The COVID-19 pandemic has brought about rapid and extensive adaptation in the practice of family medicine. In spite of the evident risk while performing their duties, family doctors are continuously in the frontline of this pandemic and are suffering accordingly.

Family doctors are the first contact for almost all infected patients and bear the risk arising from that position. They are the first line of contact in the national health systems, the first line of consultation being given to patients before seeking hospitalisation, of keeping the ‘non-COVID-related’ medical service of all primary care going.

 

When face-to-face consultation was not possible, general practice  quickly transformed its consulting modes into a remote telemedicine service while endeavouring to maintain the continuity of care.

Family doctors are the only medical group who know their patients and their families from cradle to grave and who treat not only the disease in a person but also the person with the disease.

Family doctors’ presence and expertise is essential in all healthcare planning and it would serve to the benefit of all if the inclusion of family doctors in all policymaking and organisational healthcare committees is embraced.

Consideration is due of the needs of family doctors and of how managing this outbreak has impacted their physical and mental well-being. This relates both to their unremitting workload and to the distress they suffer over the illness.

Colleagues we know well across European borders have even died at work assisting patients ill with COVID-19. Locally, some family doctors have had to separate themselves from their wives and children, or their parents, and took up separate residences to keep all their contacts, including patients, safe. From the public health aspect, the family doctor fraternity has fully supported the public health initiatives. Were this not the case, Malta would not have managed to contain the virus as well.

Having learnt lessons, now the speciality of family medicine as well as the government must steer a new norm for the safety and a better service to the patient. Along the years, the Ministry of Health has made some attempts to integrate family medicine in private practice but with little effect as the direction has always been vague and unclear. Now is the time for both parties to enter into a closer public-private partnership.

Now is the time for all chronic care to be passed on to the family doctor in private practice, leaving the employed community family doctors to man the polyclinics and the satellite specialty clinics more efficiently

It has become common practice that patients with complicated conditions are passed on to the family doctor so as to handle the tertiary care of the patient. Now is the time for all chronic care to be passed on to the family doctor in private practice, leaving the employed community family doctors to man the polyclinics and the satellite specialty clinics more efficiently. When all returns to normal and to the previous habits, it would be time to save patients needing chronic care from repeated trips for their healthcare provision: a trip for the prescription, a trip to hand in the prescription, a trip to retrieve the medicines and, sometimes, a trip to the doctor to ensure he has been given the right stuff as “the tablets look different”, and even the door-to-door delivery when needed.

Family doctors in private practice are prepared to adjust their practice to the model adopted in the Netherlands, Spain and Portugal, most of the UK, Norway and Sweden, and become dispensing practices. This implies that a patient with a chronic condition visits his doctor, has a consultation and his condition is reviewed, has his medication adjusted if necessary, is dispensed with his needed medication, makes a review appointment after a specific period, all at one stop. Of course, this process will necessitate the doctor to adjust his practice, premises and set-up. Malta Enterprise offers a good incentive for this which should be called on board for all family doctors in private practice interested in taking up this offer.

The Audit General’s report titled The General Practitioner Function ‒ The Core of Primary Healthcare unequivocally states that 70 per cent of primary care is provided by private family doctors. However, with the nebulous future of the private GP, this will certainly drop or become more difficult. This would necessitate the health service  to be funded much more than now. And again, it would not offer the personalised service that the patient enjoys today.

Let us take the bull by the horns, face the new norm and offer the patient a safer, better and continuous medical service. The profession is ready, telemedicine has been adopted by some and continuity would be guaranteed.

A recent article in the BMJ (British Medical Journal) also categorically states that when a patient relates to only one doctor, the life expectancy is prolonged by 10 years.

And, by the way, may the government take the initiative taken by Spain, Slovenia, Switzerland, Serbia, Sweden, Ireland, Finland (if contracted at work), Portugal, Belgium, France (between March and June) and incorporate COVID-19 illness acquired by healthcare workers as an occupational disease. It would be a recognition of the healthcare workers’ risk exposure.

WHO published that 25 per cent of patients who contracted COVID-19 are healthcare workers.

The European Commission would probably be implementing this measure in November this year, but the government would be making a gesture that goes beyond clapping, singing and hanging flags.

Joseph Portelli Demajo, fellow of the Malta College of Family Doctors

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