How Is Medical Care Approaching Patients, Or Why Does St. Petersburg Need One Hundred Offices Of General Practitioners

Photo: provided by Euromed Group of Companies

In St. Petersburg, the number of medical centers operating within “walking distance” from their patients will soon reach hundreds. If 10 years ago they were opened mainly by private owners, then for the last five years new buildings have been saturating the city with offices of general practitioners. We tell you how the “office” movement reduces the shortage of outpatient care in St. Petersburg.

According to the city Construction Committee, 3 new polyclinics and 5 general practice offices were built in St. Petersburg last year (a total of 11 health facilities were commissioned). In 2024, 10 healthcare facilities are planned to be commissioned, including a polyclinic in the Krasnogvardeysky district and 4 built-in offices of general practitioners. And in 2025, 30 facilities are going to be opened in St. Petersburg, 16 of them are built—in offices of general practitioners.

New polyclinics in the microdistricts under construction are opening in parallel with the “temporary” offices of general practitioners. There are no such number of compact medical centers located in residential buildings near their patients in any region of the country.

For the first time in St. Petersburg, they tried to create offices of family doctors in the mid-1990s, but there were no specialists or conditions for this. They worked at polyclinics as internists’ offices. Only in the Primorsky district under construction, single offices of VOP appeared in the early 2000s in separate rooms in new buildings. As a system, they began to develop with the advent of public-private partnerships. In 2012, the Euromed company responded to the proposal of the city authorities to open outpatient clinics in horticulture for residents of St. Petersburg who spend the summer there. A year later, it was decided to transfer this experience to the city — then a big scandal broke out due to the “failure” to provide medical care to residents of new buildings. The scandal has reached Moscow. St. Petersburg residents, on the one hand, had a long way to get to district polyclinics, on the other, queues for medical appointments stretched for weeks or even months — the capacities of existing medical institutions were not designed for such a population increase.

In all areas with high rates of housing construction, the city could not provide residents with medical care — Primorsky, Vyborg, Krasnoselsky. The construction of new polyclinics in them was constantly stalled or was not planned at all.

In 2013, for the first time in Russia, the government of St. Petersburg, the Territorial CHI Fund and the Health Committee attracted the private medical company Euromed to work in the CHI system and called this scheme a public-private partnership. The scheme turned out like this: the company finds a room, rents it, repairs it, equips it — in short, creates a medical center, it also hires medical staff. The population of the nearest houses is attached to the medical center, which receives primary medical care in it. The first 8 offices with the name “Policy. District doctors” for adults appeared in the same Primorsky district. A year later, four more were added: two in Pushkinsky (adult and children’s) and 2 in Krasnoselsky district (both for adults and children). According to contracts with the nearest district polyclinics, patients are sent to them if necessary. Because at first, as in the first offices at polyclinics, the new ones had only an appointment with a general practitioner (pediatrician), an examination (blood sampling for laboratory tests), vaccination, and a doctor’s call at home. But almost immediately it became clear that it was not enough to organize a therapist’s appointment in an office with a table, chair, examination couch and tonometer. And “narrow” specialists began to appear in the offices — neurologists, cardiologists, otorhinolaryngologists, ophthalmologists, endocrinologists and additional equipment — ECG, ultrasound, ENT equipment.

Governor of St. Petersburg Georgy Poltavchenko and Managing Partner of Euromed Group Alexander Abdin at the opening of the Polis office. District doctors” in Vyborg district Photo: provided by Euromed Group of Companies

When it became clear that the St. Petersburg experiment was a success, they tried to adopt the experience in Moscow and created the project “Doctor next door”. It was distinguished by the fact that private companies for the organization of assistance to Muscovites with an MHI policy received premises for medical centers on the principle of “rent — 1 ruble”, the area in this room (number of square meters), where free medical services were provided, was regulated. It turned out that on one half they were treated under an MHI policy, on the other — for a fee. Over time, they are increasingly refocusing on commercial medicine.

The work of Polis has been built differently since its creation. The company rents premises, pays rent in full rubles, runs its own household and receives “attached population” — residents of nearby houses, and provides medical care only within the framework of compulsory medical insurance, that is, free of charge.

Photo: provided by Euromed Group of Companies

However, at first people did not believe in free. The interior, similar to what patients saw in private clinics, information technology (doctor’s appointment, medical records management), attentive attitude were alarming: patients expected a trick in the form of payment for help. But it was not there, and it is not there, even the cash register did not appear. And the range of services was expanding. Now it is already a medical examination, which has become in demand among young people after the covid epidemic.

The city continued to grow with new neighborhoods, but the capacities of existing polyclinics were not designed for their residents, and they were far from being “within walking distance”. The number of Polis offices has reached more than two dozen, and another private company, the XXI Century Medical Center, has joined the creation of new offices in new buildings. At first it was one office of general practitioners in the Nevsky district, later their number grew to four: three in the Nevsky district, one in Kalininsky.

“When the state found itself in a difficult situation, it found a like—minded person in our company – we developed a joint program to get out of a difficult situation by creating GP offices. Our cooperation has been called a public-private partnership. Formally, of course, this is not a PPP, but the work of a private medical institution in the compulsory health insurance system in accordance with 323-FZ. But this is definitely a partnership between the company and the public health system, since the offices and polyclinics of Polis work where people find themselves without medical care within walking distance, required by law,” explains Alexander Abdin, ideologist of the Polis program within the framework of PPP, managing partner of the Euromed Group. — The infrastructure has not kept pace with the pace of settlement of new neighborhoods for several years, but we have come and are coming to help residents. When the city authorities open a polyclinic there, we can shut down our work.”

In fact, despite the opening of new clinics, the need for general practitioners’ offices does not disappear. PPP, invented in the early 2010s, showed that it is a good temporary way to provide medical care to St. Petersburg residents. And when Alexander Beglov became governor of St. Petersburg, one of his first decisions was to buy out premises from developers for 12 state offices of general practitioners.

As Dmitry Motovilov, Deputy chairman of the Health Committee, reported on the St. Petersburg TV channel, in the spring of 2024 there were already 96 offices in St. Petersburg, 72 of them state-owned, and several more are planned to open. Saturation of new buildings with “first aid medicine” also occurs because the construction business assumes social obligations: in projects of quarterly development, premises on the first floors for general practitioners are provided. They are donated to the city with full decoration. Opening an office — purchasing specialized equipment and medicines, hiring staff — is already the concern of the city.

The governor of St. Petersburg, Alexander Beglov, at the opening of polyclinic No. 128 in the Vyborg district Photo: Telegram channel of Alexander Beglov

With the advent of new medical facilities within walking distance, it is easier for St. Petersburg residents to get the necessary help. In Primorsky, Moscow, Vyborg, Krasnoselsky and Pushkinsky districts, along with the newly established state offices, more than 200 doctors continue to provide medical care in 20 Polis medical centers. When Alexander Beglov opened a new polyclinic in the Vyborg district, their number decreased. Children’s and adult “Policies” treated residents of St. Petersburg here for 8 years, the kindergarten was closed.

In 2024, the “Policies” working in the CHI began to be combined into 6 outpatient clinics with an increase in the number of “narrow” specialties in each, this allows patients to receive a full range of medical services all 7 days a week from 8:00 to 20:00. Three medical centers, in fact, have become polyclinics, which have doctors of almost all specialties and new diagnostic equipment, up to an X-ray machine.