The authors of this study conducted a literature review in 2015 to ascertain the nursing activity that currently operates in the primary healthcare (PH) system in Portugal. They analysed 11 studies published between 2007 and 2013. Their analysis identified four key aspects of PH nursing in Portugal: technical procedures, health promotion, independent actions, and management and training practices. The authors believe that the healthcare model in Portugal is in transition, although reasons for this were not clearly identified.
To understand the paper, the healthcare system in Portugal needs description. The Portuguese national health service (NHS) is similar to the British model, with healthcare being free at the point of delivery. The Ministry of Health is responsible for developing Portuguese health policy, with the Healthcare Regulatory Authority (2018) responsible for regulating the activity of all healthcare. Portuguese PH is given via a mix of public and private health service providers, with patients having access to the NHS via their family doctors (GPs) and PH nurses for health surveillance and promotion, disease prevention, diagnosis and treatment, and social and medical rehabilitation.
Since 2008, healthcare has been delivered by public health units such as family health units (FHUs), community care units and personalised healthcare units. FHUs give GPs and nurses greater flexibility and allow for better integrated inter-professional working, and are recognised as giving superior care to other PH units (Organisation for Economic Co-operation and Development (OECD), 2015). All these units utilise various levels of multidisciplinary teamwork and inter-cooperative and complementary networks, administrative autonomy and clinical governance systems (Redondo and Santana, 2011). They have organisational (but not financial) autonomy, and vertical integration of healthcare allows local health units to integrate with hospitals and PH units in the same organisation (European Observatory on Health Systems and Policies, 2017).
Like many countries, Portugal faces challenges such as population aging and inequalities in health (Directorate-General of Health, 2016), which in turn is affected by a shortage of GPs that is expected to worsen due to GP retirement (World Health Organization, 2017). A total of 23 countries in the European Union have licensed advanced nurse practitioners, who undertake work previously done by GPs (Pulcini et al., 2010). However, Portugal is unlikely to follow this model in the near future, as even the right for nurses to prescribe is ‘hotly debated’ (Buchan et al., 2013).
The OECD (2015) stated that the transformation of the Portuguese model in PH is required to improve quality, and the reviewed study appears to agree with this assertion. Nurses in Portugal need to consider how PH models in other countries effectively address the social, political, epidemiological and technological aspects of healthcare. Portuguese nurses can harness their commitment to quality by grasping the opportunity to be involved in shaping changes, and ensuring dynamic PH models are utilised to improve the health of the nation and the quality of care.
Biography
Natasha Duke is a nurse practitioner, working in roles related to regulation of nurses and governance of pharmaceutical companies. She is undertaking a part-time doctorate at the University of Southampton.
References
- Buchan J, Temido M, Fronteira I, et al. (2013) Nurses in advanced roles: A review of acceptability in Portugal. Revista Latino-Americana de Enfermagem 21: 38–46. [DOI] [PubMed] [Google Scholar]
- Directorate-General of Health (2016) Nova ambição para a saúde pública focada em serviços locais. Available at: https://www.dgs.pt/documentos-e-publicacoes/nova-ambicao-para-a-saude-publica-focada-em-servicos-locais1.aspx (accessed xx month xxxx).
- European Observatory on Health Systems and Policies (2017) Health care systems in transition (HiT) profile of Portugal. Available at: http://www.hspm.org/countries/portugal25062012/livinghit.aspx?Section=2.3 Organization&Type=Section (accessed 28 February 2018).
- Healthcare Regulatory Authority (2018) Portuguese Healthcare Regulation Authority (HRA) (Entidade Reguladora da Saúde – ERS). Available at: https://www.ers.pt/pages/146 (accessed 28 February 2018).
- Organisation for Economic Co-operation and Development (2015) Portugal: Raising Standards, Paris: OECD Publishing. [Google Scholar]
- Pulcini J, Jelic M, Gul R, et al. (2010) An international survey on advanced practice nursing education, practice, and regulation. Journal of Nursing Scholarship 42(1): 31–39. [DOI] [PubMed] [Google Scholar]
- World Health Organization (2017) Portugal: European Region. Available at: http://www.who.int/health-laws/countries/prt-en.pdf (accessed 28 February 2018).