1. ICS: CATALONIAN HEALTH INSTITUTE

2. INTRODUCTION Spanish Health System: National Health System Spanish Health System: National Health System Reformed in 1984 to become the current Primary Health System Reformed in 1984 to become the current Primary Health System Federal type government where each region manages its own budget. Catalonia since 1981 Federal type government where each region manages its own budget. Catalonia since 1981

3. CATALONIAN HEALTH CARE CATSALUT: acts like a public insurance company. It is directly dependent on the Catalan Government. CATSALUT: acts like a public insurance company. It is directly dependent on the Catalan Government. Integrates all resources (public or private) into the Public Health Offer. Integrates all resources (public or private) into the Public Health Offer.

4. Primary Health Care in Catalonia CatSalut PHC services’ suppliers EBAs Town HallICS Contrac.

5. ICS: CATALONIAN HEALTH INSTITUTE It’s the “biggest” primary health care supplier (with approximately 85% of the services)

6. ICS: ORGANIZATION Management PHC division 7 PHC Subdivision 4 PHC Services 10 PHC Centres Barcelona City Dreta Congrés

8. 1. Who are we?

9. SAP DRETA PRIMARY CARE SERVICES 10 PHC Centres Support Units: Radiology Laboratory Special units: Mental Health Paliative Home Care Phisiotherapy

10. CONGRÉS 9C

11. CONGRÉS PRIMARY CARE CENTRE Created in 1997 Created in 1997 Population: 32.648 inhabitants Population: 32.648 inhabitants 27% older than 65 27% older than 65 > 15 years old > 15 years old The PHC with the oldest population in Barcelona The PHC with the oldest population in Barcelona

12. CONGRÉS: STAFF Director1 Director1 Head of nursing 1 Head of nursing 1 Medical staff20 Medical staff20 Pediatricians2 Pediatricians2 Nursing staff17 Nursing staff17 Social worker 1 Social worker 1 Dentist1 Dentist1 Head of admin. 1 Head of admin. 1 Admin. staff17 Admin. staff17 Women´s health 3 gynae, 3midw. Women´s health 3 gynae, 3midw. Mental Health 2 psych. Mental Health 2 psych.

13. PERSONNEL FEATURES Personnel size decided by the institution Personnel size decided by the institution Jobs entry by public competition (there is no free personnel selection) Jobs entry by public competition (there is no free personnel selection) (1800 –3000 Euros / month) x 14 doctor (1200-1800 Euros/ month ) x 14 nurse Salary payment, with incentives related to quantity/quality work and also years worked Salary payment, with incentives related to quantity/quality work and also years worked Work hours: 7 hours x 5 days (plus saturdays on rota) Work hours: 7 hours x 5 days (plus saturdays on rota)

14. 2. Who do we care for?

15. POPULATION FEATURES Aged population Aged population High morbimortality High morbimortality

16. 3. How do we organize?

17. GENERAL ORGANIZATION Each Basic Unit of Care (doctor and nurse) does 4 surgery based sessions and 1 home visit session per week Each Basic Unit of Care (doctor and nurse) does 4 surgery based sessions and 1 home visit session per week Each doctor and nurse have a population of 2000 clients under their care Each doctor and nurse have a population of 2000 clients under their care

18. 3.1. Access

19. CONTACT OUR SERVICES Appointments: directly requested by the patient or requested by the health team Appointments: directly requested by the patient or requested by the health team Number of visits per day: limited to 35 ( 7 -10 minutes/visit) Number of visits per day: limited to 35 ( 7 -10 minutes/visit) Urgent visits handled by 1 member of the team every day Urgent visits handled by 1 member of the team every day On call hours carried out by a different team On call hours carried out by a different team

20. 3.2. Surgery Sessions

21. 9 - 14 h. Office/ Home visits 14 - 15 h. Team sessions TEAM ACTIVITY 15-20 h. Office/ Home visits

22. 3.3. Home Care

23. HOME CARE Scheduled Acute and Chronic home visits: ATDOM Programme Scheduled Acute and Chronic home visits: ATDOM Programme Support teams (PADES): Paliative Home Care Support teams (PADES): Paliative Home Care

24. 3.4. Specialized Care

25. The specialist in the centre The hospital specialist comes to the centre to: The hospital specialist comes to the centre to: Visit Visit Provide consultancy services Provide consultancy services To teach To teach Hours of work adjusted to Primary Care Team needs Hours of work adjusted to Primary Care Team needs

26. 3.5. Community

27. Talks on Health Talks on Health One per month One per month Based on topics that the clients find interesting Based on topics that the clients find interesting TALKS TO THE COMMUNITY

28. 4. Teaching

29. TEACHING Teaching scheme started in 1978 Teaching scheme started in 1978 Specialists in Family Medicine Specialists in Family Medicine Four years of formation Four years of formation Every Registrar has its own tutor in Primary Care Every Registrar has its own tutor in Primary Care Acreditation needed for tutors and teaching centres Acreditation needed for tutors and teaching centres

30. 5. Research

31. RESEARCH Important role in the professional curriculum Important role in the professional curriculum Foundation that supports research in primary care: Goll i Gurina. Foundation that supports research in primary care: Goll i Gurina. Different research lines depending on preferences Different research lines depending on preferences