Skip to main content

Primary Care in Europe: Entering the Age of Austerity


Many European countries have well-developed health systems that offer universal access to health services and which have a strong primary care sector. Primary care physicians are the point of first contact with the health care system in such countries, providing open access to all patients, and dealing with most of the problems patients present with. Strong primary care sectors have allowed health systems in Europe to make efficient use of health care resources, for example, through the gatekeeping role of primary care physicians. However, as the financial crisis in Europe continues to progress, it is now starting to affect health and social services. In Ireland, for example, this has led to a reduction in the number of hospital beds and in recruitment to unfilled posts in the health service. In Italy, additional user charges have been imposed on patients. The potential impact of this new era of financial austerity were discussed in an article I published in the Journal of Ambulatory Care Management.

Countries such as Spain and Greece may see even more radical changes in their health systems.
In many European countries, physicians have come to expect annual real-term increases in spending on health. This era of steadily increased health spending has now ended for many countries and will not return for many years. Primary care physicians in Europe will have to learn to work in an environment where health care funding and resources will be much more limited than in the past. One way in which these resource constraints have already begun to impact on primary care physicians is through the effect that cuts in specialist service are having on their own workload. Primary care physicians in countries such as the UK are increasingly finding that they will have to find ways of dealing with work that was formerly undertaken provided by hospital physicians.

Another consequence of the new financial environment is the introduction of elements of a competitive market into health systems in the belief that markets in health care can improve quality of health services without increasing the costs of health care provision. This has been controversial with substantial criticism from both health professionals and patients; and has led to concerns about a potential trade-off between equity and choice in countries that have progressed down this route. Other concerns about the introduction of competition between health care providers include a belief that such changes could fragment health services and risk marginalising patients with complex health needs and high health care costs.

Primary care physicians are now working in a much more hostile financial environment and one in which new providers of care may compete for some of their roles and activities. The longer term effects of such changes, such as the impact they will have on primary care as a career choice for young physicians, remain to be seen.

Comments

Popular posts from this blog

Improving discharge planning in NHS hospitals

Factors that need to be considered in discharge planning that have been identified in previous projects include:

Ensuring that discharge arrangements are discussed with patients, family members and carers; and that they are given a copy of the discharge summary.Adequate coordination between the hospital, community health services, general practices, and the providers of social care services.There is a follow-up after discharge of patients at high risk of complications or readmission - either in person or by telephone - to ensure that the discharge arrangements are working well. Medicines reconciliation is carried out. This is the process of verifying patient medication lists at a point-of-care transition, such as hospital discharge, to identify which medications have been added, discontinued, or changed from pre-admission medication lists.Ensuring that any outstanding test results at discharge are obtained and passed on to primary care teams; and ensuring there are clear arrangements …

What will Brexit mean for the NHS?

On the 29 March 2017, the Prime Minister of the UK Theresa May, formally notified the European Union (EU) Council President, Donald Tusk, of the UK’s intention to leave the EU. Theresa May’s letter to Donald Tusk triggers a two-year process during which the UK will have to negotiate both the terms of its exit from EU and the arrangements that will replace those we have had for over 40 years with the other member states of the EU. The consequences of the United Kingdom’s departure from the EU (commonly referred to as ‘Brexit’) will be wide-ranging and will affect all areas of UK’s society, including the National Health Service (NHS).

For the NHS, Brexit comes at a time when it faces many other major challenges. These include severe financial pressures, rising workload, increased waiting times for both primary care and specialist services, and shortages of health professionals in many key areas (such as in general practice and in emergency departments). The NHS also faces challenges fr…

Can GPs issue private prescriptions to NHS patients?

The NHS prescription charge in England is currently £8.60 per item. At this level, many commonly prescribed drugs will cost less than the prescription charge and so some NHS patients may occasionally ask if they can have a private prescription rather than an NHS prescription.

In the past, some GPs have been advised that they could issue both an NHS FP10 and a private prescription, and let the patient decide which to use. But the British Medical Association's General Practice Committee has obtained legal advice that said under the current primary care contract, GPs in England may not issue a private prescription alongside or as an alternative to an NHS FP10 prescription. In any consultation where a GP needs to issue an FP10, the concurrent issue of a private prescription would be a breach of NHS regulations.

The issuing of a private prescription in such circumstances could also be seen as an attempt to deprive the NHS of the funds it would receive from the prescription charge. Fur…