The petitioner shall: Ministry of Health of the Slovak Republic
Name of the petition:
–Petition for the maintenance of outpatient emergency services for adults and outpatient emergency services for children and adolescents in the Poliklinika of the Nitra self-governing region in Šali
It's quare: No.
Number of persons supporting the petition: 4,700
Date of delivery: 16.10.2023
Date of equipment: 30.11.2023
Type of equipment: Paragraph 5 (6) of Law No 85/1990 Coll. on petition law as amended - not evaluated
Reason for equipment:
On 16.10.2023, a letter dated 9.10.2023 from the mayor of Šaľa addressed to the Minister of Health, along with a copy of the letter from the director of Poliklinika of the Nitra Self-governing Region Šaľa dated 25.09.2023, as well as 209 pcs of petition sheets in documentary form, marked as the original copy of the original version of the Slovak Republic, was delivered to the mail office of the Slovak Republic on 16.10.2023.Petition for maintaining outpatient emergency services for adults and outpatient emergency services for children and adolescents in the Poliklinika of the Nitra self-governing region in Šali. The letter of 9.10.2023 stated that the petition was supported by more than 4 700 inhabitants.
MZ SR received documentation received and after evaluation of the content as well as the formal details 209 pcs of petition sheets in documentary form marked as "Petition for the maintenance of outpatient emergency services for adults and outpatient emergency services for children and adolescents in the Poliklinika of the Nitra Self-governing Region in Šali" in the context of the provisions of § 3 (3), § 4a (5), (6), § 5 paragraph 1 of the Act on petition law registered in the Special Report of the Registry as petition under sp. zn. Pet 13/2023, with certain shortcomings. MZ SR, within the meaning of § 5 (4) of the Act on Petition Law of 19.10.2023, called upon the City of Šaľa to remedy the identified deficiencies within the legal deadline and with an instruction. The shortcomings of the petition were corrected by letter dated 08.11.2023, received by MZ SR on 13.11.2023.
Since the petition received is in the nature of the application, the Ministry of the Slovak Republic, as a public authority responsible for its execution, is obliged to arrange the petition in question pursuant to § 5 (6) of the Act on petition law, in which, if it is apparent from the contents of the petition that the petition cannot be dealt with pursuant to § 5 (5) of the Act on petition law, the public authority responsible for the execution of the petition containing the request or proposal will assess its content and send a written reply together with the statement of reasons to the representative within the period under § 5 (5) of the Act on petition law.
In accordance with the above provisions of the law on petition law of MZ SR as a public authority materially competent to handle the petition, he submitted the following reply to the representative.
Reason for the intention of the proposal
The amendment of the decree establishing catchment areas and fixed points for the ambulance of fixed outpatient emergency care was prepared in cooperation with the expert company representing primary paediatricians, with the main expert and county experts of MZ SR for general outpatient care for children and adolescents. The proposal was prepared in close cooperation and at the initiative of primary paediatricians themselves, who for several years highlight the unsustainable personnel situation in primary paediatrics. It should be seen in the context of the overall personnel crisis of primary paediatricians in the Slovak Republic. According to the preliminary results of the state of the network in 2023 (official results in terms of the legislative terms of MZ SR published by 30.06. of the relevant year) in Slovakia lack 20% primary paediatricians (229 doctors) and each second paediatrician is in retirement age. In the near future, the current network with half the pediatricians at retirement age will be unsustainable.
Objective
The MZ SR proceeded to this adjustment, pursuing the main goal of keeping in operation the ambulance of primary paediatrics during the day. Without primary paediatricians in ambulances, it is not possible to operate outpatient standby. This measure is a stabilisation measure of primary paediatricity in the Slovak Republic. We approach the call of more than 600 primary paediatricians (out of about 1 000 primary paediatricians in Slovakia) with full respect, and we want to prevent the collapse of primary paediatrics in Slovakia as a whole. Over the last period, several primary paediatrics have been phased out, with regions losing primary children's daily care, which may result in regional inaccessibility of primary healthcare.
