114 / 188
Health systems in transition
Portugal
114
provide some of these hospital specialties in primary care settings aims not
only to improve access to the population but also to avoid hospital overuse. The
range of services provided by GPs in primary care centres is as follows:
•
general medical care for the adult population
•
prenatal care
•
children’s care
•
women’s health
•
family planning and perinatal care
•
first aid
•
certification of incapacity to work
•
home visits
•
preventive services, including immunization and screening for breast and
cervical cancer and other preventable diseases.
Patients must register with a GP, and can choose among the available
clinicians within the primary health care unit of their residence area. Some
people seek health care services in the area where they work, but most choose
a GP in their residential area. GPs work with a system of patient lists, with
an average of approximately 1900 patients. People may change GPs if they
write an application, explaining their reasons for the change to the Executive
Director of the ACES. There is no statutory limit to how often people can
change their GP.
Data from 2015 show that 7.2 million NHS users had at least one medical
appointment at primary care centres (ACSS, 2016c). Between 2011 and 2015
there was a 6.3% increase in the number of NHS users who had at least one
medical appointment at primary care centres, but a 6.0% and 9.6% reduction
in the number of overall medical appointments and face-to-face medical
appointments, respectively. Home visits showed a 3.0% increase during the
same period, but are still very limited: 198 993 in 2015 (ACSS, 2016c).
Despite a reduction of 27% in one year, by the end of 2016 the number of
NHS users not registered with a GP was 769 537 (ACSS, 2017) (see Section 6.2).
Thus, because they may not get a timely response, many patients go directly to
emergency care services in hospitals or the private sector where the full range
of diagnostic tests can be obtained in a few hours (see section 5.5). In fact, a
patient that is not registered with a GP faces long waiting times at the primary
care centre and hence, the patient usually prefers waiting for a long time in the