Primary Care Development
Brian Murphy,
National Primary Care & Social Inclusion Manager
21st April 2012
Policy
Primary Care - Ireland
POLICY:
Quality and Fairness – A Health System for you – 2001
 Better Health for Everyone
 Fair Access
 Responsive and Appropriate Care
 High Performance.
Primary Care – A New Direction - 2001
 Sets out a plan for the development of primary care in
Ireland.
 Integrated, interdisciplinary, high-quality, team-based
and user friendly set of services.
 Delivered in the community by integrated
multidisciplinary primary care teams and primary care
networks.
HSE Structures
Current National Structures
Health Areas:
Directorates

The following seven areas will be the subject of a
Directorship:






Hospital Care,
Primary Care,
Mental Health,
Children and Family Services,
Social Care, Public Health and
Corporate/Shared Services.

Seven key individuals will be appointed as Directors, one of
the seven will be appointed as the Director General.

Re-organisation of the HSE at the directorate, regional and
local level in a manner which facilitates a smooth transition
from the current structure to the structures required under
UHI.
Service Delivery Model
Level IV
Tertiary Acute Services
Level III
Integrated Service Areas
(Including Secondary Care Hospitals)
Level II
Community Health &
Social Care Networks
Level I
Primary Care Teams
Home
Home
100,000-350,000
30,000-50,000
7,000-10,000
Patient
Primary Care Team
Development
Primary Care Team Development

Primary Care Teams mapped for the
entire country - 485 teams - targeted
be in place by end of 2012

Plan to create 128 Health and
Social Care Networks
Other
GP
PHN
Phy
SW
OT
HH
Core
Extend
ed
SLT
Current Status





End of March 2012 – 403 PCTs in place
(83% of Target)
Over 3,319 Staff working on functioning
Teams
Over 1,522 GPs participating on Teams
3,515 staff assigned to all Teams
Primary Care Teams in place provide
services for over 3.4 million of a
population
Rate of PCT Development
Network and Care Group
Services
Network Services & Linkages
Integrated
Services
PCT ‘A’
• Counselling
• Local
Multi
Agencies
• Child Protection
Hospitals
• Orthodontics
PCT ‘E’
PCT ‘B’
• Area
• Private
Providers
• Voluntary
• Psychiatry
PCT ‘D’
PCT ‘C’
• Dietetics
• Support
Groups
• Specialist
• Home
Help
• Other
• Alternative
Care
Each Primary Care
Team is planned to
be part of a wider
network known as the
HSCN.
Health & Social Care Network Services












Audiology Services
Psychology / Counselling Services
Podiatry Services
Community Health Medical Services (Area Medical
Officers)
Community Welfare Services
Dental Services
Dietetic Services
Ophthalmology Services
Environmental Health Services
Civil Registration Services
Community Development Services
Carers Services
Specialist / Care Group Services







Child and Family Services
Disability Services
Health Promotion Services
Mental Health Services
Older People Services
Palliative Care Services including
Hospice Service
Social Inclusion Services
PCT/HSCN Management
Current Management of PCTs/HSCNs




Historically organisational arrangements positioned &
managed directly employed staff in professional
disciplines which inhibited collaboration and the
provision of integrated services.
Currently HSE professionals working within PCTs /
HSCNs receive clinical and administrative supervision
through existing professional structures i.e. line
managers.
Certain professions, i.e. General Practitioners, Dentists
and Ophthalmologists are independent practitioners and
provide services to defined sections of the population.
Operational day to day matters - members of the team
nominate a team leader / chairperson/coordinator. He /
she acts as chairperson for clinical team meetings.
Emerging Roles

Three key new roles emerge:



Health & Social Care Network Service
Manager
Professional Discipline Lead
Primary Care Clinical Director
Chronic Disease Management
Clinical Programmes


Clinical Strategy and Programmes has been
established to improve and standardise patient
care throughout the organisation by bringing
together clinical disciplines and enabling them to
share innovative solutions to deliver greater
benefits to every user of HSE services.
The directorate has established a number of
National Clinical Programmes. The Programmes
are based on three main objectives




To improve the quality of care we deliver to all users
of HSE services
To improve access to all services
To improve cost effectiveness
GPs as Co-Leads of Programmes
Why focus on Chronic Disease





80% of GP consultations
60% of hospital bed days
2/3rds of emergency medical admissions to
hospitals.
8 of the top 11 causes of hospital admissions are
due to chronic diseases
5% of inpatients with a long-term condition
account for 42% of all acute bed days.

CDMP - 50% reduction in unplanned hospital
admissions as well as a 50% reduction in bed day
rates
Chronic Disease Management in
Primary Care

Most of the care of patients with chronic
conditions takes places within the primary
healthcare sector. This includes:




Diagnosis, treatment and rehabilitation of patients
with chronic conditions;
Early detection, assessment and follow-up
comprehensive medical treatment
Preventive activities including smoking cessation,
dietary advise and support of patients’ self care.
Estimated 15-16 million consultations in general
practice while approximately 1.9 million
consultations take place in out-patient
departments each year.
Chronic Disease Management





Cross directorate planning in delivering
integrated chronic disease programmes
Scoping of Chronic Disease watch
programme commenced in 2010
Guidelines developed on disease
management for 7 priority programmes
pertinent to Primary Care.
Development of Diabetes Care in 2012
Demonstration Models – 15 to 20 PCTs
Universal Health and Funding
Universal Health




The Programme for Government committed to reforming
the current public health system by introducing Universal
Health Insurance with equal access to care for all.
As part of this reform programme the Government is
committed to introducing Universal GP Care within the
first term of office of this Government.
Initially it is intended to extend GP cover without fees to
persons with defined long-term illnesses who are in
receipt of drugs and medicines under the Long Term
Illness Scheme.
Primary legislation is required to give effect to this
commitment. Once primary legislation has been
approved by the Oireachtas, the details of the new
arrangements will be announced.
Primary Care Funding



In line with the commitment in the Programme for
Government, additional funding of €20m has been
provided for in the NSP 2012 to fill as many
vacancies as possible and to expand existing
arrangements where sessional services are
provided by allied health professionals.
This will be increased to €25m if it can be
established that there is scope for further savings
of €5m in demand-led schemes.
The allocation of the extra posts will be subject to
approval by the Universal Primary Care Project
Team, which has been tasked with working
through the issues relating to the Programme for
Government commitments on Primary Care.
Primary Care Centres
Primary Care Centres

Existing Options:





Capital
Private Lease Agreement
34 new Primary Care Centres (PCCs),
accommodating 47 PCTs are operational
(lease arrangement or capital / exchequer
funding).
23 new PCCs planned for completion in
2012 or early 2013.
Working towards other solutions
Information Technology
Information Technology

Patient Management System





Procurement Options – Internal Development
(Prototype) or External Procurement
Electronic Referrals – HIQA Form
Healthlinks Pilot Referral Project
Unique Patient Identifier
GPIT Group
Patient Management System
Primary
Care Team
Physio IT System
OT
Phy
2w
a
com y HL7
Sta munica
nda
rds tion
Other IT System
Hospitals/Voluntary
etc
SW
GP
GP Patient
Management
Systems
HSE Patient
Management
System
OT IT System
Nurse
Other
Home
Help
Next Steps…

Continue roll out of PCTs









Staff reconfiguration
Engagement with GPs
Primary Care Centre Developments
Development of Performance Metrics
PCT Needs Assessments
Progress Integration with Acute
Develop Health and Social Care Networks
Roll out of Chronic Disease Management
Programmes & Demonstration Models
Develop ICT
Questions??