Speech by the Minister for Health and Children, Micheál Martin T.D., at the first meeting of the Primary Care Steering Group

I am delighted to be here with you this morning as the Primary Care Steering Group commences its work.

The Primary Care Strategy, Primary Care: A New Direction, which is a central element of the Health Strategy as a whole, represents a radical change in the way in which primary care services will be planned and delivered. The Government is fully committed to the implementation of this Strategy and this is specifically reflected in the new Programme for Government recently agreed. We are committed to achieving this by working in partnership with the stakeholders involved. The establishment of this Steering Group, with its wide representation of the many stakeholders involved, including the professions, the statutory and voluntary sectors and the clients of the services, is evidence of our commitment to a partnership approach.

I would like to express my appreciation of your willingness to take part in the important work of the Steering Group, as I realise that you all have many other demands, both professional and personal, on your time. However I think you will all agree that this is a particularly important body, given the crucial role which it will play in developing plans for the detailed implementation of the Primary Care Strategy. I would like in particular to thank Professor Ivan Perry for accepting my invitation to chair the Steering Group. I hope that you will give him the support and co-operation necessary to ensure that the Group functions effectively in delivering on its remit.

The Primary Care Strategy represents one of the most significant developments ever proposed for primary care in Ireland. It clearly recognises the central role of primary care in a modern health system and that the health care needs of the vast majority of people should be capable of being met by primary care services. It is important to bear in mind that the production of the National Health Strategy, and this Primary Care Strategy as a major element within that, followed a very detailed process of public consultation. Individuals, professional groups, disciplines, voluntary organisations and state agencies all contributed significantly to the development of the Strategy. A process of partnership and consultation will also inform the process of implementation and that is what lies behind the convening of this sizeable Steering Group for the Primary care Strategy.

The Strategy provides for an inter-disciplinary team-based approach to primary care provision. In addition to general practitioners, primary care teams will include nurses and midwives, health care assistants, home helps, physiotherapists, occupational therapists, social workers and administrative personnel. A wider primary care network of other primary care professionals will also provide services for the enrolled population of each primary care team. By bringing this wide range of service providers together in primary care teams, integrated services can be delivered in the community in the most appropriate and accessible way.

There is a wealth of evidence that team-based primary care is better for both patients and providers. Many other countries are introducing or have already introduced similar reforms and their experiences will help to inform the implementation of our Primary Care Strategy as we move forward with its implementation.

The Strategy, while setting out the key principles which will govern the restructuring and development of primary care, does not spell out in detail how the new structures will operate. It will therefore be necessary to consider carefully a wide range of implementation issues in relation to, for example, patient enrolment, the achievement of effective integration within primary care system and between primary and secondary care services, the delivery of certain services on an out-of-hours or extended-hours basis and improving access for primary care teams to diagnostic services. As part of the process of addressing these and many other issues, I am asking this Steering Group to give national leadership and guidance in the following areas:

  • defining a broad set of primary care services to be delivered by primary care teams
  • the development of quality systems, including the development of performance indicators, in primary care service delivery
  • identifying models and locations for the establishment of academic centres of primary care as a source of policy and practice advice to the Department of Health and Children, health boards and other bodies as appropriate
  • the development of a national framework for integration within primary care and between primary and secondary care

The Steering Group will also be able to provide policy advice to the Department of Health and Children, health boards and other bodies as appropriate. It will also be required to provide an annual report outlining the progress of the implementation of the primary care strategy. I am confident that, this Steering Group, which can draw on a wealth of practical experience in the development and delivery of primary care services, will play a major part in informing and supporting the implementation process.

The Primary Care Strategy sets out an action plan and a timetable for its implementation, spanning the period up to 2011. This implementation period recognises that there are major structural changes which must occur in order for the new primary care model to be implemented. It is also necessary to ensure that the required numbers of health professionals are trained and retained in the system over the coming decade and beyond to meet anticipated needs.

Earlier this year, I established a small Task Force of personnel drawn from my Department and from the health boards. The role of the Task Force will be to focus on driving the implementation of the team-based primary care model and the other elements of the Primary Care Strategy. To achieve this, the Task Force will work closely with the Steering Group and much of its work will involve giving effect to the conclusions reached in the Steering Group. The two bodies will be able to agree, I am sure, on the most effective working arrangements so that these objectives can be met.

I am pleased to note that the Task Force has already initiated the process for the achievement of a number of the initial objectives which, under the Strategy, are to be achieved in 2002 and 2003.

One of these initial priorities is the establishment, in representative locations around the country, of implementation projects so that different options for service delivery can be evaluated. The Task Force has already begun the process of inviting proposals which will give effect to the service delivery model described in the Strategy. By developing a number of these projects at an early date, we will be able to demonstrate how the model will work in practice. We will also be able to explore the many practical issues which arise in terms of such issues as working together as a team, the governance of primary care teams and ensuring that communities have an effective input into the process of deciding the nature of the services to be provided by specific teams.

There are many other areas where planning and development will be needed in order for the new primary care model to work as intended, such as in the provision of the necessary human resources, information and communications technology and capital infrastructure. Health boards have commenced the process of preparing needs assessments, to enable the required configuration of services on a regional basis to be determined.

In the past we have not always planned adequately for the future human resource needs of the health services, with the result that the numbers of health professionals available have not kept pace with our needs. The needs assessments will enable the human resource requirements of the new model to be determined, so that manpower planning for the decades ahead can be directed at meeting those requirements on a planned and structured basis.

Clearly, there is a lot of detailed work to be done in order to give expression to the principles enunciated in the Strategy. As I have said, the Strategy does not spell out in detail how precisely every element of the model will operate, or how every step of the implementation process will be given effect. There is scope, therefore, for you to have a major and constructive input into the development of the implementation plans in the months and, indeed, the years ahead. I look forward to this Steering Group exploring the many issues which arise and giving national leadership as we move forward with the implementation process.

I would like to thank you again for agreeing to participate in the important work of the Steering Group and I wish you well in your work over the period ahead.