Health Systems in Transition - Portugal

108 / 188

Health systems in transition Portugal 108
5.2 Patient pathways
The first point of contact within the NHS is the GP in a primary care unit; a
patient must register with a GP in his or her residential area or work place.
Theoretically, people do not have direct access to specialist care and GPs are
expected to act as gatekeepers. However, like in other European countries,
patients often bypass their GP by visiting emergency departments. Frequently,
there is a delay in obtaining a consultation depending on the specialty. The NHS
recently made available on the Internet data concerning the waiting times for
emergency care, specialist care and diagnostic services in all NHS hospitals.
Many people go directly to the emergency department in hospitals if they have
acute symptoms. However, an important proportion – approximately 40%
in 2015, according to data on – of the attendees at hospital
emergency units do not need immediate care (Table 5.1). The misuse of
emergency services has been widely noted in international reports and even in
the MoU (MoU, 2011; OECD, 2015b). People who go to emergency departments
and genuinely need specialized care are treated immediately. There are user
charges for emergency visits; however, considering that more than half of NHS
users are exempt from paying user charges, these do not appear to affect the
inappropriate use of emergency services. In 2016, the government revised both
values and exemptions for user charges (see section 3.4.1), exempting from user
charges all emergency service visits referred by primary care units, INEM and
the Saúde 24 Call Centre.
Table 5.1
Number of emergency visits, NHS hospitals, Portugal, 2015
Manchester Scale Number of
emergency visits
Percentage
Red (Immediate) 139 533 0.4%
Orange (Very urgent) 3 730 004 11.6%
Yellow (Urgent) 15 253 107 47.6%
Green (Standard) 11 542 659 36.0%
Blue (Non-urgent) 336 321 1.1%
White (Non-urgent) 1 069 666 3.3%
Total 32 071 290 100.0%
Source : SNS, 2016.