The Ministry of Health and the Gibraltar Health Authority have announced a further tranche of planned reforms to the Primary Care Centre . The new processes aim to refresh and reinvigorate the appointments system and to increase the community access to GPs and Nurse Practitioners.
The Gibraltar Health Authority is introducing a series of key supporting improvements to provide greater availability of appointments and more convenient access to primary healthcare services.
• Qualified nurses to phone routine test results to patients
• Extra GPs being recruited to provide a walk-in ‘See and Treat’ service
• Extra GPs being recruited to provide Evening Clinics
• Better balance between advance appointments and on-the-day appointments
• £5 increase in the fee for House Calls to patients under age of 65
• Sick notes for up to 5 calendar days can be requested by phone whilst retaining existing safeguards
The first reform reflects an initiative that represents modern, current and well-established practice adopted in GP practices in the UK. Qualified Nurses will be assigned to operate a telephone service in which patients will be contacted to inform them of routine clinical results. This will enable patients to receive reassurance that investigation results have been entirely normal, eliminating the need for patients to seek a further appointment with the GP, and avoiding any unnecessary worry.
On 27 December 2017, the GHA introduced GP walk-in clinics, to deal with the winter flu season. Following the introduction of extra GPs, the PCC's capacity has been enormously improved, with an average of 48 unused appointments every single weekday. This appointment availability has not been seen in the past in the winter months and our primary care services have effectively managed to keep pace with the winter flu surge that has created such difficulties in other countries.
Further full time GP posts are now to be advertised to develop a “See and Treat” style Minor Illness Service, where patients can be seen in an area that mirrors the 'Minors' area of an A&E Department with nurses and GPs working closely together to see patients as soon as they arrive. This will create￼ ￼a far more flexible service and will bridge the gap between primary care and the Accident & Emergency Department.
After consultation with patients and clinicians, and based on the success of the walk-in clinics, it has been decided that a better balance between, advance pre-booked appointments, and book-on-the- day appointments, needs to be established. To that end, the GHA will increase the number of book-on-the-day clinics available every day over the next few months. This exercise will gradually establish the right balance between, appointments providing quick and easy access to a GP, and those appointments with a preferred GP for long-term care management and regular follow-ups.
There has also been an extensive review of the House Call Service that is provided by the GPs. It is usually preferable for a patient to attend the PCC where there is a full range of clinical equipment and clinical support staff to provide a range of treatment options. However, it is understood that there are some housebound, elderly and vulnerable patients, who are simply unable to attend the PCC and the GHA is extremely keen to preserve house calls for such patients who are in genuine need. House calls fees have not increased since October 1998 and will now be adjusted, in line with the increase in the Index of Retail Prices, and reviewed automatically on an annual basis.
To that end, and with effect from today, the fee for a visit by a house call GP will be increased from £10 to £15, for patients under 65 years old. Patients who are over 65 will continue to pay £5. Patients who are exempt for social reasons will remain exempt from payment, including pensioners whose only income is the Old Age Pension.
Perhaps one of the most anticipated and requested reforms is that of evening clinics in the PCC. The GHA is already in the process of recruiting two part-time GPs, to provide an evening GP clinic, to run in the PCC between 6pm and 8pm on week days from Monday through to Friday evening. To support this change, the GHA has consulted with the Administrative Staff at the PCC, to cover the evening clinics, and will be recruiting the necessary Part Time Clerks.
Finally, the sick certificate telephone line has proven to be an enormous success and currently provides, on average, 270 sick certificates every month. This telephone service will now be enhanced by providing a sick certificate for up to five calendar days, once every quarter, instead of the current two days. This will also take effect as from today. Any additional sick certification must be requested by direct consultation with a GP, as with the current arrangements.
The Deputy Medical Director and Lead GP, Dr Krishna Rawal said, “The Primary Care Centre continues to evolve to better serve our patients and our community as a whole. These very important and extensive reforms should not be underestimated; the effect on our appointment availability will be significant and very much appreciated by patients and GPs alike, substantively increasing the time to discuss medical issues and seek advice and treatment options in a more relaxed manner.”
Minister for Health, Care and Justice, the Honourable Neil F. Costa said, “It is clear to me that we need to constantly review primary care services to meet the particular needs of our community. I am immensely proud to announce these reforms, as I cannot stress enough how important it is to enable our GPs to deliver high quality consultations for all patients in an environment where time ￼pressures are reduced and a holistic approach is not only encouraged, but is the standard working practice. Not for the first time, I wish to record my gratitude to all our hardworking, highly competent and compassionate clinicians and administrative staff, for their dedication.”