Most care should be in primary system

A key HSE priority was that greater than 90 per cent of health care should be provided in primary care systems, Mr. John Hennessy, HSE National Director Primary Care, told the Conference.

A key HSE priority was that greater than 90 per cent of health care should be provided in primary care systems, Mr. John Hennessy, HSE National Director Primary Care, told the Conference.

Mr. John Hennessy, HSE National Director Primary Care
Mr. John Hennessy, HSE National Director Primary Care

Many services previously accessible in hospitals were now possible in local communities and central to the modernisation of the health service was the development of a greater range and volume of community based services to accommodate these changes.

Priorities which were now being worked on to deliver the commitment that 90 per cent of care would be provided in primary settings included:

  • Targeted investment to address gaps in key primary care services – e.g. chronic illness management, ophthalmology and diagnostics.
  • Improving the primary care infrastructure in the form of better Primary Care Centres and ICT enabled communications.
  • Extending the coverage of Community Intervention Teams (with an increased emphasis in the greater Dublin area) to facilitate hospital avoidance and resolve delayed discharge problems.
  • Facilitate the discharge of complex patients to primary care – this must be done safely and in accordance with clinical governance standards.
  • Providing for demographic pressures and demand-led growth in medical cards and local schemes.
  • Reducing costs in areas like generic prescribing for drugs and medicines and introducing reference pricing for commonly prescribed products.
  • Expanding programmes that worked in social inclusion such as the needle exchange and methadone replacement programmes and targeting specific funding to address disadvantaged groups and increasing levels of homelessness.
  • Reporting primary care activity in a way that fairly reflected the scale of the work.

Mr. Hennessy said the overall objectives were the positioning of primary care so that it fulfilled its potential as a central part of the health care system and was strong on productivity, results and achieving targets.

The National Directors were moving to a commissioning model, alongside a devolved and empowered delivery system.

He said many people in Ireland were affected by chronic diseases and disabilities related to poor diet, smoking, alcohol and substance misuse and insufficient exercise.  Lifestyle factors had the potential to jeopardise many of the health gains achieved in recent years.

We needed to shift the emphasis of the health system away from an “illness model” dependent on care in hospitals to a more balanced model where primary care services were strengthened and wellbeing promoted.

Mr. Hennessy said that by the best reckoning primary care and social inclusion provided services to about 3.5 million people each year.

The primary care portfolio included primary care, PCRS, the GP out of hours service, social inclusion, civil registration, oral health and medicines management.

This included responsibility for an annual budget of approximately €3 billion and over 11,000 staff.  The PCRS accounted for a range of services through 6,600 primary care contractors and 12 community health schemes.

He said the management of quality, safety and governance would be critical elements of the emerging healthcare system and the National Directors were moving to a commissioning model, alongside a devolved and empowered delivery system.

A successful system would see primary care managing the majority of patients who required a routine straightforward level of urgent or planned care, with treatment being delivered at home or a close to home as possible.  Hospital and specialist services managing the minority of patient who required emergency and complex planned care, where the relevant expertise is concentrated and long stay providing residential care for those who needed it.

“The obvious priority is to have all services working a single integrated system and for patient journeys through the system to be as seamless and as delay free as possible.”