1、Primary Health CareA comparison of the UK and Cyprus Systems of HealthSavoula GhobrialNursing programme CoordinatorUniversity of Nicosia1Savoula GhobrialPresentation OverviewIntroductionWhat is Primary Care - Definition of primary careOverview of the UK Health System - Primary Care in the UKOverview

2、 of the Cyprus Health System - Primary Care in CyprusConclusions/Recommendations2Savoula GhobrialIntroductionPrimary 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 objec

3、tive. Across the WHO European Region, primary care is delivered through a wide range of: institutional, financial, professional clinical configurations 3Savoula GhobrialPRIMARY CAREPrimary care is: the term for the health services that play a central role in the local community including:GPs special

4、ist practice nursespharmacistsdentists and midwives. Every citizen should have the best possible access to these services.4Savoula GhobrialWhat 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 w

5、ith the health service. It covers services provided by:family doctors (GPs)community and practice nursescommunity therapists (such as physiotherapists and occupational therapists)community pharmacistsOptometristsdentists and midwives.5Savoula GhobrialOverview of the UK NHS6Savoula GhobrialNHS Struct

6、ure7Savoula GhobrialPrimary care in UK (in England)State funded systemDivision into commissioners + providers of careCommissioners decide what care is to be providedMust implement national guidanceNSF (National Service Frameworks)NICE (National Institute for Clinical Effectiveness) guidanceMust meet

7、 Access Targets 4 hours casualtySame day and 48 hour access to a GP2 weeks suspected cancer13 weeks OPD, 6 months to surgeryInspection:Healthcare CommissionMany health communities have large deficits.8Savoula GhobrialPrimary Care TrustsPrimary care trusts (PCTs) areat the centre of the modernisation

8、 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. 9Savoula GhobrialPrimary Care TrustsThe

9、y work with other health and social care organisations and local authorities to make sure that the communitys 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 c

10、hoices which patients make themselves10Savoula GhobrialPCTs 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 hosp

11、ital 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 11Savoula GhobrialPCTs are re

12、sponsible 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 in

13、terventions. This can includeeverything from ensuring that smoking cessation services are achieving high long-term quit rates toensuring that the primary care element of the targets of national service frameworks are met.12Savoula GhobrialKey Findings:Significant investment being made in the UK to s

14、upport the development of inter-professional learning (IPL) in university medical, nursing and allied health disciplinesinter-professional care seen as central to the development and delivery of quality health careIPL mandated and fundedPrimary care nurses increasingly front-line workersSystematisin

15、g remuneration and career structures13Savoula GhobrialHave more equitable resource distributionsHave health insurance or services that are provided by the governmentHave little or no private health insuranceHave no or low co-payments for health servicesAre rated as better by their populationsHave pr

16、imary care that includes a wider range of services and is family orientedHave better health at lower costsPrimary Care Oriented CountriesSources: Starfield and Shi, Health Policy 2002; 60:201-18. van Doorslaer et al, Health Econ 2004; 13:629-47. Schoen et al, Health Aff 2005; W5: 509-25. 14Savoula G

17、hobrialCommunity 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, includingview of the health care system as NOT needing complete rebuildingfi

18、nding the regular physicians advice helpfulcoordination of careThe 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 A

19、ff 2005; W5: 509-25.15Savoula GhobrialMortality/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, longe

20、r 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.16Savoula GhobrialHigh quality primary car

21、e is a core component of a high quality healthcare systemStrong primary care is associated with higher patient satisfactionStronger primary care is associated with lower health inequalitiesStronger primary care is associated with lower hospital admissionsStronger primary care is associated with bett

22、er value for moneyStudies 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.Countries that have weaker primary care have higher costs acro

23、ss the healthcare system. Within countries, areas that have more primary care physicians are associated with lower spending.In the UK, an increase in the number of GPs is associated with lower admissions for both acute illness and chronic illness. Primary care services continue to deliver very high

24、patient satisfaction. Patient satisfaction with the quality of general practice is over 85%. Delivering the vision for primary care will be critical to the successful implementation of the Next Stage Review recommendations. 17Savoula GhobrialCyprus Health SystemCyprus has a population of appr. 780.0

25、00 peopleThe Ministry of Health is responsible for the Health Care System.There are two systems of medical careThe governmental health sectorThe private sector18Savoula GhobrialCyprus Health SystemThe Governmental Health Sector provides medical and health care free of charge to: low income populatio

26、nNational guard soldiersCivil 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 visitors19Savoula GhobrialCyprus Health SystemServices offered by the Gov

27、ernment areprimarily: - Secondary - Tertiary health services Also there is an extensive network of - rural hospitals - rural health centres - sub-centres and dispensaries providing primary care20Savoula GhobrialCyprus Health SystemManpower includes: - physicians (512) - dentists - pharmacists - nurs

28、es (2.198) - health inspectors - health visitors (RITE, 2007)21Savoula GhobrialCyprus Health SystemThe 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/volunt

29、ary services offering mostly palliative support care; and-rehabilitation for chronic disorders e.g. diabetes, cancer, cardiac disorders etc22Savoula GhobrialCyprus Health SystemThe mMinistry of Health formulatesNational health policiesCoordinates the activities of both the private & public sectorReg

30、ulates Health care standardsPromotes the enactment of relevant legislation23Savoula GhobrialPrimary Healthcare Services in Cyprus38 Primary Care Health Centers (PCHC)6 PCHC are serving urban areas7 PC clinics located in the hospital setting25 PCHC are serving rural areas with another 274 health stat

31、ions(Annual Report of the Ministry of Health 2004:162 )24Savoula GhobrialGeneral Practitioners in daily practiceGPs 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 rur

32、al PCHC areas work on a 24 hour basis two or three times/ week. (Phylaktou, 2004)25Savoula GhobrialCyprus Policy Options: Primary Care Nursing WorkforceReform primary care funding for quality nursing care outcomesEstablish remuneration and career structuresReform payment methods for cost-effective p

33、rimary nursing careEnable nurses to spend more time on prevention & patient educationRe-design Post basic/graduate nurse education to include specialist community and primary care coursesImplement a career frameworkImplement a National model of inter-professional learning26Savoula GhobrialThe vision

34、 for primary care in CyprusPrimary 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 peopl

35、e 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 t