Primary Health Care

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Primary Health Care

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

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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

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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

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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.

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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.

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Overview of the UK NHS
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NHS Structure
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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.

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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.

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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

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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

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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.

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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

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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
60201-18. van Doorslaer et al, Health Econ 2004
13629-47. Schoen et al, Health Aff 2005 W5
509-25.
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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 physicians 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.
Source Schoen et al, Health Aff 2005 W5 509-25.
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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.

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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.
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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

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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

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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

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Cyprus Health System

• Manpower includes
• - physicians (512)
• - dentists
• - pharmacists
• - nurses (2.198)
• - health inspectors
• - health visitors
  (RITE, 2007)

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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

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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

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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 2004162
  )

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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)

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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

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The vision for primary care in Cyprus
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.
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..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

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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.

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