Speech by Minister at launch of Primary Care Document

I´m delighted to welcome you to the launch of Primary Care: A New Direction, a key component of the new Health Strategy. It´s great that you were able to accept my invitation to be here for such an early start. I know that some of you will have been to the launch of Quality and Fairness: A Health System for You in the Mansion house. What we´re addressing today is central to that plan – so central, and so detailed as to require a separate publication and presentation.

The consultation process told us, early on, that while people may not use the term “primary care” services, they certainly know what they want. They want community-based, well-integrated, round-the-clock services that are easy to reach. They want themselves, their family members and their communities put right at the centre of care delivery.

That´s what today is all about.

Primary care is the first port of call for the majority of people who use health services. It can meet 90-95% of all health and personal social service needs. It is a vital public service.

25 years ago, the World Health Organisation, in a meeting in Alma Ata, (which I´m told is in Kazakhstan,) set out a broad, visionary definition of primary care. That definition is central what we´re launching to-day. The definition says primary care should

  1. Be an integral part of the whole health system as well as the wider social and economic development of community
  2. Ensure greater community participation
  3. Act as the first point of contact for health and social needs
  4. Be a process which also provides on-going care
  5. Be scientifically sound, practical and affordable.

Primary care, in summary, is the central part of the health system and should be “of the community for the community” To-day´s plan very much meets this view of primary care. It gives clear expression to the principle of people-centredness, one of the four underpinning the new Health Strategy. Primary care is about the day-to-day realities of peoples lives. It is the range of basic services which quietly provide the majority of health care for people in our towns and villages up and down the country. In discussions about health and the health services, it is easy to focus on the hospital sector– the tip of the iceberg, rather than primary care which is the large part of the iceberg below the surface.

We need to think of the whole iceberg- it is all one system. We need to recognise that development of primary care can have significant impacts on the burden placed on our hospital system- especially in the accident and emergency departments and the out-patients departments.

15-16 million visits to GP´s occur each year in Ireland compared to 2 million attendances at out-patients and A&E departments. A small shift in the number of people referred by their GP to a hospital could have a dramatic impact on the numbers being seen in out-patients and A&E. Developing primary care will provide a means whereby those conditions which require referral can be prevented or identified earlier. It will also allow many of those who are seen in the out-patient system to be discharged back to the care of their GP.

There is much to be proud of in our present primary care system. In recent surveys of public opinion and in our own consultation process, people reported very positively about their experiences of primary care. However, this is against a background of an increasingly difficult working environment for those delivering the service . Demands are great and keeping up with the pace of change has been difficult. The resilience of the primary care services in the face of these growing pressures has been remarkable. Staff working in primary health care have maintained high quality services, often in difficult circumstances.

Now, the government wishes, in partnership with them, to build on their success and to face the challenges that lie ahead. This will involve equipping primary care to meet the opportunities provided by technology and the increasing range of care required in the community.

We must, act together. Act together to deal with the increasing burden of work that will fall on primary care. Act together to integrate all primary care professionals into strong and well supported teams.

The level of integration and enhancement required will need to be supported through a programme of investment in the infrastructure of primary care. This means investing in premises, in new staff, in staff training and in information and communications technology. This will ensure that we end up with a co-ordinated, user-friendly, inter-dependent range of services in suitable locations.

In order to achieve this, we require improved human resource planning for primary care and we need to ensure that the provisions of, for example, the Bacon report on Current and Future Supply and Demand Conditions in the Labour Market for Certain Professional Therapists are applied to primary care as well as secondary care. WONCA, the World Organisation of Family Doctors outlined the role of a GP to reflect a broad holistic view. GPs, according to this view, have a responsibility to both the community they serve as well as the individuals within it. This very much fits the broad holistic view of primary care set out at Alma Ata.

