The Ministry of Health, together with the sector - associations of general practitioners, medical practitioners in Rīga and the regions - drafted an informative report "On the Strengthening of Primary Health Care", which was presented to the Government on Tuesday, 21 May. Strong and accessible primary health care (PHC) is the cornerstone of the healthcare system, and provides a major relief of pressure on the next levels of care. Work on plans to improve primary health care started in think tanks and continued in a working group set up by the Minister for Health Hosam Abu Meri, with all organisations representing general practitioners, independent health experts, by agreeing on the changes and developments required.
Through joint efforts of the working group, the experts have defined an optimal model of general practitioners’ practice - number of patients, availability of the practice for patients during office hours, electronic communication with the practice; the number of specialists in the general practitioner’s practice, manipulation and extension of cooperation with additional specialists (e.g. physiotherapists, nutritionists, midwives); provision of premises and practice equipment; social security, support and continuing education. The measures concern the facilitation of the takeover process of general practitioners' practices in order to encourage the entry of new general practitioners in the public sector. It is also envisaged to continue the recruitment and retention of doctors in the public sector and to improve family medicine residency training. Improvements are planned in the area of technical support in new and existing practices.
Access to general practitioners and the quality of services provided in urban and rural areas should be equal, including in hard-to-reach rural areas, and there should be sufficient incentives for general practitioners working in rural areas. Experience of other countries demonstrates the need for the support mechanisms in rural areas to ensure access to health care services. The experience of European countries over recent years also shows that a multidisciplinary approach - teamwork - is effective in both hospital care and family medicine, reducing waiting lists, increasing the number of patients served during the day and promoting the diversity and availability of primary health care services closer to home. The involvement of nurses and physician assistants, who can prescribe medicines under certain circumstances, as well as the development of collaborative practices, or general practitioners working with other physicians to ensure that their patients have access to a physiotherapist or psychologist closer to home, for example," says Hosam Abu Meri on the development of family medicine.
Healthcare professionals, including general practitioners, have been paid a premium in countries across the world to address the urban-rural gap in access to healthcare services. Therefore, to improve access to doctors in rural areas, it is planned to increase the premium depending on the population density of the area and the number of registered patients, as currently the premium for a general practitioner's practice 60 km and 200 km from the capital may not differ. It is very important to provide the support or mentoring to new general practitioner practices, especially on issues related to work organisation, and therefore it is planned to introduce and finance a mentoring programme.
The measures to be taken from 2024 onwards will require additional EUR 4.62 million, while from 2025 onwards the additional funding of EUR 15.56 million and EUR 17.8 million annually thereafter. With the involvement of local authorities, the mapping and location of existing general practitioner practices is planned to be improved already this year - in 2024. It is also planned to start the strengthening of general practitioner practices with additional staff, including non-medical staff (e.g. receptionists), that would provide nurses or physician assistants with more time for patient care, monitoring of chronic patients, therapeutic and diagnostic manipulations, and preventive work, including patient education. In 2025, it is also planned to set up a methodological leadership centre for family medicine, to develop common quality guidelines and criteria.
There are currently 1,211 general practitioners under contract with the National Health Service to provide state-funded healthcare services. The measures contained in the Informative Report will contribute to the development of quality primary health care services, access to services and reduce the workload of secondary health care professionals and hospitals. As a result of the measures introduced, patients will have timely and comprehensible communication with their general practitioners and will have their chronic conditions monitored.
The development of primary health care is guided by the Government Action Plan and the Public Health Guidelines 2021-2027. The informative report on primary healthcare follows the report on the development of the hospital network in Latvia considered by the Government on 30 April.