Although the population is living longer, more people are living with co-morbidities, non-communicable diseases and needing complex care interventions. Building a sustainable health and social care service for future generations, therefore, implies bringing care back to the community and reorient policies towards primary care as it covers the complete life-cycle and includes long-term care services. In effect, primary care is an effective tool to reduce inequities in societies (De Maeseneer et al., 2007).
However, if the EU Member States are to succeed in developing primary care, we need a whole system and mindset change at the policy, practice and education levels. There is an increasing evidence that interventions led by nurses can contribute to an improvement of patient outcomes, particularly linked to the early discharge schemes and to self-management, allowing patients to stay longer at home. To allow nurses to further strengthen their role and to deliver safe and high-quality cost-effective patient care in the future, a change of both mindset and health systems is required.
Unfortunately, an old-fashioned way of thinking, the medical approach to primary care, is disastrous for any future development. As such, it is key to address the organisation of primary care and the human resources needed to support frontline, taking into account the central role played by the health professional workforce in influencing primary care outcomes. The public hearing showed again stakeholders think for their own box: the IT community pushes for what we are discussing already in the last 15 years, the Pharma pushes for access to medicine, … everybody wants to have an impact on the recommendations. Even Hopkins and US IT push for their views to be incorporated in EU policies. Will this hearing lead to better EU policies?
To turn primary care into a policy window opportunity, the EFN calls on the EU institutions to:
- Ensure the frontline primary workforce receive more support to empower the health and social sector as an investment for well-being, productivity and growth – This needs to be the focus: get citizens, there where people live and work, on your side! Show what is in for them! ;
- Engage frontline nursing in designing primary care policies “fit for practice”, and use at full potential nursing research and knowledge to better coordinate health and social care services;
- Focus on more robust health and social care outcomes measurement, including nursing-sensitive organisational and observational data to improve the quality and safety of care within a person-centred approach;
- Remind policy-makers and industry that nurses are to a large extent responsible for the frontline collection of healthcare data which risks pulling nurses away from the bedside, compromising quality and safety of care and outcomes. Those people advocating for Big Data are often not connected with frontline;
- Promote the design and implementation of eHealth services in nursing and social care (ENS4care guidelines) to make continuity of care and integrated care a reality, facilitating an optimal coordination and integration within and across the primary and secondary care interface, and health and social care by using ICT solutions that are ‘fit for practice’.
- Make sure Primary Care policies are gender sensitive. As the largest part of the workforce in health and social care are women, women needs to lead the design of Primary care!
Furthermore, the EFN calls on the national/regional/local bodies to:
- Foster a transformational change in the health and social care system by developing advanced roles for nurses in coordinating and integrating services – somebody needs to do the work;
- Support the implementation of re-organisational pathways that have proven to be effective in increasing the accessibility to health and social care services;
- Invest in the education of general care nurses ensuring they are competent to independently deliver high quality and safe care (major progress has been made with the introduction of art 31 of Directive 2013/55/EU);
- Strengthen inter-professional working, which is of utmost importance for a successful, safe and quality healthcare system and which will ensure continuity of care;
- Move away from the traditional medical and disease-specific model towards a people-centred integrated model, driven by frontline. This will be the major challenge as most stakeholders (industry, …) think in a disease pattern. This will stop Primary Care to deploy.
The pro-active engagement of professionals operating in the health and social care sector is crucial in designing tools to measure performance, outcomes! Therefore, there is an urgent need to bring together a professional stakeholders group of experts, representing frontline, to design ‘fit for purpose’ EU Policies.
>> To view the videos of the hearing – Tools and methodologies for assessing the performance of primary care (03 October 2017), click here.