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Primary Health Care


Primary Health Care A comparison of the UK and Cyprus Systems of Health Savoula Ghobrial Nursing programme Coordinator University of Nicosia Presentation Overview ... – PowerPoint PPT presentation

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Title: Primary Health Care

Primary Health Care
  • A comparison of the UK and Cyprus
  • Systems of Health
  • Savoula Ghobrial
  • Nursing programme Coordinator
  • University of Nicosia

Presentation Overview
  • Introduction
  • What is Primary Care
  • - Definition of primary care
  • Overview of the UK Health System
  • - Primary Care in the UK
  • Overview of the Cyprus Health System
  • - Primary Care in Cyprus
  • Conclusions/Recommendations

  • Primary 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 objective.
  • Across the WHO European Region, primary care is
    delivered through a wide range of
  • institutional,
  • financial,
  • professional
  • clinical configurations

  • Primary care is
  • the term for the health services that play a
    central role in the local community including
  • GPs
  • specialist practice nurses
  • pharmacists
  • dentists and midwives.
  • Every citizen should have the best possible
    access to these services.

What 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
    with the health service.
  • It covers services provided by
  • family doctors (GPs)
  • community and practice nurses
  • community therapists (such as physiotherapists
    and occupational therapists)
  • community pharmacists
  • Optometrists
  • dentists and
  • midwives.

Overview of the UK NHS
NHS Structure
Primary care in UK (in England)
  • State funded system
  • Division into commissioners providers of care
  • Commissioners decide what care is to be
  • Must implement national guidance
  • NSF (National Service Frameworks)
  • NICE (National Institute for Clinical
    Effectiveness) guidance
  • Must meet Access Targets
  • 4 hours casualty
  • Same day and 48 hour access to a GP
  • 2 weeks suspected cancer
  • 13 weeks OPD,
  • 6 months to surgery
  • Inspection
  • Healthcare Commission
  • Many health communities have large deficits.

Primary Care Trusts
  • Primary care trusts (PCTs) are at the centre of
    the modernisation 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.

Primary Care Trusts
  • They work with other health and social care
    organisations and local authorities to make sure
    that the community's 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 choices
    which patients make themselves

PCTs 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
    hospital 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

PCTs are responsible 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
  • This can include everything from ensuring that
    smoking cessation services are achieving high
    long-term 'quit' rates to ensuring that the
    primary care element of the targets of national
    service frameworks are met.

Key Findings
  • Significant investment being made in the UK to
    support the development of inter-professional
    learning (IPL) in university medical, nursing and
    allied health disciplines
  • inter-professional care seen as central to the
    development and delivery of quality health care
  • IPL mandated and funded
  • Primary care nurses increasingly front-line
  • Systematising remuneration and career structures

Primary Care Oriented Countries
  • Have more equitable resource distributions
  • Have health insurance or services that are
    provided by the government
  • Have little or no private health insurance
  • Have no or low co-payments for health services
  • Are rated as better by their populations
  • Have primary care that includes a wider range of
    services and is family oriented
  • Have better health at lower costs

Sources Starfield and Shi, Health Policy 2002
60201-18. van Doorslaer et al, Health Econ 2004
13629-47. Schoen et al, Health Aff 2005 W5
Community 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, including
  • view of the health care system as NOT needing
    complete rebuilding
  • finding the regular physicians advice helpful
  • coordination of care

The 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 Aff 2005 W5 509-25.
Mortality/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, longer 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.

High quality primary care is a core component of
a high quality healthcare system
Strong primary care is associated with higher
patient satisfaction
Primary care services continue to deliver very
high patient satisfaction. Patient satisfaction
with the quality of general practice is over 85.
Studies 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.
Stronger primary care is associated with lower
health inequalities
Stronger primary care is associated with lower
hospital admissions
In the UK, an increase in the number of GPs is
associated with lower admissions for both acute
illness and chronic illness.
Stronger primary care is associated with better
value for money
Countries that have weaker primary care have
higher costs across the healthcare system.
Within countries, areas that have more primary
care physicians are associated with lower
Delivering the vision for primary care will be
critical to the successful implementation of the
Next Stage Review recommendations.
Cyprus Health System
  • Cyprus has a population of appr. 780.000 people
  • The Ministry of Health is responsible for the
    Health Care System.
  • There are two systems of medical care
  • The governmental health sector
  • The private sector

Cyprus Health System
  • The Governmental Health Sector provides
  • medical and health care free of charge to
  • low income population
  • National guard soldiers
  • Civil 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 visitors

Cyprus Health System
  • Services offered by the Government are
  • primarily
  • - Secondary
  • - Tertiary health services
  • Also there is an extensive network of
  • - rural hospitals
  • - rural health centres
  • - sub-centres and dispensaries providing
    primary care

Cyprus Health System
  • Manpower includes
  • - physicians (512)
  • - dentists
  • - pharmacists
  • - nurses (2.198)
  • - health inspectors
  • - health visitors
    (RITE, 2007)

Cyprus Health System
  • The 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
  • - non profit/voluntary services offering mostly
    palliative support care and
  • -rehabilitation for chronic disorders e.g.
    diabetes, cancer, cardiac disorders etc

Cyprus Health System
  • The m
  • Ministry of Health formulates
  • National health policies
  • Coordinates the activities of both the private
    public sector
  • Regulates Health care standards
  • Promotes the enactment of relevant legislation

Primary Healthcare Services in Cyprus
  • 38 Primary Care Health Centers (PCHC)
  • 6 PCHC are serving urban areas
  • 7 PC clinics located in the hospital setting
  • 25 PCHC are serving rural areas with another 274
    health stations
  • (Annual Report of the Ministry of Health 2004162

General Practitioners in daily practice
  • GPs 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 rural PCHC areas work on a 24 hour
    basis two or three times/ week.

  • (Phylaktou, 2004)

Cyprus Policy Options Primary Care Nursing
  • Reform primary care funding for quality nursing
    care outcomes
  • Establish remuneration and career structures
  • Reform payment methods for cost-effective primary
    nursing care
  • Enable nurses to spend more time on prevention
    patient education
  • Re-design Post basic/graduate nurse education to
    include specialist community and primary care
  • Implement a career framework
  • Implement a National model of inter-professional

The vision for primary care in Cyprus
Primary 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
people 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 to ensure they are
involved in determining how care is delivered for
themselves and their communities.
..and most importantly
  • In Cyprus, nurses and nursing could and should
    play a significant role in the development of
    primary care services, Health Promotion and the
    prevention of disease and other chronic disabling
  • Through the development of specialist practice
    roles e.g. Specialist diabetic nurse, nurse
    consultants, acute and chronic pain specialists,
    infection control nurses, specialist community
    nurses, paediatric specialist, 1st surgical
    assistant, to name just a few

  • For the success of this dream, we need to become
    autonomous accountable practitioners, to further
    develop nursing knowledge, to improve our
    practice through CPD/EBL, education, nursing
    research and international and local
  • Additional to that we need to pursue a trusting
    relationship on equal terms with our medical
    colleagues, who will respect us for our
    contribution to the health of the nation and the
    successful implementation of health care

T h a n k y o u f o r y o u r a t t e n
t i o n