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Από την 1η Ιουνίου 2019, το σύστημα υγείας της Κύπρου θα αλλάξει και στην πράξη, αφού με την εφαρμογή της πρώτης φάσης του Γενικού Συστήματος Υγείας θα πιάσουν δουλειά και οι προσωπικοί γιατροί.
Ο κάθε προσωπικός γιατρός θα δικαιούται να εγγράψει στον κατάλογό του μέχρι και 2500 ασθενείς. Προσωπικός γιατρός μπορεί να είναι γιατρός με ειδικότητα στη γενική ιατρική, παιδίατρος για τα παιδιά κάτω των 15 ετών, γηρίατρος για τα άτομα άνω των 65 ετών, παθολόγος ή άλλος γιατρός ο οποίος, σύμφωνα με τη σχετική νομοθεσία, διαθέτει ειδική εκπαίδευση στη γενική ιατρική αναγνωρισμένη από το Ιατρικό Συμβούλιο Κύπρου ή διαθέτει πιστοποιητικό που βεβαιώνει το δικαίωμα «άσκησης δραστηριοτήτων του γιατρού γενικής ιατρικής στο πλαίσιο του εθνικού συστήματος κοινωνικής ασφάλισης στην Κύπρο ή σε άλλα κράτη-μέλη της ΕΕ».
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Εγγραφή ή Είσοδος
--- Τέλος παράθεσης ---
Από την 1η Ιουνίου 2019, το σύστημα υγείας της Κύπρου θα αλλάξει και στην πράξη, αφού με την εφαρμογή της πρώτης φάσης του Γενικού Συστήματος Υγείας θα πιάσουν δουλειά και οι προσωπικοί γιατροί.
Ο κάθε προσωπικός γιατρός θα δικαιούται να εγγράψει στον κατάλογό του μέχρι και 2500 ασθενείς. Προσωπικός γιατρός μπορεί να είναι γιατρός με ειδικότητα στη γενική ιατρική, παιδίατρος για τα παιδιά κάτω των 15 ετών, γηρίατρος για τα άτομα άνω των 65 ετών, παθολόγος ή άλλος γιατρός ο οποίος, σύμφωνα με τη σχετική νομοθεσία, διαθέτει ειδική εκπαίδευση στη γενική ιατρική αναγνωρισμένη από το Ιατρικό Συμβούλιο Κύπρου ή διαθέτει πιστοποιητικό που βεβαιώνει το δικαίωμα «άσκησης δραστηριοτήτων του γιατρού γενικής ιατρικής στο πλαίσιο του εθνικού συστήματος κοινωνικής ασφάλισης στην Κύπρο ή σε άλλα κράτη-μέλη της ΕΕ».
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Συμβόλαιο των ιδιωτών Ολλανδών Γενικών Ιατρών με το κράτος για παροχή υπηρεσιών ΠΦΥ ως οικογενειακοί ιατροί
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Primary Care Home – a model for Ireland?
By Editorial Staff 18th October 2017
Dr Lucia Gannon, NAGP National Council, reports on a fact-finding mission to see a new healthcare model in action in England
A delegation from Ireland, led by the NAGP, visited the UK late last month to learn about an innovative new model of primary care — the Primary Care Home.
The visit was prompted by presentations given at the Primary Care Partnership Conference in Dublin earlier this year, by both Dr Nav Chana, Chair of the National Association of Primary Care (NAPC) in the UK, and Claire Oatway, COO of the Beacon Medical Group in Plymouth.
Dr Lucia Gannon, NAGP National Council
The achievements of the Beacon Medical Group, one example of a Primary Care Home, included improved quality of care, improved staff satisfaction and significant financial savings.
While the Primary Care Home is not transferable to Ireland in its present format, it did contain interventions that could be of benefit here. The NAGP decided to explore this further, by spending two days in Plymouth visiting the Beacon Medical Group, listening to the partners, staff, and other members of the primary care team, and meeting the voluntary groups who make up this home.
