“On the other hand the writer is incorrect in stating that“The document does guarantee that health centres will continue to remain open as they currently are and therefore patients who are used to going there and get a free service will be able to continue to do so”
I refer to Reform in primary care by Prof Pierre Mallia (TMI, 16 December,) and no doubt appreciate his longstanding endeavour to having family doctors more organised.
Nonetheless, one must be time-warped to refer to “the sabotage” dating back two decades. My dictionary defines sabotage as deliberate subversion or treason. I owe it to so many family doctors who have also contributed in the national interest to safeguard against social and economic inequalities.
Why should one take it out on doctor-MPs when simultaneously one states: “Many doctors have to work part-time to make ends meet. We have seen that many have maintained a government employment. But what about the hundreds of doctors who do company work? Take our department of family medicine, for example, which has full-timers and part-timers. It would be ridiculous either way to have doctors working within such a department without seeing patients as well. The point is that the very WONCA (World Organisation of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians) documents quoted by the report all advocate that family doctors in many countries do other work as well which is not only legitimate, but also necessary. At present there are 149 full-time equivalents (FTEs) catering for a population of 413,609 giving a doctor/patient ratio of 2,776 patients. Moreover, there are nearly 400 doctors on the specialist register, not all of whom are FTEs, but who all provide patient care. One would assume that therefore there can be half the Maltese population who have private doctors who are not FTEs. Certainly one cannot put these out of a job; certainly one cannot leave these patients without a doctor. What doctor-of-your-choice would it be?”
On the other hand the writer is incorrect in stating that “The document does guarantee that health centres will continue to remain open as they currently are and therefore patients who are used to going there and get a free service will be able to continue to do so.” In fact less government presence in primary health care is already preceding IT availability and, in the opinion of so many participants on radio/TV programmes, it is a pity that the document did not focus on how to ameliorate polyclinics to “serve as centres for the treatment of minor yet urgent conditions; conditions that may not be easily treated by the family doctor in the clinic or at home, but which do not need access to hospital services”.
Your columnist asks “Why are we maintaining a dual system of health centres while at the same time investing in group practices from tax money?” It is obvious that with less government presence we would inevitably raise our fees substantially once our services would become exclusive and mandatory, having no other way to discourage demand. In fact the document is only rhetorical in stating: “The tariff of fees charged by family doctors shall be determined by the free market and it is not envisaged that at present government will be required to intervene to set fees. However, in order to safeguard patients, annual national surveys will be carried out to benchmark fees across Malta and Gozo, according to districts. These surveys will give information on the range, mean and median of the fee structure across the various districts in Malta and Gozo. Such benchmarks will be published and voluntary adherence to these benchmarks will be expected.”
Here again, as in the one-off energy allowance for households, it is not enough to only protect the worst off with the Energy Benefit or Pink Form. Are households earning e150 weekly and hence not Pink Card holders not also our concern? On the contrary, along with the POYC, this system subsidising patients receiving medication for chronic illness will further increase the 80,000 Schedule V (Yellow Card) users, with government continuing to finance more medicines for those who could afford them. It is very clear that not even straight talk from my end at the last PN General Council could change pre-set agendas.
I did expect Prof. Mallia to criticise the document for not encouraging family doctors to work in underprivileged areas to have enough human resources to pool into group practices or as he prefers family doctors’ networking. In spite of my insistence, this matter has been totally neglected by the document’s authors, confirming that equity was never a priority.
As Ms Vanessa Macdonald wrote “The government could invest in health centres and make them centres of excellence as it did schools and Mater Dei. Instead, it is shoving its responsibility onto the private sector.” (9 December ). And Ms Pamela Hansen in her contribution Shifting, or solving the problem? (TMIS, 13 December) went one better: “Medicine is a caring profession, making money is not. Some doctors need to decide whether they are doctors or businessmen.”
On a political level, I must assume that at least at basic primary level, a Christian Democrat government will manage to safeguard against the latter. On a professional level, I have already gone public in stating that I will not be registering in this system as I am confident that from the patient’s perspective, “time to listen, talk and explain”, the top patient priority regarding general practice (“Primary care in the driver’s seat?” Organisational reform in European primary care, 2006), will be better served my way!
Jean Pierre Farrugia is a Nationalist MP