Contact Person: Assoc.Prof.Lyubomir Kirov,MD,PhD
National Association of General Practitioners in Bulgaria
Sofia, Bulgaria, 1407, “N.I.Vaptzarov” str. 17-21
“From general practitioners for general practitioners,
following the key working principles –
justified criticism, clear decisions and clear sight into the future.
Balanced, open for dialogue, constructive, steady. ”
It was ten years ago, as the healthcare reform in Bulgaria started, that the General pattern for medical care was introduced. In it, the General Practitioner/family doctor was given central position. The ex-district physicians were transformed into the “all-new” characters; they were internists and pediatricians, a lot of whom possessed certified specializations in the respective field of medicine. Their qualification, however, was – and is being – conveniently forgotten and ignored by the state institutions in the system of healthcare.
How It All Started
Being a only natural process under the new conditions, the need appeared for creating some organization to represent GPs. On December 17th 2000 in the town of Hissar near Plovdiv a group of enthusiasts from various regions of our country founded the National Association of General Practitioners in Bulgaria /NAGPB for short/. Voting on a Statute and electing its governing body gave start to its activity in spreading and upholding the Association’s principles. Ours is the only legitimate organization defending the interests of general practitioners nationwide. NAGPB has also been fully acknowledged by the Bulgarian Medical Union (for the respective field of the medical profession), and is also a co-founder and full member of the Association of General Practice/Family Medicine of South-East Europe. We boast regional structures in 28 districts in Bulgaria, with over 3 000 GPs being our members of their own free will. The Association is justly considered to be the best built and organized professional structure of medics in Bulgaria.
NAGPB has been created to mainly defend the rights, social and economic rights of general practicing doctors, raising the prestige of the profession and securing better quality services to our patients.
We possess a finely functioning structure for processing the suggestions, ideas and problems being given by our colleagues – from the horizontal local levels, to be then related to the vertical level. To ensure more swift interaction we have introduced electronic connection between the members of the Managing Committee and the National Council, fully automated mailing lists and mobile phones in closed groups.
The so created structure guarantees quick and precise interaction between the various levels, and a very short period of time is needed from the moment a good idea is given till it becomes a concrete resolution.
Who Are We Now?
Open for dialogue, balanced, constructive, businesslike, consistent, always adequately responding to change.
Sticking to the principles of all non-profit organizations, offering some sort of public service by means of programs and strategies depending on the respective field they operate in – and all of this having in mind the target audience so as to gain their trust. In this respect, the activities and objectives of NAGPB are many-sided, we are not a pure trade union nor are we limited to activities within the country.
As of the present moment, the Association is well-established, has a big number of members, and this makes it possible to take more and more active part in decision-making on a national level. We no longer need to work on building the organization and strengthening our reputation as the true representative of our branch. NAGPB currently faces new challenges to deal with – sustain its stability and power to present and justify our civil and professional points of view.
The regional representatives of the Association do the work for us alongside their regular full-time job. However, the network of regional representatives is still not prepared enough to cooperate on a local level with the regional representatives of other institutions, which would make it possible to promote initiatives from bottom to top.
WHAT HAVE WE ACTUALLY ACHIEVED?
One of our tasks has been taking part in the preparation and negotiations on the National Framework Agreement /NFA for short/.
As a result of the activity of NAGPB specific medical changes were implemented – ones concerning the practice of the family doctor. We initiated and realized a change in the Instruction for Prophylactic Examinations and Following patients with chronic diseases, which gave GPs the right to look after all cases of Type 2 diabetes and arterial hypertension; prophylactics of all persons over 18 was introduced by means of changing the rules in an Instruction – and this change later became part of the National Framework Agreement.
In 2006 we prepared and presented to the Ministry of Health, Parliament, National Health Insurance Fund and the Bulgarian Medical Union a complete and with justification Draft of Budget and National Framework Agreement for the sector of Primary Care for the next year 2007. 13 000 000 leva /roughly 6.5 million €/ were “saved” for urgent care and emergency portals from the budget for Primary care. A suitable solution was suggested to the problem of urgent care – unfortunately not accepted. Appendices to the finally not signed 2007 NFA were fully negotiated. A text was added to the NHIF budget for 2007 forbidding the money not spent from the Primary Care budget to be in any way used for other expenses. In 2007 we worked out a Draft Budget for Primary Care 2008, which was in time presented to the Ministry of Health, Parliament, National Health Insurance Fund and the Bulgarian Medical Union. To make everyday practice of our colleagues easier, after meetings and discussions with the NHIF, the procedure for replacing a lost Personal Health Insurance Booklet was made easier. A detailed and complete Draft for changes in the Regulations was done and once more presented to Ministry of Health, Parliament, National Health Insurance Fund and the Bulgarian Medical Union. We built a working pattern for quick and timely response to any call or letter from fellow-GPs, members or not of NAGPB.
