Primary Care in IrelandPolicy in TransitionAisling GannonPartner & Head of Healthcare Eversheds
History and chronology at a glance1978:• International Conference on Primary Health Care: International declaration underlining the importance of primary health care.1999:• WHO members adopted the principle of primary health care being key to “health for all”, requiring “innovative partnerships, unifying policies”.
History and chronology at a glance2001:• “Primary Care – A New Direction” - Irish strategy.2011:• Minister Reilly - “Reforming the Health System”, he hopes to see greater progress (in the area of primary care) during his time in office.• Minister Shortall – Confirms that the development of Primary Care Teams (“PCTs”) and Primary Care Services are a priority under the programme for government.
WHO:Target 15 - 2010• “By the year 2010 people in the region (Europe) should have much better access to family and community–oriented primary health care, supported by a flexible and responsive hospital system.In particular:15.1 at least 90% of countries should have comprehensive primary health care services, ensuring continuity of care through efficient and cost-effective systems of referral to, and feedback from, secondary and tertiary hospital services;
WHO:Target 15 – 201015.2 at least 90% of countries should have family health physicians and nurses working at the core of this integrated primary health care service, using multiprofessional teams from the health, social and other sectors and involving local communities;15.3 at least 90% of countries should have health services that ensure individuals’ participation and recognises and supports people as producers of health care”. - Health 21
WHO:Primary Care strategy at a glance• “…the only sensible way out of the present quandary is to ensure a more integrated health service system where PHC is equipped to solve all problems that can be effectively dealt with at that level, while hospital care is reserved for those that cannot”. - Health 21
WHO:Primary Care strategy at a glance• “The full potential of PHC to reduce the numerous unnecessary admissions to hospital has certainly not been realised. In many countries hospitals continue to dominate health care, often treating patients who could and should be better treated at the community level. Although in theory they can offer facilities not only for the rapid admission of patients from PHC but also for their return to that level, this often does not happen properly in practice”. - Health 21
Ireland 2011 – strategy at a glance 210 PCCs 527 PCTs Primary Care Team “PCT” Primary Care Team “PCT” Primary Care Team “PCT” (serves population (serves population (serves population of c.7,000 – 10,000 of c.7,000 – 10,000 of c. 7,000 – 10,000 patients) Patients) patients) 137 HSCNs Health & Social Care Network (“HSCN”) Serves population of c. 30,000 each
Who?• Developers, investors, business managers, financial investors clearly already support the concept of PCCs.• It is the GPs we still need to convince to come together in PCTs/PCCs.
What?• What we must do is develop our national policy and strategy in line with and in consultation with our GPs.
When?Now – starting today• The economic climate must be viewed as an opportunity. An opportunity to rethink the way forward.• Upcoming budget and end of calendar year, rethink policy for 2012.• Medical Council – competence rules (effective May 2011).
Where?Nationwide• Each PCT serves a population of c.7,000 – 10,000. Each HSCN serves a population of c. 30,000• Apparently, to date the HSE states: There are only 32 PCTs complete and in operation There are only 16 PCCs open under the leasing agreement.
How?• Albert Einstein defined insanity as doing the same thing over and over again and expecting different results.• We must engage appropriately and professionally to support and induce GPs to lead the next phase of this strategy.• Some suggestions… …
Some suggestions:a) Potential for alternate GP contracts – those in PCTs and those not.c) Potential to consider linking patient lists to patient audits and patient outcomes, in favour of PCTs.e) Managing CPD requirements collectively through teams in PCCs.
Some suggestionsa) Review proposals with banks, investors and GPs regarding potential for equity risk sharing (i.e. alternatives to 25 year HSE leases).c) Licensing, regulatory and accreditation developments likely to be easier if managed by PCTs/PCCs.• There is no quick-fix solution. We must all work together. It will be worth it