The Malta College of Family Doctors (MCFD) and the Association of Private Family Doctors (APFD) in a joint statement on Monday regarding the upcoming Budget, said that they are ”grateful of the massive increase in the health budget in the past decade, however it should also be supported by investment in primary care.”
They noted that substantial investments in much needed secondary care space are moving forward, such as the Vincent Moran Regional Hub, the St Vincent de Paule Hospital and the Gozo General Hospital.
Entitlement medicines have increased and training of medical personnel has ramped up, they said. A number of health strategies have been rolled out in the last legislature and work on them is moving forward in earnest.
The two VOs said that ”this legislature has already set the mark for investing in primary care, by providing family doctors with the biggest set of tools since 2007 – new blood investigations to access, more entitlement medicines to prescribe and new radiological investigations to order on behalf of patients.”
The Ministry of Health has informed the public of new secondary care investments, such as the extension of the Emergency Department at Mater Dei, the refurbishing of wards at Mount Carmel Hospital, the new acute Psychiatric Unit at Mater Dei and the Helipad at Gozo General Hospital.
On one hand, the MCFD and the APFD expect the Budget for 2027 to cater for this investment. However, data from the “State of Health in the EU: Malta Country Health Profile 2025”, shows that the health spending in Malta in 2023 accounted for 8.8% of Malta’s GDP (slightly lower than the EU average of 10.0 %).
On the other hand, the two Voluntary Organisations said that they wish to point out that such investment should be supported by parallel investment in primary care, as otherwise this investment needs to be repeated in a next decade. The same “State of Health in the EU: Malta Country Health Profile 2025″ shows that Malta’s share of spending on prevention was among the lowest in the EU in 2023.
They pointed out that the ”Emergency Department is overloaded with work and the extension is understandable. All attempts should be undertaken to route a substantial percentage of patients who attend Emergency Department unnecessarily or because there is no second option to other pathways.”
The VOs said that ”an educational campaign to direct unnecessary self-referrals to primary care is most welcome, and this should include the foreigners among us as its target. Family Doctors can participate in decreasing the numbers going to Emergency because there is no second options if semi- urgent pathways (with defined protocols) to outpatients can be created.”
The acute psychiatric unit at Mater Dei is much needed, as it would decrease the to-and-fro of patients from Mount Carmel to Mater Dei and back as well as allow any patient in Mater Dei to be seen more holistically. Family Doctors can help to decrease the load of this unit if they are given access to antipsychotics by entitlement, in the same way as this and the previous legislature have provided entitlement access to family doctors for a number of medications for anxiety, depression, eating disorders and obsessive-compulsive disorder.
”The investment in family doctors is justified because data from the European Health Information Survey (EHIS) 2019-2020 demonstrates that the demand for healthcare services is high, with 77.2% of respondents having visited a General Practitioner (GP) in the previous year and 34.3% had visited a medical or surgical specialist in the same period,” the VOs said.
They pointed out that ”the dependence on private primary care services is still evident. Indeed, 69.4% of respondents had visited a private GP in the previous 12 months compared to 30.5% who had visited a government GP in the same period.”
They added that ”this is consistent with earlier data suggesting that the private sector caters for 70% of the primary care services in Malta. Similarly, there was a higher rate of specialist consultation in the private sector (25.6%) than in the public sector (18.4%).”
The VOs said that this high accessibility of primary care services can be expected to deliver even higher end-point quality service if:
1. more tools are accessible to all primary care family doctors/general practitioners, such as more blood tests, more pathology tests, more radiological investigations and more entitlement rights; and
2. all General Practitioners/Family Doctors (both in the public and private primary care services) have access to the same tools.
The doctors insisted that ”this would on one hand improve the patient experience of the health service as they would decrease the number of stops needed and days taken off work to access health services, shift the workload of the public service to more useful tasks and on the other hand shift expenses from the relatively more expensive secondary hospital care services to the relatively less expensive primary care services. In the EU every 1 Euro invested in primary care gives a return of up to 14 Euro savings in expenses incurred in secondary care within a decade.”
They added that an additional important tool in health care is communication through digital health platforms.
The same Malta Health report for 2023 shows that investment in health information and communication technology in Malta declined between 2018 and 2021, and remains below the EU average. ”For sure investment is needed to strengthen the digital health infrastructure – System uptime and platform outages, maintenance windows (ideally off-peak), pre-release quality assurance and controlled feature roll-outs,;; the VOs said.
They stressed that ”to date the digital health platform used in the private primary care service (myHealth) continues to have less features than the public primary care service (iSOFT) though over many years it was repeatedly promised that they will be at par.”
The two Voluntary Organisations called for a strong investment in primary care, with actions aiming to improve the role of the family doctor in helping patients with undifferentiated health issues, across a broad spectrum, acting as first contact, providing continuity of care, a comprehensive service, and co-ordinate with other health care services.
Additionally, they called for further targeted actions to decrease the number of people with obesity, lack of exercise, uncontrolled hypertension, uncontrolled cholesterol level, uncontrolled diabetes, and smoking, substance and alcohol addiction are welcome. Today’s investment if successful is known to lead to less heart attacks, strokes and amputations in future years. The result is more people with better quality of life, less expensive interventions in the future and an improved workforce.
Likewise, they said that a strong investment in caring for common mental health issues like anxiety and depression, decreasing substance abuse, improving sexual health, and dealing with contraception and family planning at the community level will improve the quality of life of many.
Concluding, the two Voluntary Organisations call for a structure that improves the possibility and funding of research in primary care about our reality, as a means to be able to direct future interventions better.
The Malta College of Family Doctors (MCFD) is a Voluntary Organisation that ”strives to improve the academic and clinical performance of family doctors (known as “it-tobba tal- familja” or “general practitioners”) and the standards of primary health care in our country.”
The Association of Private Family Doctors (APFD) is a Voluntary Organisation that ”strives to improve family medicine and primary health care in our country on behalf of the private family doctors (known as “it-tobba tal-familja” or “general practitioners”) and their patients.”
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