrial

Key Findings: • Significant investment being made in the UK to support the development of inter-professional learning (IPL) in university medical, nursing and allied health disciplines • inter-professional care seen as central to the development and delivery of quality health care • IPL mandated and funded • Primary care nurses increasingly front-line workers • Systematising remuneration and career structures Savoula Ghobrial

Primary Care Oriented Countries • Have more equitable resource distributions • Have health insurance or services that are provided by the government • Have little or no private health insurance • Have no or low co-payments for health services • Are rated as better by their populations • Have primary care that includes a wider range of services and is family oriented • Have better health at lower costs Sources: Starfield and Shi, Health Policy 2002; 60:201-18. van Doorslaer et al, Health Econ 2004; 13:629-47. Schoen et al, Health Aff 2005; W5: 509-25. Savoula Ghobrial

Community surveys in industrialized countries show that primary care oriented countries (Australia, Canada, New Zealand, United Kingdom) are rated higher than other countries (US and Germany) on many aspects of care, including • view of the health care system as NOT needing complete rebuilding • finding the regular physician’s advice helpful • coordination of care The United States rates the poorest on ALL aspects of experienced care, including access, person-focused care over time, unnecessary tests, polypharmacy, adverse effects, and rating of medical care received. Savoula Ghobrial Source: Schoen et al, Health Aff 2005; W5: 509-25.

Mortality/Morbidity and Primary Care • Shi (1994) found, in the US, that primary care is “by far the most significant variable related to better health status, correlating to lower overall mortality, lower death rates due to diseases of the heart and cancer, longer life expectancy, lower neonatal death rate, and low birth weight.” • In studies undertaken by Shi and Starfield (2000, 2001) on income inequality and primary care, an association was established between higher primary physician supply and good health status. Savoula Ghobrial

High quality primary care is a core component of a high quality healthcare system… Strong primary care is associated with higher patient satisfaction Primary care services continue to deliver very high patient satisfaction. Patient satisfaction with the quality of general practice is over 85%. Studies have shown that access to primary care reduces effects of poverty on self reported health status. In Yorkshire and Humber 99% of people are registered with a GP – this offers great potential to tackle inequalities. Stronger primary care is associated with lower health inequalities Stronger primary care is associated with lower hospital admissions In the UK, an increase in the number of GPs is associated with lower admissions for both acute illness and chronic illness. Stronger primary care is associated with better value for money Countries that have weaker primary care have higher costs across the healthcare system. Within countries, areas that have more primary care physicians are associated with lower spending. Delivering the vision for primary care will be critical to the successful implementation of the Next Stage Review recommendations. Savoula Ghobrial

Cyprus Health System • Cyprus has a population of appr. 780.000 people • The Ministry of Health is responsible for the Health Care System. There are two systems of medical care • The governmental health sector • The private sector Savoula Ghobrial

Cyprus Health System The Governmental Health Sector provides medical and health care free of charge to: • low income population • National guard soldiers • Civil servants and their dependants Furthermore, medical care is provided free of charge in all cases receiving treatment at the A/E departments, irrespective of economic status or nationality including visitors Savoula Ghobrial

Cyprus Health System Services offered by the Government are primarily: - Secondary - Tertiary health services • Also there is an extensive network of - rural hospitals - rural health centres - sub-centres and dispensaries providing primary care Savoula Ghobrial

Cyprus Health System Manpower includes: - physicians (512) - dentists - pharmacists - nurses (2.198) - health inspectors - health visitors (RITE, 2007) Savoula Ghobrial

Cyprus Health System • The private health services are dominated by the solo practicing physician and dentist offering all types of outpatients services. - 100 small private clinics/Hospitals in urban areas - non profit/voluntary services offering mostly palliative support care; and -rehabilitation for chronic disorders e.g. diabetes, cancer, cardiac disorders etc Savoula Ghobrial

Cyprus Health System • The m • Ministry of Health formulates • National health policies • Coordinates the activities of both the private & public sector • Regulates Health care standards • Promotes the enactment of relevant legislation Savoula Ghobrial

Primary Healthcare Services in Cyprus • 38 Primary Care Health Centers (PCHC) • 6 PCHC are serving urban areas • 7 PC clinics located in the hospital setting • 25 PCHC are serving rural areas with another 274 health stations (Annual Report of the Ministry of Health 2004:162 ) Savoula Ghobrial

General Practitioners in daily practice • GPs practice either at PCHC (urban or rural), Out-patient Clinics and Emergency Departments of General Hospitals. • GPs at emergency departments work on a shift basis schedule. • GPs at some rural PCHC areas work on a 24 hour basis two or three times/ week. • (Phylaktou, 2004) Savoula Ghobrial

Cyprus Policy Options: Primary Care Nursing Workforce • Reform primary care funding for quality nursing care outcomes • Establish remuneration and career structures • Reform payment methods for cost-effective primary nursing care • Enable nurses to spend more time on prevention & patient education • Re-design Post basic/graduate nurse education to include specialist community and primary care courses • Implement a career framework • Implement a National model of inter-professional learning Savoula Ghobrial

Primary Care is the cornerstone of our future National Health Service. Primary care ensures that the NHS provides appropriate care and helps people improve their health and well being. It is the first port of call and main healthcare provider for the vast majority of people in the area they live. The aim is to see universally high quality primary care that is flexible to respond to the patients needs, regardless of where, when, or to whom they are delivered. General practice will have a critical role as part of primary care. The practice will act as navigator and co-ordinator of the care patients receive; it will focus on health and healthcare; and it will work in partnership with patients to ensure they are involved in determining how care is delivered for themselves and their communities. The vision for primary care in Cyprus Savoula Ghobrial

..and most importantly • In Cyprus, nurses and nursing could and should play a significant role in the development of primary care services, Health Promotion and the prevention of disease and other chronic disabling conditions. • Through the development of specialist practice roles e.g. Specialist diabetic nurse, nurse consultants, acute and chronic pain specialists, infection control nurses, specialist community nurses, paediatric specialist, 1st surgical assistant, to name just a few… Savoula Ghobrial

BUT… • For the success of this dream, we need to become autonomous accountable practitioners, to further develop nursing knowledge, to improve our practice through CPD/EBL, education, nursing research and international and local collaborations. • Additional to that we need to pursue a trusting relationship on equal terms with our medical colleagues, who will respect us for our contribution to the health of the nation and the successful implementation of health care policies. Savoula Ghobrial

T h a n k y o u f o r y o u r a t t e n t i o n Savoula Ghobrial

Primary Health Care