Staffing of primary health care in the Russian Federation
The Russian system of public health protection and primary health care as its component require reforming. Excessively narrow specialization of outpatient care loses the identity of the primary health care doctor as a «guardian of health». The state bears the financial burden associated with large investments in specialized medical care, which is much more expensive. It is required to reform district assistance in organizational and personnel support.Unfortunately, 30 years of reforming primary health care on the principle of general medical practice have not brought Russia closer to the formation of a new organizational and institutionally sustainable model of primary health care.Purpose of the study. Based on the analysis of the reported data on the availability of medical personnel in primary health care in the Russian Federation and its subjects and the content of the analysis of author’s studies, proposals were developed for reforming primary health care and general medical practices.Materials and methods: content analysis, statistical, sociological, analytical, direct observation. The article used the results of the research work of the authors of the article, followed by content analysis and the development of proposals for reforming primary health care, district service and general education, in particular. Results. The article provides an analysis of the provision of doctors, therapist and general practitioners in the Russian Federation in dynamics (2016-2020), a ranking of indicators of the provision of general practitioner in the constituent entities of the Russian Federation is carried out. The analysis showed that over the 5 years, the provision of district physicians increased slightly: general practitioner (from 0,63 to 0,72‰î), district therapist (from 2,98 to 3,21), in total, the provision of these specialists increased from3,61 to 3,93‰ and their share (2020) amounted to 8,6% of the total number of doctors in the Russian Federation, which deter-mines the need to prioritize the reform of primary health care in the context of the development of general medical practice. Based on content analysis and our own research on the state of primary health care and the development of primary health care in the Russian Federation, proposals were developed for reforming primary health care and promising models of primary health care in the city were scientifically substantiated.Findings. The introduction of promising general medical practice models in the urban environment implies a complete transition of the medical organization providing medical care on an outpatient basis to general medical practice, while reducing the staff positions of medical specialists. It is necessary to expand the job responsibilities of the general practitioner’s nurse with a ratio of general practitioner to general practitioner’s nurse of 1:2.It is necessary to develop regulatory, legal and managerial decisions regarding the priorities of primary health care and the development of general medical practice in its structure.