The delegation included Fianna Fáil TD and Spokesperson on Primary Care and Community Health Services, John Brassil, TD; Fine Gael Seanad Spokesman on Health Senator Colm Burke; HSE National Clinical Advisor and Group Lead for Primary Care Dr David Hanlon; and HSE Policy Analyst Joan Gallagher.
NAGP members present included Dr Emmet Kerin, President; Dr Andrew Jordan, Chairman; Mr Chris Goodey, CEO; and myself, Dr Lucia Gannon.
The publication of the all-party Sláintecare Report in May outlined a 10-year vision for the future of healthcare in Ireland, and a shift away from the hospital-centric system to more primary and community-based care closer to people’s homes. The NAGP welcomed the following principles that were highlighted in the report:
• More care for patients delivered in the community;
• The implementation of an integrated care system;
• The development of general practice;
• Enhanced teams working in primary care with GP leadership;
• Better access to community diagnostics through service hubs;
• Ring-fenced transitional funding underpinned by legislation;
• An emphasis on clinical leadership, governance and State accountability.
These principles are all embodied in the Primary Care Home model of healthcare delivery.
Three aims of STPs
In the UK, it was recognised that the NHS needed to change radically to meet the healthcare needs of people in the 21st century. Sustainability and transformation plans (STPs) formed part of the NHS’s ‘Five Year Forward View’. STPs were charged with designing the future of health and social care for a defined population, and were expected to meet three aims: improved health and wellbeing; transformed quality of care delivery; and sustainable finances.
The Primary Care Home was developed by the NAPC as a means of transforming primary care delivery in a way that could meet those aims.
There are four defining characteristics of the model:
1. Provision of care to a defined registered population of between 30,000 and 50,000;
2. An integrated workforce, with a strong focus on partnerships spanning primary, secondary and social care, inclusive of patients and the voluntary sector;
3. A combined focus on personalisation of care with improvements in population health outcomes;
4. Aligned clinical and financial drivers through a unified, whole population budget with appropriate shared risks and rewards.
The Primary Care Home was formally launched in 2015. Initially, it received 67 applications from general practices around the UK. Fifteen sites were chosen as rapid test sites to pilot the project. Two years later, there are more than 191 sites involved in the project, covering 8 million patients, or 14 per cent of the population.
Creating the practice
Beacon Medical Group is a large practice, formed initially by the merger of three individual practices, which now includes four practices and covers a population of approximately 40,000 patients. It includes 30 general practitioners, 24 full partners, seven salaried general practitioners and one non-clinical partner who is the COO. It employs 140 staff, including ceptionists, nurses, clinical nurse practitioners, non-prescribing clinical pharmacists, advanced medical practitioners and admin staff.
Governance lies with the Board of partners, who meet every two weeks. Partners pooled their resources at the time of amalgamation and signed one partnership agreement.
Partners meet every four weeks. The home has a single Primary Medical Services contract and income comes from core services (60%), specialist services, services commissioned by the CCG and rental income from NHS England for surgery premises. Expenditure is decided by the partners on the basis of the needs of the local population.
General practitioners and their staff work closely with other members of the primary care and social care team. Some of these ancillary medical services have co-located to the home, in order to exchange information and formulate care plans more efficiently.
Integration of staff
The home also integrates with secondary care. Beacon Medical Centre is responsible for 10 per cent of the patients referred to the local hospital. This means that the hospital staff are interested in engaging with the medical centre on many issues, including patient referrals and discharges and access to diagnostics.
Over the two-day trip, we heard presentations from secondary care, primary care nursing, social care personnel and the voluntary sector. All outlined how the formation of the Primary Care Home had improved quality of care for patients and improved job satisfaction for staff. Among the many financial benefits accrued in the two years since its inception were:
• Reduced ED attendances (Stg£27K);
• Reduced admissions from ED (£295K);
• Reduced GP referral (330 referrals to hospital avoided);
• Reduced prescribing (£220K);
• Reduced GP waiting times (six day reduction in waiting times);
• Increased staff satisfaction (86% of staff regarded the Beacon as a good employer);
• Increased staff recruitment and retention (seven new GPs recruited in two years).
