GHA announces new primary care reforms

Negative test results and further sick leave certificates will be issued over the telephone as part of new reforms at the Primary Care Centre to free up further appointments.

The reforms were announced yesterday by the Minister for Health, Neil Costa, who stressed the changes would result in increased availability of appointments.

Mr Costa highlighted how 750 appointments had been freed following recent reforms, and the six further reforms now introduced would continue this trend.

From now on nurses will telephone patients following routine tests, but only if the result is negative. Currently around 80% of routine test results come back negative.

“They will only call if there is nothing to worry about,” Mr Costa told reporters.

Positive test results will continue to be issued in person by a doctor.

Since the reforms an average of 48 appointments go unused a day, with the minister promising that if appointments become available throughout the day patients will be notified and asked to come in.

In a bid to increase the availability of appointments Mr Costa announced sick leave certificates issued by the telephone will change from a maximum of two days to five consecutive days.

Mr Costa said health care staff found that two days did not give people with more severe ailments enough time to recuperate.

He clarified that the number of days granted on sick leave would be under the discretion of the medical staff and this does not mean people are entitled to five days off if they call the service.

The telephone sick line can be used once every three months. This means a person using the telephone service could be granted a maximum of 20 days certified sick leave annually.

On average 270 sick certificates are issued every month via the telephone service.

“Given that there are on average 27,000 employees only 1% of employees a month are calling this service,” Mr Costa said.

Evening clinics will also be introduced with an estimated 15 to 20 more appointment slots available.

The clinic will run every weekday between 6pm and 8pm and will be manned by two part-time clerks and two doctors. The vacancies are currently open, with the clinic expected to open at a later date.

Further full time GP posts are soon to be advertised to develop a ‘see and treat’ style Minor Illness Service, which aims to create a more flexible service that will bridge the gap between the PCC and Accident and Emergency.

“The Primary Care Centre continues to evolve to better serve our patients and our community as a whole,” said Deputy Medical Director Dr Krishna Rawal.

“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.”

Mr Costa stressed that the improvements to the PCC aim to reduce the workload at the Accident and Emergency Department at St Bernard’s Hospital.

Some 31,000 people attended A&E last year, the equivalent of the local population attending once over, and Mr Costa hopes that recent improvements will drive patients with non-emergency needs to the PCC.

“Almost the entirety of Gibraltar attended A&E at least once during the course of a calendar year, so we have with that in mind been working on reforms to see that we can relieve the pressure off A&E which truly ought to be used only for accidents and emergencies,” Mr Costa said.

“I don’t think we have done enough in advising and educating the community as to when A&E attendances ought to happen. Our view was that we needed to improve appointment availability, access to GPs and the hours in which patients can attend the Primary Care Centre.”

The fee for house calls will see an increase from £10 to £15 with immediate effect, for the first time since 1998.
The current charge of £5 for pensioners aged over 65 will remain unchanged.

Patients who are exempt for social reasons will remain exempt from payment, including pensioners whose only income is the old age pension.

“It is clear to me that we need to constantly review primary care services to meet the particular needs of our community,” Mr Costa said.

“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 practise. 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.”