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According to the physicians of the Healthcare Employers’ Association (PPOZ), the ordinance issued last week concerning the implementation of coordinated care in POZ is a threat both to the primary health care system and to patients who will have to reckon with limited access to services. The problem is exacerbated by a limited number of POZ facilities, as well as staff limits, which impose additional obligations on current employees. Doctors also draw attention to issues that were omitted in the regulation of the President of the NFZ, e.g. those concerning capitation rate indexation by inflation or rules of functioning of teleconsultations.
According to the new regulation by the President of the NFZ, Filip Nowak, from 1 October 2021, primary care clinics (POZ) should appoint a coordinator to support patients in the treatment process. The task of the coordinator is to improve communication between the doctor and the patient, as well as to inform about the next stages of treatment, which is particularly important for patients with chronic diseases. According to the legislation, a coordinator may be a doctor, nurse or registrar who already works in the clinic, so the facilities do not have to employ additional staff for the new position.
The decision to introduce changes in POZ was made after analysing the results of the pilot project POZ PLUS, which involved over 350,000 patients from all over Poland. The process of implementing the changes has been divided into several stages, the first of which focuses on preventive measures. Then the programme is to be extended to care for patients with chronic diseases, and from January 2022 it will also include patients struggling with hypertension, diabetes, heart or thyroid diseases. Comprehensive visits for patients with chronic diseases are also expected to appear at a later stage, and there are plans to expand the available diagnostic tests that can be ordered by the GP.
Lack of consultation and report on the POZ PLUS programme
As emphasised by doctors from Healthcare Employers’ Association (Porozumienie Pracodawców Ochrony Zdrowia, PPOZ), the ordinance of the President of the NFZ was not consulted with representatives of the GP environment, nor was it reviewed by them. According to Bożena Janicka, the President of PPOZ, the regulation should be rejected in its entirety. Such an opinion of physicians is mainly influenced by the knowledge of health service realities. In 132 districts in Poland, there are no POZ facilities and patients have no access to the services of a GP. Moreover, the imposition of the coordinator’s function on the already employed staff of the clinics will limit access to services for patients of the facilities.
The President of PPOZ draws attention to the lack of a final report and summary of the POZ PLUS programme, which should be subject to an in-depth analysis by practitioners. As he adds, although coordinated care should be an important element of health care in Poland, the current lack of staff makes it impossible to implement this project.
The ordinance needs to be clarified
Problems also arise with other topics addressed in the ordinance, such as prescription advice, which requires clarification, changes in the scope of NFZ control and lack of additional funds for preventive healthcare. Important omitted issues are also teleconsultations, as well as valorisation of the capitation rate by inflation. The doctors addressed the President of the NFZ on this issue, and they also sent their message to the Prime Minister, the Parliamentary Committee on Health, the Minister of Health and the Patients’ Rights Ombudsman. In addition, they proposed that coordinated care be introduced on an optional basis so that facilities and patients would have the opportunity to choose.