The Auditor General noted that in line with the National Health System Strategy for Malta (NHSS, 2014-2020), public General Practitioner (GP) services provided through health centres and peripheral clinics increasingly focused on health promotion, disease prevention issues and sought to further embrace continuity of care principles.  However, despite the high levels of satisfaction from service users, in its current set-up, the further extension of patient-centric approaches entails addressing factors relating to social, economic, financial, operational and management issues. 

In a statement earlier today, the NAO pointed out that in recent years, primary health care increasingly attracted more national and EU funds.  However, funding levels remain below the required amounts and restrict the derivation of implementation plans and a more expedient implementation of the measures listed in national strategic documents. 

The cost of providing GP services reflects clinical, logistical and patient safety arrangements. However, in some cases, current operational practices are subject to varying degrees of cost-efficiency concerns. A case in point relates to GPs' deployment, which does not always correspond to prevailing user demand. This is particularly evident within the smaller scale health centres during peak hours and, to a larger degree, at health centres providing GP services on a round the clock basis. 

Management information limitations hinder the Primary Health Care Department's (PHCD) planning and monitoring functions associated with the provision of GP services.  Moreover, the unavailability or non-optimal use of IT systems precludes the derivation of accurate patient statistics and unit costs associated with the various services provided by GPs.  The foregoing implies that PHCD is not always in a position to evaluate the feasibility of the various approaches available when considering the further broadening and extension of services. 

This audit has provided strong indications that, generally, the GP Function is adhering to national strategic measures. On the other hand, it remains challenging to broaden the GP Function and to make it more patient-centric without a shift in funding relativities, which reflect more realistically the long-term socio-economic advantages of investments in primary health care.  Within this context, the opportunity exists for further exploiting the interrelationship and potential synergies of private and public sectors collaboration.  Through closer stakeholder involvement, the public GP Function can further contribute towards placing primary health care at the fulcrum of national health services.   

The Report proposes a number of recommendations based on the critical issues identified.

A copy of the Report is available in the publications section of the NAO website http://www.nao.gov.mt, as well as on the NAO Facebook page.