Address by the Minister for Health and Children, Mr. Micheál Martin T.D., at the launch of the Progress Report on implementation of the Primary Care Strategy

I am delighted to be here with you this afternoon to launch the Progress Report on Implementation of the Primary Care Strategy. The Report has been produced by the National Primary Care Steering Group and provides an overview of progress to date since the publication of the Strategy, Primary Care: A New Direction, in November 2001.

Primary Care: A New Direction sets out a new vision for primary care in Ireland. This vision was shaped by the clear message from the users, and indeed the providers, of primary care services, who told us exactly what a modern health service should provide – a first class continuum of care that is close to home and available around the clock. This strategy provides the blueprint for the delivery of that kind of care, promoting a team-based approach to the provision of a fully integrated primary care service.

I would like to take this opportunity to acknowledge the high quality of the services already provided by those working in primary care. This is borne out by the high satisfaction levels recorded in formal surveys among people who have actually used the services. Those who work to plan and provide primary care services can rightly be very proud of the favourable regard in which the public hold these services. I believe that this is testimony to the professional commitment and the hard work of those working within the system, who have maintained high quality services and have earned the respect and praise of the communities which they serve.

However, no system is beyond improvement, and those who work in the sector are especially well placed to see the enormous potential offered by the primary care strategy that is to build upon our current strengths and develop a world-class primary care service.

The Strategy clearly acknowledges that there is a significant need to expand capacity in primary care. However, simple assertions that the implementation of the Strategy is primarily about injecting additional funding do not reflect the reality within the health system in terms of the “state of readiness” for multidisciplinary teamworking. There is a range of complex and multi-factorial issues which need to be addressed during the implementation process.

It was in recognition of the Government´s partnership approach to the development and implementation of health policy and to addressing the practical aspects of implementation that I established the National Primary Care Steering Group in June 2002, to contribute to the further development and implementation of primary care policy. The Group includes a broad representation from the medical, nursing, health and social care professions, the community and voluntary pillar and service users, the statutory agencies and other service providers.

I would like to express my appreciation for the work of the Group to date, which is reflected in todayÂ’s publication of this Progress Report. I would like in particular to thank Professor Ivan Perry for his contribution and commitment as Chairman of the Steering Group. Under his leadership the Group has worked effectively to produce several very worthwhile inputs to the continuing development and implementation of the integrated and multidisciplinary model of primary care. I appreciate also that the members of the Steering Group have many other demands on their time and I would like to acknowledge the commitment they have made to participating in the GroupÂ’s work despite their busy schedules.

I recognise that the full implementation of the Primary Care Strategy will require significant investment, over a sustained period, in order to expand capacity and enable primary care to fulfil to the maxmum its role as the cornerstone of our health system. I wish therefore to take this opportunity to reiterate the GovernmentÂ’s commitment to the implementation of the Primary Care Strategy.

It has always been acknowledged that change of the magnitude described in the strategy would not be accomplished overnight, and indeed it would be inappropriate to seek to implement radical change in such a manner. The Strategy sets out an implementation plan which recognises the extent of the change required to successfully establish the new model as the key element in the delivery of a modern health service. In formulating the Strategy, we intentionally set out to move beyond short-term thinking and to create a longer-term plan with clear goals and action points to guide day-to-day and year-on-year decision-making over a ten year implementation period.

In the course of implementing the strategy, we are examining a range of different approaches to developing service delivery and also to encourage and facilitate the provision of modern, well-equipped, user-friendly buildings from which the broad range of primary care services, including general practice, can be delivered.

Currently any teams being established involve combining health board-delivered services and personnel with those of independent contractors, principally general practitioners. Enabling primary care teams to be established in a number of structural formats would provide a variety of means to deliver on the strategy in a way that would support and facilitate the creation of cohesive and integrated primary care teams. Among the options we intend to examine is whether primary care teams might be established as individual functional entities, with appropriate legal and contractual provisions to ensure that they meet the identified needs of the population served.

