General practice organisation and healthcare reform : what do Maltese general practitioners think?

Abstract

In Malta, two-thirds of primary healthcare is delivered by private general practitioners (GPs), mostly working single-handed without supporting staff. The combined lack of patient registration and transferable medical records lead to fragmentation of care, duplication of resources and suboptimal disease prevention and management. In 2009, the government proposed a reform to encourage partnerships which was shelved. The aim of this article is to explore the opinions of GPs about how practice organisation might influence them and their patients and to seek GPs’ views about possible healthcare reform initiatives. A postal cross-sectional survey of all specialists in family medicine resident in Malta. An instrument was designed, piloted and validated. SPSS® (v. 20) was used for analysis. One hundred and fifty (44%) questionnaires were returned. Respondents were representative of the sample as regards demographic and employment characteristics. Only 26% of GPs are female, but most work in partnerships or the public service. Seventy-seven per cent of private GPs work single-handed. Group practitioners are more likely to utilise electronic medical records and appointments, and to employ secretaries. Doctors acknowledge that although patients prefer one GP, partnerships can deliver better patient care. GPs believe that partnerships are beneficial for themselves, and would consider joining one. Females and young doctors favour partnerships. Respondents, particularly young doctors, favour patient registration and reform. Public doctors who work part-time privately oppose reform. Most GPs favour group practices and health reform, especially females and young doctors (whose proportions are increasing). Primary care should be urgently reformed and patient registration introduced. Public-private agreements would stimulate partnership formation. Public group practices could cater for means-tested citizens.