Speech for Micheál Martin T.D, Minister for Health and Children for the opening of the Irish Nurses Organisation Special Discussion Forum on the Primary Health Care Strategy from Vision to Action

On the 28th November 2001 a number of you here today accepted my invitation to attend the launch of Primary Care: A New Direction, exactly three months later I am delighted to be here to open this timely discussion forum on moving from vision to reality.

Introduction to the model

As you know, 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 set out a broad, visionary definition of primary care. 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.

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.

Many of you here to-day are involved in providing primary care services and there is much for you to be proud of in our present 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 of you delivering the service . Demands are great and keeping up with the pace of change has been difficult.

Now, the Government wishes, in partnership with you, to build on your 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.

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 education and 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.

Importance of Primary Care

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.

The vision for an integrated primary care service is outlined in Quality and Fairness: A Health System for You. Primary care is the first of the six frameworks for change set out in the health strategy, which rebalances the emphasis from secondary care to primary care and from hospital care to community care. These concepts are outlined in more detail in Primary Care: A New Direction.

This Primary Care Strategy gives clear expression to the principle of people-centredness, which is one of the four underpinning the new Health Strategy. Team approach.

Many countries have now acknowledged that primary care should be the cornerstone of modern health services by preparing strategies that have highlighted the importance of a team-based approach. The Government is committed to strengthening primary care through the development of primary care teams. This will develop the necessary capacity to ensure that primary care can contribute further to the health of the population.

Primary care teams will operate in one-stop-shops where teams, including GPs, nurses, midwives, social workers, occupational therapists, physiotherapists, home helps and several others, will work together.

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. These primary care centres will allow patients to refer themselves to individual services, including nursing and midwifery services. Services will be provided on an extended hours basis and out of hours services will be greatly improved and, because of their inter-disciplinary nature, will have a major impact on reducing the demand for specialist services.

The recent success of GP co-operatives in many health board areas will be built on by the development of primary care co-operatives which will depend on making other professionals available on an out-of-hours basis.

Team members

In order to achieve this, we require improved human resource planning for primary care. The term “primary care” is often used synonymously with “‘general practice” (GP). However, it is broader than general practice alone. Therefore, 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.

Nurses and midwives are well prepared for the increasing emphasis the Government wishes to see given to illness prevention and health promotion at community level. This is a key component of Primary Care: A New Direction.

Nurses and midwives have experience in forming partnerships with individuals, families and communities in many community settings. However, I recognise that delegated medical authority can sometimes confine nursing to an assistant role and may preclude collaboration and may prevent full potential of the role of nurses and midwives being realised within a primary care team setting. This is a challenge that we must overcome.

No one discipline holds the solution to delivering effective primary care. As nurses and midwives, you have an opportunity to examine your traditional roles and titles to ensure that you develop the primary care roles that directly meet the needs of the communities you serve. Both generic nursing and midwifery skills and specialist nursing and midwifery competencies should complement the work of the integrated health care team.

Health care assistants, who act as support to nurses 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, speech and language therapists and community pharmacists have particular skills in primary care which could also reduce pressure on the hospital system. Therefore, we plan to employ adequate numbers of these professionals specifically to work in the primary care setting. No team can function effectively without administrative support. Our plan for human resource development in primary care will address this.


Primary care: A New Direction is a comprehensive and ambitious Strategy. It provides a blueprint to guide policy makers and service providers. It will enable primary care to develop the capacity to meet the challenges with which it is faced such as ageing of the population, earlier hospital discharge, care in appropriate settings as well as the opportunities afforded through modern information and communications technology.

There is now a unique opportunity for nurses and midwives to establish comprehensive, community based practice models of primary care which could contribute to more co-ordinated nursing services as part of the primary care team.

Action 20: Nursing and Midwifery in the Community

Nurses and midwives are central to making the vision a reality. This central role is reflected throughout the strategy but expressed explicitly in Action Number 20 – the development of a National Strategy for Nursing and Midwifery in the Community.