Specific initiatives also included an urgent care team to deal with same- day GP requests. This team consisted of an advanced nurse practitioner, advanced medical practitioner, clinical pharmacist, nursing team and a duty doctor, which covered all 40,000 patients from a single site.
Telephone calls were triaged by the AMP, who was dealing with up to 200 calls a day. Patients were advised and directed to the most suitable healthcare provider.
The centre had a ‘no waiting room’ policy for urgent care, meaning that rather than waiting for a GP, they would see a different member of the team if this was appropriate.
Many of these patients could be dealt with very well by a nurse or clinical pharmacist, leaving the doctor free to deal with the more complex cases.
This initiative resulted in all patients requesting urgent care being seen on the same day with no waiting time and led to significant reductions in attendances at out of hours and ED departments.
Another initiative has been a Care Home Pilot whereby a clinical pharmacist and a GP with a special interest in elder care visited six nursing and care homes once a month and provided medication reviews and physical examination.
There were a total of 1,745 patient contacts throughout the year resulting in the initiation of 302 new medications, the de-prescribing of 970 medications, leading to a saving of £83,364 (€92,750) on medication costs.
There was also a reduction in emergency admissions, reduction in OOH contacts and positive feedback from patients, care home staff and GPs.
Specialist services
Two GP partners with a special interest in musculoskeletal medicine and dermatology have also provided specialist services to the whole patient population.
This resulted in significant reductions in knee, shoulder and plastic surgery referrals. Patient and doctor satisfaction was high with this service as wait times were long in secondary care, and GPs had been providing significant monitoring for these patients.
The practice also encouraged patients to set up a patient participation group to provide feedback on services and share information on patients’ needs. This has been very successful.
The group meet every month on their own and discuss their issues. They then meet with a member of staff monthly. Because of these meetings, many new initiatives have been put in place.
The patients produce a practice newsletter, and they assist with annual flu clinics, guiding people to the appropriate person or room. They organise local health and lifestyle community events and also attend meetings concerning the integrated health and social care plan for the area, and input their concerns and wishes and actively seek funding streams where appropriate and necessary.
A further initiative has seen a liaison psychiatrist visit the practice, offering advice on mental health issues and management strategies, especially for the frequent attenders with unexplained medical symptoms.
Our impression of the Beacon Medical Group was of enthusiastic and motivated service providers who were happy in their work and interested in providing high quality care to patients in the community. Their motto was ‘right care, right person, right time’ and they worked as a highly integrated team to achieve this for individual patients, while also monitoring population health outcomes.
General practitioners felt more in control of their workload and had renewed enthusiasm for their work. Much of the work that did not need a GP was delegated to other members of the team, who were professionals with their own indemnity but felt well supported by their GP colleagues.
There was an open-door policy for all team members who could collaborate with ease throughout the day, making formal and often inefficient meetings unnecessary.
Provider autonomy
When questioned as to the success of this innovation, many people felt it worked because it allowed providers autonomy, individual skills were recognised and valued, and close connections with the voluntary sector helped care providers respond to feedback and the needs of patients quickly and effectively. Only deliverable initiatives were considered, and they were scaled to local need.
In essence, this was a bottom-up, self-organising system that was allowed to grow organically, adapt as necessary, celebrate successes and learn from failures.
It was based on collaboration throughout the whole primary care system and staff felt that they were empowered drivers of change.
The Primary Care Home model has the potential to bring higher patient satisfaction along with a safer, more cost-effective health service.
Many of the interventions contained in this model could be easily adapted for Ireland.
The NAGP wish to thank the Irish delegation for attending, as well as the NAPC and Beacon Medical Group for hosting us.

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Lessons for advancing Universal Health Coverage , OECD- WHO
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