Family and care equity: ‘consensus and dialogue needed’

The Spanish Society of Primary Care Physicians (Semergen) kicked off its 44th National Congress with a pre-congress panel that analyzed a problem of impact, both in the daily clinical practice of family physicians and Planning and organization of the National Health System (NHS) as a whole. In this sense, the medical organization considers it “very important” open channels of “dialogue and debate” that generate “consensus, knowledge” to help strengthen equity in primary care.

It rises from society that current The primary care (PC) model is in a moment of transformation forced by some circumstances that have a decisive impact on the system, such as the lack of family medicine specialists to cover a significant number of vacancies in many parts of Spain, the need to propose an organizational model aimed at achieving the most decisive first step to care, with greater opportunities and in which the family doctor is more recognized and motivated.

“It is very important for Semergen that he succeeded assembled this group of experts with experience in health management who have agreed to a package whose purpose is to generate quality discussion and knowledge to contribute to strengthening the fairness of the system so that the reasonable differences that arise in a decentralized health care model such as the SNS do not lead to significant inequalities in the provision of health care and in the daily practice of family doctors in different communities or health areas “.

Conclusions of the expert group

The main conclusions of the expert group have been announced at the National Congress and are generally based on high level of equity in access to health care that is provided in our health system:

• Aaccess to BKP in our SNS is mostly universal and fair, although there are organizational differences that may cause inequality. For this reason, and under the leadership of the Ministry of Health and the active participation of the autonomous communities, work must be done to identify inequalities and expand procedures and practices that evidence shows to be effective and efficient.

• The portfolio of services of AP should be homogeneous between the different autonomous communities. The biggest differences are likely to be found in access to additional and diagnostic tests by family physicians from one health area or another. For this reason, it is necessary to work on defining a catalog of diagnostic tests, in which what should be accessible from a computer and what should not be defined, or what tests can be accessible for certain cases.

• vVariability of health care chains and organizational measures it can also generate significant inequities in health care delivery. That is why it is necessary establishing evidence-based protocols which determine what the optimal care pathways should be to improve the resolution of medical consultations with a computer.

• The Family physician access to clinical and pharmacotherapeutic information of their patients is essential to ensure continuity of care. In some Communities there is shared access to this information, but in many others there is not, creating greater difficulties for the comprehensive care of patients by their GP.

• Regarding the preventive work carried out by the PA, it is also necessary to establish a clear portfolio of services for what prevention policies and specific screening programs should be implemented in a fair manner in all autonomous communities. Disease prevention and health promotion should be one of the main lines of action in computer teams, and this activity should also be carried out under fair conditions.

• The pharmaceutical visa systems they also present significant inequalities between some areas and others, which makes it difficult in some communities for patients to access certain types of medicine and to carry out pre-screening work, which calls into question the system’s trust in the family doctor.

• Our health system lacks a policy to evaluate what is done and how it is done. In order to define a homogeneous portfolio of services with procedures that are also common to different communities, it would be necessary to establish, by consensus of a working group, a set of indicators that allow the quantification of what provides real value and what does not. The collection and analysis of this information under the direction of the Ministry of Health, with the participation of the autonomous communities and advice from scientific societies and patient organizations; This would allow drawing the ideal baseline situation for the definition of a more egalitarian and fair model.

• The increase in resolution capacity of computer doctors suggeststo commit to a physician training and recertification program enabling you to improve your skills throughout your career to offer more and better care services. To do this, it is necessary to increase the hours devoted to the training of family doctors in a fair way between the different autonomous communities.

• the main thing risk of injustice which currently exists in SNS and specifically in the computer is eshortage of human resources and the difficulty in meeting the needs of family doctors in some areas of Spain. It is urgent to adopt fair measures for the country as a whole, which include improving economic conditions, but go further and take into account other aspects of professional careers and family reconciliation. Only in this way can numerous family medicine positions, especially in the most rural areas, remain vacant year after year, which significantly affects the equity of computer access in these areas relative to urban centers.

• In line with the above and together with these measures aimed at attracting and retaining PC physicians in specific geographical areas, it is urgent to define and implement a global action plan for addressing the specific needs of HCWs in rural areas, making family medicine more attractive in these areas. For this, new organizational measures must be considered that allow the development of new models of care delivery taking advantage of the opportunities offered by telemedicine and non-face-to-face care.

Furthermore, in the debate held, the need to increasing resolution capacity in the field of primary care and family medicine consultations. The president of Semergen, Jose Polo, insisted on the importance of provide adequate resources to the BKP“in human resources, which is very important, but also in equitable access to diagnostic technology as a key aspect to achieve high-resolution practice.”