Principles and baselines
The main purpose of the proposal was to maintain the availability of APS operations for children and adolescents while respecting the limited personnel capacities of primary paediatricians at present. Consolidation of the APS fixed point network is based on two basic principles:
- concentration of limited personnel capacities of primary paediatricians in sustainable groups or teams in optimal number, 15 primary paediatricians and reduce their burden;
- the location of the APS in a place where there is also urgent reception, or a paediatric department, to ensure the continuity of other health care components where necessary. It is a way to keep available and functional APS in the regions of Slovakia for the next period.
Data base
- Size of adapted catchment areas - takes into account the population of the child population (18 + 364 days) in the region
Source: Slovak Statistical Data
International recommendations define the optimal number of children per fixed point of 50,000 children. For primary paediatric care and APS, the baseline is the absolute number of people living in the region.
- Real numbers of treated patients after 20.00 at fixed points APS
Due to the fact that the data interface for reporting APS providers (dose 751a) does not have an item power time, only the date of performance, a direct on-site survey was carried out at individual fixed points by the doctors themselves who serve at given fixed points. The period under review was March 2023. At most fixed points, the number of treated patients varies between 0 and 2 at 20:00. The overall result is that on average 2% of visits are made between 7:00 and 8:00 hours and 1% between 20.00 and 22.00 hours.
- personnel capacity and age composition of primary pediatricians at a fixed point
- Impact on potential burden on secondary fixed points or urgent revenues
Possible concerns about the transfer of APS visits to urgent revenues were not confirmed by the last regulation in 2018. A comparison of the number of visits to APS and emergency incomes in 2018 and 2019 showed a decrease in the annual number of visits to APS for children and an increase to 1 000 insured persons by 7%, APS for adults by 19%, while increasing the number of visits to institutional emergency services by 4%. In total, however, APS visits and urgent revenues decreased by 5% per 1 000 insured persons.
The proposed scheme for only 3 catchment areas defines a catchment area with a population greater than the recommended 50,000 children, namely:
fixed point Bratislava – 151 232 children
fixed point Košice Þ 78 313 children
fixed point Prešov – 59 204
This adjustment is without prejudice to the very definition of outpatient emergency care according to which APS is defined as healthcare provided to a person who is not immediately in danger of life. Outpatient emergency services are not due to severe conditions such as asthma attacks or serious injuries, such patients are immediately treated for urgent hospital income.
Additional APS
This amendment is without prejudice to the possibility provided for by current legislation in the form of the possibility of establishing an APS supplementary point within the meaning of § 8a Act No. 576/2004 Coll. on health care, health care services and amending certain laws. According to the provisions in question, the provision of an additional outpatient emergency service is provided by an operator in a catchment area where a fixed point for which he is authorised to operate an outpatient emergency room for adults or a fixed point for which he is authorised to operate an outpatient emergency room for children and adolescents. The additional outpatient emergency service shall be provided to the organisers continuously for at least two hours on working days between 16.00 and 22.00 on a continuous basis, within at least two hours on duty days between 7.00 and 22.00 when the organiser is authorised to operate an outpatient additional emergency service.
The regulator determines the network of fixed points APS, but if the organizer decides to operate in its catchment area, the current legislation allows it to do so. The obligation of primary pediatricians to serve in APS applies only to fixed points. Personnel security at the APS additional point is fully within the responsibility of the organizer.
Communication
MZ SR presented this proposal in February 2023 at the level of SK8 and then in March 2023 at individual meetings with representatives of individual self-governing regions.
By sending a letter to the representative of the Slovak Republic, which communicated the result of the execution of the petition entitled "Petition for the maintenance of outpatient emergency services for adults and outpatient emergency services for children and adolescents in the Poliklinika of the Nitra self-governing region in Šali" he considered the petition to be equipped in accordance with the provisions of § 5 (6) of the Act on petition law.
Place: In Bratislava– Date:5 December 2023