Public Health Ministry St. Maarten concerned about doctors availability at night


~ Gives recommendations to improve services ~

PHILIPSBURG--Create a General Practitioner's (GP) post in St. Maarten Medical Centre that will be managed and operated by GPs, and cancel the arrangement between GPs and St. Maarten Medical Center (SMMC) to see patients in the emergency department at night and on weekends, was one of several recommendations presented to Public Health VSA Minister Cornelius de Weever by Health Inspector Earl Best.

The Health Inspectorate is "very surprised" by the agreement between GPs and SMMC concerning GP care during the night and weekends in the emergency room, Dr. Best said.

This means that almost none of the general practitioners are available at night or on weekends, and that the emergency room does "figurative work" and most of the time has a long waiting line. "This affects the quality of care provided negatively."

Most GPs can be consulted by telephone during office hours; however, home visits to less ambulant patients and emergency visits are not provided by many GPs, said Best, adding this is an explanation for the fact that many GPs do not possess "a doctor's bag anymore."

The recommendation, which has to be addressed by the VSA Minister, physician organisations, SMMC and health insurers, stems from a quality and service survey carried out by the ministry.

The 20 doctors who operate as GPs had to fill out a questionnaire dealing with the subject of the survey. All of the clinics, except one GP who refused to cooperate, were visited by the inspectorate, explained Best in his presentation in A.C. Wathey Legislative Hall on Wednesday morning.

The inspectorate also recommended the development of a registration system for general practitioners and establishment of requirements for necessary training and GP skills; as well, a sound professional communication between GPs, pharmacists and medical specialists and improvement in the quality of the patient files.

Improved quality of care by developing evidence-based diagnostic and treatment protocols/guidelines for common medical conditions and the urgent introduction of an electronic health record (EHR) were outlined as very necessary.

GPs will have to ensure the practice (clinic) is easily accessible for the disabled and proper technical maintenance of equipment, Bess pointed out from the findings.

The most important part of the survey, according to the inspector, was to examine whether the GPs complied with the conditions for qualitatively responsible care, given the fact that no substantive guidelines on the medical content exist on St. Maarten.

GPs have two organisations, Windward Islands Medical Association (WIMA) and St. Maarten Medical Association (SMA) that provide peer-to-peer contacts and to organise common and continuous training.

"Yet it is striking that in St. Maarten professional communication about the individual patient and the organisation of care is a major problem; and not just between the GPs and the medical specialists but also between GPs and pharmacists," Best said. "Of course both parties have responsibilities in improving this issue. Except for inter-professional contacts within WIMA and SMA, the peer-to-peer contacts within the GP group needs improvement."

The quality of patients' files is "often very poor." This differs considerably from the GPs using an electronic patient record (EPR) and those who do not.

"St. Maarten has no accreditation for GPs. Vocational training is not mandatory. During the interviews it was often unclear how GPs maintained their skills," Best said.

Minister De Weever said the report establishes a baseline for the ministry to work with and build on to improve the health services to the community.