Action number 20 may be last on the list but is by no means last on the priority list. The National Strategy for Nursing and Midwifery in the Community is due to be published by the end of this year.

The process for the development of this Strategy embraces the concepts of Primary Health Care. Consultation with and participation of all interested groups, including nursing and midwifery groups and other health and social care professionals has been part of the strategy since the beginning.

Under the direction of the Chief Nursing Officer, Mary McCarthy a multisectoral/multidisciplinary Strategy Steering Group was established in November. As luck would have it, this group met for the first time three months ago on the same day as the launch of Primary Care: A New Direction.

A small multidisciplinary project team based within the Nursing Policy Division at the Department of Health and Children is responsible for the day-to-day operation related to the strategy.

We have much to be proud of in terms of nursing and midwifery generally. With regard to community, we have the foundation of a service that is the envy of many throughout the world. Equity and health has become an international priority and nurses and midwives are recognised as central to delivering on this agenda. To ensure equity of opportunity, resources and services, we need sound population information. While our neighbours in Northern Ireland and Britain and further a-field try to create mechanisms to link nurses and midwives more closely with populations and communities, our system is strongly embedded in a population focus. This provides us with a foundation on which to build an effective and efficient community nursing and midwifery service.

Building on this foundation presents a challenge that will require vision, courage, and lots of hard work.

The report of the Commission on Nursing identified the lack of a shared vision for nursing in the community as a major weakness in developing the current service. If we are to deliver on our vision of a health service for all – we all face a challenge of ensuring that our services are accessible and focussed on the needs of the community.

Last December, over 90 people from a range of different backgrounds including many from nursing and midwifery, came together for two days to formulate a vision for nursing and midwifery in the community. Testament to the truth of the adage on “free lunches” participants at the December meeting generated a huge amount of material and have provided a strong foundation on which to build the strategy.

The resulting working vision for nursing and midwifery in the community sits very comfortably with Primary Care: A New Direction. It has a population focus, places the community at the centre, emphasises equity, team work, and community development, and recognises the home as an important location for practice.

Participants at the December meeting also identified a number of key areas that need to be addressed to make this vision a reality. The priorities include practice, education and structure and three small working groups have been established to further develop these.

Reflecting the importance of wide consultation and participation in the development of the strategy written submissions have also been invited. Members of the strategy project team and steering group are facilitating a number of nationwide consultation meetings. Meetings with nursing and midwifery personnel are being co-ordinated through the regional Nursing and Midwifery Planning and Development Units.

A website for the strategy was launched this month. This website provides background information and regular updates on the Strategy. It also provides an opportunity for electronic submissions.

Action 1: National Primary Care Task Force

Now that I´ve dealt with Action 20, I want to fill you in on the state of play regarding Action 1.

The National Primary Care Task Force represents a strategic way to bring together the expertise necessary to ensure that all the essential elements in the primary care team can be recognised and incorporated into the best delivery of primary care services. The task force will have an extremely important role in not only bringing together all the stakeholders in a consultative and participative way but ultimately, it will be judged on the change it brings to the primary care process in this country.

In this regard I believe that it is vitally important to get the mix of the task force right from the beginning. The members of the task force are being identified at present and will be in place in the very near future. I look forward to the input that your members will make to the work of the task force and I envisage that at least one of its members will be a nurse.

As you know, the task force will work closely with a steering group on primary care. This group will include representation from the other stakeholders, including members of disciplines who cannot be accommodated on the task force and representatives of the community to be served.


In June 2000, my colleague Minister Hanafin attended the WHO European region Ministerial conference on Nursing and Midwifery in Munich. The conference concluded with the signing of a declaration which described nurses and midwives as a force for health.

I urge you to harness that force by seizing the opportunity to create an equitable and sustainable community health system by making Primary Care: A New Direction a reality.

I would like to conclude by wishing you every success today and into the future and to congratulate you all for embracing the Primary Care Strategy so positively.