As regards the provision of facilities, while the State may contribute towards such developments, because of the scale of what will be required, it is necessary to explore a range of different approaches. We wish to encourage innovative approaches that have the potential to result in the provision of appropriate facilities on a widespread basis. Such approaches might, for example, involve independent developers, or groups of health professionals, possibly in partnership with the statutory health authorities, developing facilities for the delivery of integrated primary care services. Partnerships with providers in the voluntary and community sectors will be explored, as will inter-agency initiatives such as integrated public services centres.

The Health Service Executive will bring a single national focus to the implementation of primary care policy. I know that the Primary Care Steering Group has recognised the great importance of the Health Service Reform Prgramme as a key enabler for the Primary Care Strategy and that last autumn it submitted a range of key recommendations as a contribution to the process of developing the new structures.

The Interim HSE has established a change management team, drawing on expertise from people across the health system (including a number who have been members of the Primary Care Steering Group or Task Force). This team is currently planning the transition to a single delivery system in January 2005 and designing the new HSE management structures, which will support and facilitate the progressive rollout of the primary care team and network model in the system in the years ahead.

I fully appreciate that moving to the multidisciplinary model of service delivery poses challenges both for health professionals and those charged with managing the services. Sometimes change can be seen as threatening and, while we may recognise the overall benefits which will accrue, we may be reluctant to embrace a genuine shift from our traditional way of doing things. This is natural and I recognise that, but change is necessary if we are to deliver on the potential and the promise of the Strategy. I would therefore like to take this opportunity to acknowledge the commitment of the frontline primary care professionals and health board management who have shown their willingness to adopt new ways of working in agreeing to be part of the first ten primary care implementation teams.

I know that members of these first teams are present for todayÂ’s launch and I have been very pleased to see the steady progress in each location over the past eighteen months. A number of teams are now providing new and improved services to their target populations and we are starting to see the benefits for both patients and service providers that were envisaged at the outset of the strategy.

The projects are intended to be a demonstration of the primary care model in action and to allow the practical steps needed to establish a successful primary care team to be worked through in a real way. Our commitment from the outset was to further refine and develop the model by drawing on the experience gained from the initial implementation phase. Learning from these projects will continue to inform the process of wider implementation, particularly in the context of the Health Service Reform Programme.

One of the major lessons we have learned to date is that primary care teams do not simply “happen”. Development supports are needed to assist the process of team formation and agreement on the practical steps that need to be taken to establish a fully-functioning team. In order to support this aspect of the process, my Department engaged the Office for Health Management to provide a programme of supports to the development of the initial teams. This has included supporting the development needs of the project managers, a teamworking support programme for the teams and, jointly with the Irish College of General Practitioners, a workshop which enabled the GP members of the teams to explore the issues of particular concern to them. I would like to express my appreciation of the work of the Office for Health Management and the Health Service National Partnership Forum in supporting the implementation process.

The first implementation projects are, of course, only one of the first steps towards making multidisciplinary primary care system-wide. The Strategy acknowledges that a significant component of the development of primary care teams must involve the reorientation of the substantial staff and physical resources currently within the primary care setting. In order to build towards this objective, the health boards are already working to support the development of team and collaborative working in the existing primary care services. They are also mapping, having regard to issues which include demographic, socio-economic and epidemiological factors, where existing service are located, the number and general configuration of future teams and networks, and the human resources and other capacity developments needed to support their formation into the future.

The Strategy will not succeed if it is seen as something which is being “imposed” by Government. It is crucial that those in positions of influence, both within the professions and those charged with organising and managing services, provide consistent leadership and commitment over the long term, and also work together to develop practical solutions to some of the complex operational aspects which need to be addressed.

The Primary Care Steering Group has exemplified this spirit of co-operation and communication between health professionals, service users and managers which is an intrinsic part of the new primary care model and which must be sustained in order for it to develop and flourish. I am very pleased to officially launch this Progress Report.

The National Primary Care Steering Group – Progress Report is available (PDF, 835K)