But Alma Ata says that primary care is more than just general practice. Nurses and midwives will be centre stage in the Government´s drive to improve primary care. Nursing and Midwifery, in a primary care system, provide key competencies to enhance the health of the population and care in the individual´s home and community. Ms Mary McCarthy, the Department´s Chief Nursing Officer will be talking to us this morning about the forthcoming Strategy for Nursing and Midwifery in the Community. This Strategy will include public health nurses, community mental health nurses, midwives, practice nurses, registered general nurses and other specialist nursing groups. Its aim is to develop a framework for the further integration of nursing and midwifery in a primary care setting. This will include the potential role of advanced nurse and midwife practitioners.

Health care assistants, who act as support to nurse and midwives and home helps will also be key to primary care. They provide personal care for activities of daily living and support for household duties. Both health care assistants and home helps are integral to maintaining people with particular health and social care needs in their own home and facilitating early discharge from acute care.

Health and social care professionals like dieticians, psychologists, occupational therapists, physiotherapists, psychologists, social workers, chiropodists, counsellors and speech and language therapists have particular skills in primary care which could also reduce pressure on the hospital system. Therefore, we plan to employ adequate numbers of the professionals specifically to work in the primary care setting. No team can function effectively without administrative support. The plan for human resource development in primary care will address this. The role of a primary care administrator will be to supervise clerical and receptionist staff, to organise interviewing, deal with financial matters, to co-ordinate training and development and to deal with matters relating to employee law.

The community pharmacist will often be the first point of contact for minor illness but will also be involved in health education and promotion. They will also support the development and maintenance of practice formularies, provide advice on medicines to other members of the team, liase with hospital pharmacists and provide domiciliary visits where appropriate.

This strategy recognises the importance of dental health and dental health promotion in primary care. Dentists will therefore play an important role in the future of primary care.

The time is right for a major reform of the primary care services and the introduction of a team based approach to primary care. Many other countries are introducing similar reforms and there is a wealth of evidence which tells us that team based primary care is better for both patients and providers.

A range of services will be provided locally for all. People will be encouraged to enrol with a team and with a GP within that team. Services will be provided on an extended hours basis and out of hours services will be greatly improved. An example of how this can work is the recent success of the GP cooperatives in many health board areas. Right around the country, people will gain from the expansion in the number of GP co-operatives during 2002 – a key move in our Primary Care plan.

A properly integrated primary care service can lead to better outcomes, better health status, better cost-effectiveness. It can prevent or reduce the impact of conditions that can lead to hospitalisation. It can facilitate earlier release from hospital.

Therefore, in addition to expanding the number of GP co-operatives, we´re planning Primary Care one-stop-shops where teams, including GPs, nurses, midwives, social workers, occupational therapists, physiotherapists, home helps and several others, will work together.

These primary care centres will allow patients to refer themselves to individual services. They´ll offer 24 hour cover, and, because of their inter-disciplinary nature, will have a major impact on reducing the demand for specialist services. In Primary Care, what is planned is nothing less than a visionary innovation. The resources are in place to commence these significant changes in the primary care infrastructure. Nobody can disagree with either the urgent need to address the Primary Care issue or the central place it occupies in this Strategy. It quite simply is central.

In conclusion, I want to thank all those who have given their input into the development of the new model of primary care.

I would also like to urge individual professionals and representative bodies to become involved in the work programme to deliver the kind of primary care services which will work for all of us. Much of the detail has yet to be worked out. Implementation projects that will give us a chance to evaluate the different options need your input and feedback.

I firmly believe that the Government has a real responsibility to respond to the public´s analysis of what a modern health system should provide – a first class continuum of care, close to home and available around the clock. This plan – based, as it is, on wide-ranging consultation – provides the blueprint for that kind of primary care.

  • It can make a profound and positive difference to patients – and professionals.
  • To individuals – and teams.
  • It´s visionary – and practical.
  • It provides a continuum of care – and a worthwhile career path for every professional involved.

I look forward to working with each and every stakeholder to make it happen

Thank you.