Ministry of Health of Ukraine approved Procedure for the provision of primary care services
The Ministry of Health of Ukraine has approved Procedure for provision of primary care services – the document that regulates the work of primary care doctors (general practitioners, pediatricians and family doctors), presents a well-defined package of primary care services, and forms a new culture of doctor-patient relationship. Starting July 1, 2018, all primary care facilities should provide services in full compliance with this document.
Services that will be provided by primary care doctors
Order of the Ministry of Health of Ukraine No. 504 dated March 19, 2018 "On Approval of the Procedure for Provision of Primary Care Services" (hereinafter referred to as the Procedure) defines a clear set of primary care services (the guaranteed benefit package) that will be covered by the state and paid by the National Health Service of Ukraine (NHSU).
General practitioners, pediatricians and family doctors will be responsible for monitoring patients’ health and advising on healthy lifestyle, identifying health risks in a timely manner and preventing diseases (including vaccination), diagnosing and treating common diseases, injuries, poisoning, pathological, and physiological conditions. Primary care doctors will also continuously treat patients with chronic diseases and conditions.
If necessary, primary care doctors will refer patients to specialists of secondary or tertiary care (i.e. for specialized or highly specialized medical care) and issue health certificates or notes.
Primary care physicians can also provide emergency care for an acute physical or mental disorder if a patient does not need an emergency, specialized or highly specialized care.
The competence of primary care physician includes certain palliative care services, uncomplicated pregnancy and pediatric care.
Recommended number of patients one doctor can manage
Pursuant to the Procedure, the recommended number of patients for a family doctor equals 1 800 people, for a general practitioner – 2 000 people, and for a pediatrician – 900 children.
The number of patients one primary care doctor manages may differ on a case-to-case basis depending on the socio-demographic, infrastructure and other peculiarities of the settlement or territory. For example, when a family doctor works in a village with the population of 2 000 inhabitants, then this doctor should treat all these people. No one will be deprived of medical care.
Yes, primary care doctors will do home visits, but it is now at the doctor's discretion (not patient’s or registrar’s anymore) whether a home visit is deemed necessary.
Primary care doctor will visit a patient at home when this patient is confined due to illness or disability, or urgent treatment can be given more quickly by visiting. Doctors will always encourage patients to come to the primary care facility when a home visit is not medically necessary, because this is where the best care can be provided. Moreover, in the time it takes to see one person at home, a doctor can see 2-4 patients at the hospital.
Patients can call and ask for the doctor's home visit or make an appointment, leaving personal contact information. The doctor will then call the patient back and discuss his/her health concerns and symptoms, and based on this conversation decide whether a home visit is necessary and, if so, agree on specific time.
What to do when the chosen doctor is currently unavailable
When the chosen primary care physician is not available (for example, is currently on vacation or sick leave), patients should contact a back-up physician. Patients should be notified about t any changes in advance: one week in advance when doctor’s absence is planned (for example, a vacation or business trip) and on the first day in other cases (for example, when the doctor gets sick). It is the responsibility of administration of the hospital to inform patients about any changes in a timely manner, to provide information about a back-up doctor, and to ensure access to medical care.
If a patient needs help and is currently in a different city, s/he shall contact the nearest primary care provider.
Patient-oriented service requirements for primary care providers
Primary care providers should notify patients about any changes in the address or working hours. If a patient has already scheduled an appointment, primary care provider should inform this patient personally about any changes (for example, make a call). It is equally important to inform patients when primary care facility ceases to function or is closed for some reason.
How to make an appointment and primary care provision on weekends/holidays
Patients can now schedule an appointment with a doctor personally at the reception, by telephone, by e-mail or any other means available. Patients should be informed about any changes of the phone number, e-mail address etc.
Most primary care facilities will not work full time on weekends and holidays. But the Procedure stipulates that all primary care providers may independently or jointly create special on-call rooms for providing primary care to patients outside of the regular working hours.
Technical Equipment List
In order to provide high-quality services, all primary care facilities must comply with the Technical Equipment List. The updated Exemplary list of material and technical equipment for both public and private primary care providers (Order of the Ministry of Health of Ukraine No. 148 dated January 26, 2018 "On Approval of the Exemplary List of Material and Technical Equipment for Public and Private Primary Care Providers") is now much shorter than before, and meets actual needs of the primary care sector. The necessary technical equipment will allow fulfilling the Procedure for provision of primary care services.