Standardising the Clinics of General Practitioners

Punjab Healthcare Commission (PHC) has rolled out the Minimum Service Delivery Standards (MSDS) for the Clinics of Family Physicians / General Practitioners (GPs) with a view to passing on the baton of quality to yet another tier of medical professionals, usually considered the point of the first contact for patients. Held in the private sector, the GP clinics are one of three categories of healthcare facilities run under the broad framework of the Outpatient Department (OPD). The other two being the healthcare establishments providing Single Specialty consultations, and the Multi-Specialty Clinics sometimes referred to polyclinics. The GPs, unlike the specialists/ consultants practicing at the single specialty or the multi-specialty clinics, generally hold only the basic qualification of MBBS/ MD, as recognized by the Pakistan Medical & Dental Council (PM&DC), with varied clinical experience /skills to diagnose ailments and prescribe treatment if the disease does not require specialised care or hospitalisation. In the case of patients having advanced or complicated disease, the GPs refer the patients to the concerned specialists or the adequate higher level of health facility and thus act as referral points for the secondary and tertiary level healthcare facilities for specialised care.

On the face of it, this looks like a simple interaction between two individuals, the patient and the doctor. At a deeper level, however, it is the beginning of a relationship built on trust and confidence. Because of the nature of the GP-patient relationship and the relative isolation in which the GPs function, quality care and ethics become rarely discussed issues. This makes developing the culture of clinical governance all the more important. The basic framework of the MSDS for GPs, comprising 18 standards and 47 indicators, cover all the administrative and clinical areas with a focus on quality and safe healthcare service to ensure patient safety.

Before moving further, it is important to distinguish between the roles of the Pakistan Medical and Dental Council and the Punjab Healthcare Commission. The former has the mandate to register the medical degrees of the doctors and issue a certificate of registration to enable them to practice, while the Punjab Healthcare Commission is mandated to regulate the Healthcare Establishments, which includes the infrastructure, the support functions as well as the actual delivery of healthcare services.

The ultimate objective of the Commission, as enshrined in the PHC Act, is the licensing of HCEs to improve the quality of healthcare. To become eligible for a license an HCE is required to implement quality indicators delineated in the concerned MSDS with an objective to streamline the delivery of healthcare services.

The Punjab Healthcare Commission was established as an independent health regulatory body under the PHC Act 2010, for the improvement of healthcare service delivery in Punjab through introducing a culture of clinical governance and ensuring the provision of standardised healthcare services at all healthcare establishments, both public and private, to ensure patient safety.

In the first phase, in 2012, the PHC developed and enforced MSDS for category-1 HCEs, the hospitals having more than 50 beds, followed by MSDS for Category-II HCEs, the hospitals having up to 50 beds. In the second phase, in the year 2014, the Commission started working on the development of MSDS for Category-III HCEs offering outpatient and consultation services only. It includes Basic Health Units (BHUs) in the public sector, and dental clinics, clinical laboratories, radiological diagnostic centres, clinics of GPs/family physicians, as well as those of homoeopaths and hakeems providing services under the Unani Ayurvedic and Homeopathic Practitioner Act 1965.

Keeping to its consensus-based approach, the MSDS for GPs were developed in consultation with relevant stakeholders, including the Health Department, the associations and representatives of the Family Physicians/GPs, the entire technical team of the PHC, public health experts and management experts, pharmacists, quality assurance experts and specialists. After incorporating their inputs, the draft was once again shared with the key stakeholders in a broad-based consultative workshop, attended by 38 experts from the Health Department, representatives of the Pakistan Academy of Family Physicians, nominees of Pakistan Medical Association and independently working GPs/Family Physicians and Specialists from all across Punjab. From here began the third tier of the scrutiny process and the draft was presented to the sub-committee of the Technical Advisory Committee on Standardisation and Accreditation which after review, cleared the draft for approval by the Board of Commissioners. Finally, the MSDS was sent to the government for support and notification.

Implementation of the MSDS is a multi-tier process. At the first stage, hard and soft copies of the MSDS are disseminated through capacity building training workshops to be attended by GPs/ family physicians in person. Later, the inspection team from the PHC visits the Clinic for assessment of the compliance of the MSDS at the HCEs during which the family physicians are also provided hands-on guidance to facilitate rectifying the gaps in the implementation of the MSDS. The HCEs showing the required level of compliance with the MSDS become eligible for the license. As of March 14, 2019, 104 GP clinics have qualified for the permit.

It is pertinent to note that the process of registration for the GP Clinics had begun much earlier, and so far 6,539 have been registered, and as many as 4,216 Clinics have applied for the licenses. So far 1,408 family physicians have been trained in 53 training sessions. Punjab Healthcare Commission is striving hard to introduce the culture of clinical governance in HCEs all across Punjab. This effort shall not only improve quality of care in the healthcare establishments but would also assist the Commission in eradicating quackery.

ePaper - Nawaiwaqt