Every healthcare provider, whether a doctor or otherwise, practices their profession according to their own knowledge, the country of their education, and their experience. There is no uniformity in the healthcare system in Cyprus.
A significant gap exists in monitoring and evaluating healthcare professionals and the quality of services. There are no common, official quality standards, clinical protocols, and guidelines; continuous education is not ensured, and there is a need to focus on disease prevention.
The study/proposal conducted by PWC, on behalf of the coordinating committee of the Ministry of Health for the creation of the National Clinical Documentation Centre, is ready and has been delivered to the Health Minister, Michalis Damianos, who has already engaged with the relevant stakeholders, including the Cyprus Medical Association (CMA), whose role in this case is particularly significant.
The National Clinical Documentation Centre will have the authority to prepare national clinical guidelines/protocols, plan the training of healthcare professionals, and monitor and evaluate healthcare providers for the implementation of common standards.
Beyond analysing the operation of similar organisations in other EU countries and internationally, the study provides an extensive description of the current situation prevailing in Cyprus concerning the implementation of clinical protocols, the control and evaluation of clinical practice, and the training of professionals.
“As the GHS matures and as we see happening in most healthcare systems in Europe and internationally, the healthcare sector in Cyprus must now focus on optimising the quality and sustainability of healthcare services. This direction appears to be one-way, as patients are now more informed and demanding, the population of Cyprus is ageing significantly, and at the same time, the cost of providing healthcare services increases by approximately 6% year on year.”
The findings of the study and the coordinating committee regarding the current situation can be summarised as follows:
a) There is a lack of quality standards/clinical protocols/guidelines/pathways.
b) Different experiences and expertise of healthcare professionals are observed, along with a lack of continuous education.
c) There is a need for greater emphasis on disease prevention and management.
d) Regulatory gaps are identified concerning the monitoring and evaluation of healthcare quality.
As stated in the study, “In Cyprus, there are no national healthcare quality standards or clinical protocols/guidelines that are uniformly applied across the healthcare system (within and outside of the GHS). Scientific societies may adopt certain clinical protocols/guidelines from other countries, but this does not always appear to be done in a coordinated manner among various medical specialties and levels of care, without broad acceptance from the entire medical community and other stakeholders.”
This, as noted, results in “healthcare professionals practising in Cyprus having different experiences and expertise depending on the country where they studied or trained.” Consequently, different approaches and “heterogeneity in the provision of healthcare services from professional to professional and from patient to patient” are observed.
“For example, regarding primary care, doctors with different specialties (general medicine, pathology, or doctors without a specialty but with experience in primary care) are entitled to contract with GHS as personal doctors. Therefore, the different experiences and expertise and the lack of common continuous education and quality standards may lead to heterogeneity in service provision among GHS beneficiaries.”
Regarding the monitoring and evaluation of healthcare professionals and service quality, the advisory committee states in its report that this will always be based on European and international practices by staff from the Centre and external collaborators/experts.
With the implementation of GHS, it is reported that “the Ministry of Health is called upon to assume its new role as a regulator of the Health sector. At present, apart from checks carried out by the Ministry for providers’ compliance with legislation, mainly focusing on facilities and minimum required staff ratios, there is no comprehensive monitoring and evaluation program/mechanism for the quality of healthcare services provided by providers. Moreover, legislations often require revision based on contemporary evidence, which is usually time-consuming. It is worth noting that for some areas, there is no legislation at all yet (palliative care and rehabilitation, and therefore, they are not adequately regulated).”
Therefore, “the establishment of a National Clinical Evidence Centre, either as part of the Ministry of Health or as a separate entity, is necessary to fill the current gap regarding the determination of national quality standards and the monitoring and evaluation of quality based on scientifically evidenced healthcare provision.”
Proposal for a private law entity and developments
The study analyses different operation models of the National Clinical Evidence Centre (NCEC). From the data analysis, it appears that the most suitable model for Cyprus, taking into account the cost, is one that foresees the operation of a private law entity. The coordinating committee, which recently met with the Minister of Health, Michalis Damianos, made a related proposal, which the Minister was called upon to process.
At the same time, Michalis Damianos, as we are informed, had already met with the Pancyprian Medical Association, which, according to a decision of the Ministerial Council in 2020, should appoint a representative to the coordinating committee, something it has not done so far (relevant information has occasionally come to light).
During the meeting, the Minister of Health invited the CMA to contact the other members of the coordinating committee, to communicate and cooperate in order to jointly define the framework of the Centre’s operation and to subsequently hold a joint meeting to advance the necessary procedures.
However, the study emphasizes that “regardless of the decision on the entity form with which the NCEC will be established and despite the budget required to establish it, it is important to note that its operation is expected to have economic benefits beyond the quality benefits for the patient. Specifically, the establishment of the NCEC is expected to lead to more efficient use of healthcare resources, as the interventions of healthcare professionals will be based on contemporary medical practices. By adapting clinical protocols/guidelines/pathways and training healthcare professionals in their implementation, unnecessary healthcare expenses (e.g., unnecessary issuing of referrals or application of more expensive but less effective treatments) are expected to be limited due to the improvement of the efficiency and effectiveness of interventions.”
