This Government is committed to reforming our health system and, in particular, to enhancing and expanding capacity in the primary care sector.
There has been significant progress on many of the recommendations in the 30th Dáil's Joint Committee on Health and Children Report on "Primary Care in the Community", including the following:
The number of GP training places has been increased from 120 to 157 per annum.
The Irish College of General Practitioners and the HSE are working towards developing a fast-track training scheme for doctors who have extensive experience in General Practice, but who lack some component of training making them ineligible to hold a General Medical Service (GMS) contract (there are some 250 doctors in this position).
The Health (Provision of General Practitioner Services) Bill 2011 provides for the elimination of restrictions on GPs wishing to obtain a contract to treat public patients under the GMS Scheme. This new legislation will allow many young, highly qualified and vocationally trained GPs who currently have great difficulty in obtaining a GMS contract to apply for contracts.
At the end of October 2011, there were 401 Primary Care Teams operating, with almost 3,000 staff members (including nurses, occupational therapists, physiotherapists, speech and language therapists, social workers, dieticians, psychologists, home helps, health care assistants, community mental health nurses) and 1,521 GPs participating. The following table gives a breakdown of these figures by HSE Area.
HSE Area
|
No. of Teams in Place
|
No. of GPs Participating
|
No. of HSE Staff on Teams in Place
|
Population Covered
|
Dublin Mid Leinster
|
117
|
428
|
1,082
|
945,217 (78%)
|
Dublin North East
|
85
|
241
|
542
|
647,520 (70%)
|
South
|
104
|
437
|
542
|
807,265 (75%)
|
West
|
95
|
415
|
804
|
851,269 (83%)
|
Total
|
401
|
1,521
|
2,970
|
3,251,271 (76%)
|
Approximately 60% of the Primary Care Teams include mental health personnel or have direct linkages with mental health services.
A Framework document to support community participation and service user involvement through Primary Care Teams and Health and Social Care Networks has been developed.
Modern, well-equipped Primary Care Centres (PCCs) are central to the effective functioning of Primary Care Teams. They allow multi-disciplinary services to be made available on a single site, provide a single point of access for users and encourage closer coordination between health providers. 17 PCCs have opened to date under leasing arrangements together with a further 15 funded by the Exchequer. The new centres will greatly assist in the provision of modern services, in particular chronic disease management by multi-disciplinary teams.
The Capital Investment Framework 2012 -2016 published earlier this month is evidence of this Government's commitment to the health sector. In a time of fiscal consolidation, the Government has provided substantial funding to support critical health infrastructure development, including additional Primary Care Centres. The funding for primary care will ensure that, in addition to private sector investment, primary care centres will also be provided by the State through a combination of converting existing HSE-owned premises, acquisition of premises and greenfield construction. State funding will be targeted at disadvantaged areas with the greatest health needs. An accommodation needs assessment for Primary Care Centres is currently being finalised by the HSE.
Access to GP care without fees will be extended in 2012 to persons covered by the Long Term Illness Scheme and in the following year to patients who receive medicines under the High Tech Drugs Scheme. Access to subsidised GP care will be extended to all in the next phase and universal access to GP care without fees will occur in the final phase. The delivery of universal primary care will require the recruitment of additional doctors, nurses and other primary care professionals. A consultancy study commenced in October 2011 which aims to develop a model of demand for and supply of GP and practice nurse services. The study entails a number of elements including:
An estimation of current utilisation rates of GP and practice nurse services, including a breakdown by geographical area to the degree that is supported by the available data;
A projection of the effect on utilisation/demand for GP and practice nurse services of demographic change including population ageing and epidemiological trends;
An assessment of any mismatch between demand and supply; and
A sensitivity analysis assessing the effect on matching demand and supply of adopting alternative demographic and epidemiological assumptions.
The Programme for Government also provides for the introduction of a new GMS contract with GPs with an increased emphasis on the management of chronic conditions, such as diabetes and cardiovascular conditions. It is envisaged that the new contract will also focus on prevention and will include a requirement for GPs to provide care as part of integrated multi-disciplinary Primary Care Teams.