We are open to, and actively looking for contacts with all healthcare-related institutions.
ACTIVE TRAINING PROGRAMS
An extremely well-developed activity of NAGPB, where in the process of continuing medical education we are not only active users but also organizers. Inform the highest possible number of General Practitioners within the country of the latest developments in contemporary prophylactics and treatment of a number of diseases, of the modern therapeutic approaches in medication-based therapy on the basis of the experience throughout the world – these have been our aims in the educational activities already done or planned for the future.
Training sessions are always centered on the application of new models and points in practice, so they are as fruitful and practical as possible in the daily activities of any family doctor. We strictly stick to this principle.
Up until now, NAGPB together with the Departments of General Medicine throughout the country have founded the Bulgarian National Society of General Medicine; we actively and successfully participate in and organize the Continuing Medical Education for GPs – this is a key point in raising their qualification and professional level; a section of Family Planning was also formed.
Nine Guidelines for GPs are ready: for high temperature in children; dislipidemy; arterial hypertension; gastroenterology (in 3 parts); benign prostate hyperplasia; headache, DM type 2. These aim to ensure high quality diagnostics and treatment in a number of illnesses by following the given algorithms. 3 Congresses of General Medicine were held – with international participation – in 2005, 2006 and 2010 respectively; and the first of them started a new tradition. The Annual National Conference in October 2007 was the first of its kind, and is now held every year in the period between the Congresses. Bulgarian General Practitioners enjoyed their first opportunity to take part in a European Conference of General Medicine held jointly with the French Association of Family Doctors in January, March and May 2007. NAGPB was a hostess of the II-nd International conference of A GP/FM SEE held in Plovdive in 2011.
Annually, our Association, in partnership with our regional structures throughout the country, runs between 7 and 9 local Conferences of Continuing Medical Education. NAGPB members regularly participate in international congresses and conferences: WONCA World Congress in Italy, Turkey, Macedonia, Republika Srpska, Czech Republic. In addition, we are also members of the International Board for designing and accreditation of a unified framework for Continuing Medical Education, where 16 countries are represented: 14 from Europe plus the USA and Israel. We have joined the activities of LINNEAUS Euro-PC, which is a European Union international organization working on patient safety.
Some of the NAGPB Projects have been finalized, others are still being worked on. In 2010 we prepared the Medical Standard for General Medicine (to be approved by the Ministry of Health). By our initiative and with our help the use of electronic signature was introduced when sending our reports to the NHIF. This saves paperwork and time. Long ago have we prepared and presented to the Bulgarian Medical Union and the Ministry of Health Guidelines for Good Practice in General Medicine. So far no other medical community in Bulgaria has done this. We also prepared a Draft of Improved Methodology for criteria of and extra payment for GPs working in unfavorable conditions (e.g. remote rural areas). We started working on Quality Control for Primary Care medical activities. We keep working actively to promote these documents and introduce them in practice.
BY WAY OF CONCLUSION
Our Association boasts well-developed public relations, works actively to make our medical services popular, contacts all healthcare related institutions demanding the development, application and improvement of policies and practices in the interest of patients and doctors, sticking to good practices and policies at the highest world level.
As part of our activities, the Association lobbies in the academic and political communities to directly affect the professional and economic interests of our community. The objective is to guarantee that our Association is as much as possible involved in the making of the National Framework Agreement, all strategic and normative documents and to do this in dialogue with the regional and central administration.
We general practitioners are the “first contact” doctors – organizing and coordinating the whole healthcare system and therefore balanced, constructive, businesslike and always ready to meet all challenges and changes. We have set to ourselves more ambitious goals and are convinced that we will manage to:
- Ø Raise the respect for the subject of general medicine in the academic circles
- ØMake general medicine a more attractive option for a professional career choice
- ØUnite academism and practice
- ØGain the sympathy and support of the public in our country and abroad