The abolition of GPs will take us back 33 years to the time of communism. This was announced in their position by the IMRO on the occasion of the discussion about the idea of the Ministry of Health to remove the figure of the general practitioner from the Bulgarian health system. According to them, this is an ill-considered step that will actually deprive the already chronically ill population in our country of pre-hospital care.
„The proposal of “We continue the change” in this form aims to return polyclinics as an alternative and component of pre-hospital care, which is very puzzling. With most of their ideas, the new rulers have repeatedly shown their curtsey and bias towards the days before November 10, 1989. Inexplicable nostalgia for a period that is high time to realize that it is long gone and has no place in the modern European state. Such populist measures are inadequate and devoid of logical thought, or even just from the PR point of view, aimed at „caressing“ the nostalgic note to the past communist reality, when „everyone had everything“, but in reality no one had anything.”, „said the IMRO and added that on the occasion of the proposal they want to ask several questions, namely:
1. To what extent has this unjustified change with clear motives been discussed with the medical community and in particular with general practitioners, who represent the largest class of doctors in Bulgaria?
Undoubtedly, the idea envisaged will fundamentally affect the structure of primary medical care, ensuring timely and adequate access of citizens to quality medical care.
It is no coincidence that in the strategies for healthcare development GPs are identified with the term „gatekeepers„, being guardians of the stability of the health system and a kind of filter for screening patients based on their diseases, the need for specialized medical care and the specifics of each case.
This change is directly related to the complete reorganization and change of pre-hospital care, which in turn is a time-consuming process, without a clear horizon for implementation and without a clear idea of its real effectiveness.
At present, the pre-hospital care in Bulgaria adequately provides the necessary health needs of the population, as patient has access and the right to choose about the attending physician, diagnosis and treatment.
2. Which modern health system does not have specialists in general medicine?
It is no coincidence that in the strategies for healthcare development GPs are identified with the term „gatekeepers„, being guardians of the stability of the health system and a kind of filter for screening patients based on their diseases, the need for specialized medical care and the specifics of each case.
The role of the general practitioner is fundamental in family and child health and should not be underestimated in any way. The patient’s trust in the doctor is built over the years and costs a lot of work associated with a high level of professionalism and empathy on the part of GPs.
3. Would such an attempt to circumvent GPs lead to an explosion of costs without improving health?
The idea of change in healthcare circulated in the media is unsubstantiated, unfounded and lacks clear motives, as well as economic justification of its benefits with the relevant financial analyzes. This idea puts at risk the entire pre-hospital healthcare system with the risk of underfunding of the sector and the overall collapse of our healthcare system. Governments should be aware that pre-hospital care is a cornerstone and a pillar of the entire health care system, being the basis of the health and social iceberg.
Patients are not obliged and have the necessary depth of knowledge about what is best for them as diagnosis and treatment and rely on the doctor as a person to whom they can trust their health and the treatment of their disease. This is a fundamental axiom for quality and adequate treatment and achieving the best therapeutic results. The relationship between the doctor and the patient is key in the process of building trust and achieving the desired results, and a visit to a specialist at the patient’s discretion may pose risks to his health and life. And this is the symbiosis in the relationship between the GP and the patient.
4. Is this idea for change in line with current WHO health strategies on health development and improvement?
A little-known fact about the rulers of “We Continue the change” party, which emphasizes their ignorance of the subject in depth, is that a conference organized by the World Health Organization and UNICEF in 1978 in Alma-Ata explicitly prepared and is still in force. a statement that explicitly emphasizes the importance of primary health care as a strategy to achieve better health care for the population. Thanks to this act, today in developed countries over 90% of medical activities can be undertaken by GPs.
All these questions and doubts do not have a clear answer at the moment, and the idea of changing the system of pre-hospital care is unsubstantiated and unfounded in terms of legality, appropriateness and expected health and economic results.
In our society there is a feeling that the government shows a clear ignorance of the matter, as well as the role of the general practitioner in a modern health system, namely to be a link between the health system and the patient by building strong trust and empathy for the individual patient, his family and the middle.
GPs treat the person, not just his or her illness, no matter how detailed it is in his or her health record. The electronic health record system is currently a platform that has no clear horizon, no clearly defined real benefits and efficiencies.
The intentions announced by the ruling „We continue the change“ party are causing confusion and outrage among GPs and their patients.
Undoubtedly, there are problems in primary medical care, the IMRO pointed out. According to them, however, the proposed solutions contradict the basic principles of the specialty „General Medicine“, which are defined by European and global organizations of family doctors. Over 20 years of efforts to promote primary care physicians would be lightly erased in another ill-considered reform.
