The Latest Duties of a Primary Care Physician. 7 Chapters
- The standards for Primary Health Care (PHC) were announced by the Ministry of Health on December 31, 2024
- The full list of requirements can be found in the annex to the announcement published in the Official Journal of the Minister of Health (item 145)
- The guidelines are divided into 7 key areas, such as: patient care, respect for patient rights, work organization, quality improvement, personnel management, documentation and safety.
- The aim of the new rules is to improve the quality of medical services and increase patient safety in primary care clinics.
On December 31, 2024 , a notice regarding accreditation standards in the field of primary health care was published in the Official Journal of the Ministry of Health.
- Pursuant to art. 22 section 5 of the Act of 16 June 2023 on quality in health care and patient safety (Journal of Laws item 1692), accreditation standards in the field of primary health care are announced, constituting an annex to the announcement - we read.
Accreditation standards are divided into individual parts:
I. Patient care (PC)
As we read in the description, providing appropriate care is a process that requires the organization and management of various aspects of healthcare. In order to provide appropriate care, it is necessary to establish the scope of competences of individual people, to agree on the actions taken and to ensure an efficient flow of information:
- Regardless of the form of employment of the unit's staff, they should cooperate closely with each other.
- primary healthcare patient care should also include preventive measures aimed at improving health effectiveness;
- analysis of various health indicators is a good method of monitoring the clinical results obtained;
- patient care in primary care should be accessible and well organized;
- the patient should be able to easily make an appointment at the selected location of a given unit, as well as the opportunity to obtain advice from a doctor, nurse, or midwife in various forms, in particular as part of a teleconsultation or home visit.
The use of both the telephone and modern communicators, which allow for sending a photo or an audiovisual connection, makes it easier to use a doctor's advice, especially when the doctor knows the patient and their medical history well, and also when the patient lives far from the office or has difficulty moving and reaching the office. The entity performing medical activity should develop a comprehensive approach to the care provided, ensuring the expected availability and a coordinated approach to patient care, including both health promotion and effective treatment.
II. Comprehensive care (CCA)
It was stated that the comprehensiveness and versatility of care is a fundamental feature that distinguishes the competences of a primary care physician from the competences of specialists. It consists in providing comprehensive health care to the patient regardless of their age, gender and health problem. The primary care team undertakes preventive and therapeutic actions in specific disease entities.
It was recalled that a primary care physician has basic competences in many medical specialties, not only internal medicine and pediatrics, but also surgical ones, such as laryngology, ophthalmology or gynecology, but limited to the most common, moderately complicated clinical conditions. In the event of more complex health problems, a primary care physician should be responsible for coordinating various levels of medical care, such as: outpatient specialist care (AOS) or hospital treatment, adapting the treatment plan to the individual needs of the patient. A key element of comprehensive care is ensuring appropriate access to health care services.
In the case of treatment of a patient by various entities of the healthcare system, it is particularly important to ensure continuity of care. Quality deficits and adverse events most often occur during the patient's transfer phase. Well-functioning healthcare should enable efficient transfer of not only the patient, but also information about the patient that is important for further treatment. This applies to both information transferred by the entity providing primary healthcare services to other providers, as well as obtaining feedback. Proper organization of therapeutic activities will streamline the treatment process. It allows to avoid repetitions, errors and provides the patient with effective and comprehensive medical care. It is important to ensure a smooth flow of information between all entities involved in the patient's treatment. It will prevent the patient from being left without care and ensure their safety and effectiveness of therapy - we read.
III. Patient Rights and Obligations (PP)
As mentioned, in the family medicine model, the primary care physician's direct, personal care of the patient and their family, based on mutual trust, is considered to be of paramount importance. An empathetic, partnership-based relationship between the primary care physician and the patient and a personalized approach to the patient's problems help build trust, which increases the chance of the patient's conscious participation in taking care of their health and engaging in the treatment process.
A patient using healthcare services expects not only high medical competence of the staff, but also to be treated with respect and kindness. Relationships of mutual understanding between the patient and the staff facilitate taking into account the individual needs of the patient, their conscious participation in the treatment process and greater adherence (adherence to the doctor's recommendations), which increases the chances of successful treatment. The basic method of checking how patients assess the quality of healthcare in the unit is to collect feedback from patients in the form of a survey.
The unit implements mechanisms for enforcing patient obligations, in particular:
- an order to behave in a cultured manner that does not disturb other patients;
- the obligation to maintain personal hygiene and order;
- respect for staff and other healthcare workers (especially those providing patient care);
- no tolerance for aggression towards staff (information on the protection due to a public official).
As we read, the manager and staff should respect the patient's rights and tactfully require the patient to fulfill their obligations. Training on this subject should take place periodically, no less than once a year, and should be conducted by people with training and up-to-date knowledge based on the announcements and positions of the Patient Rights Advocate. However, respecting the patient's rights alone does not guarantee a high assessment of care from patients: an inherent component of care should be the empathy of the staff towards patients, kindness and sensitivity to individual psychological needs.
It was also mentioned that in the case of minors, incapacitated patients or patients incapable of giving informed consent, accreditation standards also apply to the patient's legal representatives, under the terms specified in generally applicable law.
The patient participates in the process of choosing a medical procedure: he or she receives information about alternative methods of treatment and participates in the process of choosing a treatment method.
IV. Quality Improvement (QI)
Quality improvement comes down to improving the essential processes of providing services and providing care or improving the important - from the patient's perspective - effects resulting from the implemented processes. Effects are usually classified into medical effects - recovery, improvement of health, reduction of symptoms, prevention of unwanted medical events and into non-medical effects important for the patient such as:
- sense of security,
- satisfaction,
- satisfaction,
- trust.
The unit, in order to function properly, implements and should implement a whole range of auxiliary processes that do not have a significant impact on the effects on patients. The most effective method of improving essential processes is systematically planned and implemented programs of continuous, cyclical quality improvement. This requires specific knowledge, going beyond medical knowledge and the widest possible involvement of the unit's staff in these programs - it was added.
V. Safety of care (SOC)
In this case, it was emphasized that "efforts to ensure the safety of the patient in contacts with an individual, doctor or nurse are the primary duty of every medical organization. The maxim attributed to Hippocrates, the father of medicine, known in Latin as primum non nocere, means that the first duty of medical professionals is to do no harm, including ensuring the safety of the patient."
VI. Medical Information (IM)
The basic carrier of medical information is medical documentation, the purpose of which is to provide medical personnel with important information about the course of diagnosis and treatment of the patient, which increases the chances of proper treatment and avoiding adverse events.
On the other hand, electronic medical documentation allows for the analysis of data contained therein, generation of statistical summaries, searching for specific information supporting the decision-making process, such as, in particular, automatic analysis of possible drug interactions. At the same time, it was indicated that entries in medical documentation are also a form of confirmation of work performed and the basis for settlements with the public payer. Medical documentation can also constitute evidence in the case of conducted proceedings. It is important that it is kept carefully and transparently.
VII. Quality of management (JK)
Of great importance for the optimal provision of services in primary healthcare is the preparation of the unit’s staff to work and cooperate as a team, and the local conditions should ensure the safety and comfort of the team working with patients.
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