Garth Rattray | MOHW public-private partnership should facilitate family doctors

Last Sunday I attended the World Family Doctor Day (WFDD) 2025 virtual conference. It was part of the annual celebration to honour and highlight the important role that family doctors play in healthcare systems across the globe. This year’s theme was “The impact of the Ageing Population on Primary Healthcare”. World Family Doctor Day is May 19 annually.

I was a part of the second to last item on the programme, a panel discussion on the “Public-Private Sector Partnership (the relationship between the Ministry of Health and the Private-Public Health System)”.

Dr Tamu Davidson represented the Ministry of Health and Wellness (MOHW). She did a very well-prepared and comprehensive presentation on the MOHW’s public-private partnership.

Part of her slide presentation spoke to Public Private Partnership (PPP) service contracts with private providers to outsource radiology or surgical procedures, the treatment of patients with chronic illnesses, immunization services, management contracts with private firms for the operation of public facilities – the management or operation of regional hospitals.

There was also an explanation of the PPP in relation to the construction and temporary operation of health centres, the use of CT or MRI machines in private clinics by public patients, cleaning, catering, IT, or ambulance services, online consultations co-hosted by private clinics and public specialists, and NHF partnerships with retail pharmacies.

We were shown that PPP arrangements allowed for expanded patient access to subsidised medication, reduced waiting times for MRI, CT, and ultrasound services, faster turnaround and availability of specialised tests, and improved immunisation coverage through free vaccinations.

PROBLEM

The problem with the MOHW PPP is that, for the sake of patients, it needs to facilitate and prioritise general practitioners/family practitioners/primary care physicians easily interfacing with the public healthcare system and medical personnel. Private and public primary care physicians form the hub of patient care. Yet, there is no seamless cooperation between the government healthcare system and private practitioners because when it comes to the management of the patients that entrust their health and their lives to us, the government system completely leaves us out of the loop.

I have tried to visit with patients while they are admitted in public hospitals and, although I am obviously no security threat and presented a valid [medical] ID, if I arrive outside [official] visiting hours, I am turned away by security guards, and if I arrive within visiting hours I’m told to join the line, or the crowd for a security pass. As long as it is not inconvenient for the nursing staff, any doctor should be able to visit their patient while they are in the hospital. I have also been told that I cannot leave my telephone number for attending physicians to call me on important matters relating to my patients. This is untenable.

When discharged public hospital patients end up back in our care, we have absolutely no idea about what investigations they did, the results of those investigations, what diagnosis was made, what treatment plan was made, what intervention they received, what medications they were discharged on, and what plans and arrangements were made for their follow up. Patients need a brief discharge summary in the event that they need to see any other physician, anywhere. Without that, their health and lives are in jeopardy.

Patients turn up in our offices totally confused and ignorant about their journey through the public clinics and hospital system. They can’t tell us anything. We sometimes end up telephoning private pharmacies to get their list of medications. God help us if they filled their script at a public pharmacy.

TEST RESULTS

When we ask patients to pick up copies of their test results, they are told that we (the physicians) must write a letter to the administration and the relevant outpatient clinic for the patients to get them. This ignores the fact that patients are entitled to access their medical notes because, whereas the physical or electronic records belong to whichever medical facility has them, the information belongs to the patient. In fact, the Jamaica Data Protection Act 2020 grants individuals the right to access their personal data. The MOHW practice of requesting letters from us before patients can access their own personal data (results and relevant notes), is in contravention of the Act.

Whenever patients return to us after we refer them to a public health centre, to a public hospital clinic, or if they ended up in a public emergency room for treatment or was admitted, we often have to start from scratch. Sometimes we are forced to re-order important investigations.

Some patients have allergies or idiosyncratic reactions to some medications. Despite us telling them this and asking them to acquire a Medic Alert bracelet or pendant, they may forget. We could provide this essential information, and information about their investigations and treatment. This would allow for the continuity of care if they are being seen in the public healthcare system. Isolating us denies patients these all-important things. There is no public–private partnership there.

Whereas individuals within the MOHW are diligent professionals, as a government entity, it is alienating private medical practitioners. Doctors with valid medical IDs should not be barred from visiting with patients admitted to public healthcare facilities. Public and private doctors need to communicate freely with one another. Patients must be provided with discharge summaries, and copies of their results. For the sake of patients, I challenge the MOHW to fix these problems to make the PPP function efficiently.

Garth Rattray is a medical doctor with a family practice, and author of ‘The Long and Short of Thick and Thin’. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com.