I propose to take Questions Nos. 424 and 425 together.
The implementation of the Primary Care Strategy is an essential component of the health service reform process. The key objective is to develop services in the community which will give people direct access to integrated multi-disciplinary teams of general practitioners, nurses, physiotherapists, occupational therapists and other allied health professionals.
The development of the Teams is a work in progress with enhancements occurring in terms of team membership and organisational delivery over time. At the end of December 2014, core Team staff amounted to approximately 3,000, providing services for almost 4 million of the population.
264.5 Primary Care Team posts (Public Health Nurses; Registered General Nurses; Occupational Therapists; Physiotherapists; and Speech & Language Therapists) were approved in 2013. 247 posts are now filled or start dates agreed. The recruitment process is continuing regarding the remaining posts.
On 8 October, the HSE launched the Community Healthcare Organisations Report. The Report sets out plans for a comprehensive reorganisation of health services outside the acute hospital system. The primary focus is to provide the maximum proportion of care to people in the communities where they live and to achieve joined-up, integrated services.
The present 17 Integrated Service Areas will be replaced by nine Community Healthcare Organisations, which will be part of the HSE. Existing resources will be reorganised into 90 Primary Care Networks, each serving about 50,000 of the population. Each network will be headed by an identified, accountable person responsible for care delivery by professionals such as nurses, therapists and social workers so as to meet a wide range of people’s needs in a joined-up way. There will be strong GP involvement and a focus on decision-making at local level. The new structures will also have a strong focus on building good linkages with the acute hospital system so that people’s care pathways are appropriately planned and their needs met in the right setting.
The implementation of the recommendations of the CHO Report, including the establishment of the CHOs and their management structures, has been listed as a key priority of the HSE’s National Service Plan for 2015. The HSE has appointed seven of the nine Chief Officers. The process is ongoing in relation to the remaining two posts.
There are currently 8 Community Intervention Teams (CITs) in place in Dublin North, Dublin South, Cork, Limerick, Tipperary, Clare, Carlow/Kilkenny and Galway. CITs work in partnership with Primary Care Teams, General Practice, Community Response Beds, community nursing, home support services, acute hospitals and other professional, voluntary and external providers to deliver enhanced services and patient centred care in the most appropriate setting. The CIT provides a rapid and integrated response to an appropriate patient with an acute episode of illness who requires CIT services for a defined/short period of time in the community/home, thus helping to increase hospital avoidance and earlier discharge from acute hospitals.
There are currently over 2,400 GPs providing services to 1,768,700 medical card holders and 159,576 GP visit card holders under the General Medical Services scheme. 90% of the population have access to GP out-of-hours services in 14 centres nationally, in all HSE regions, in at least part of every county.
The development of Primary Care Centres (PCC) to accommodate the HSE’s Primary Care Teams and GPs in the one location is a key enabler for the delivery of primary care services. There are three methods used by the HSE for the development of PCCs: Direct Build; Public Private Partnership (PPP) Programme; and Operational Lease. To date, there are 85 PCCs in operation (42 of which have opened since March 2011). There are currently 37 locations where primary care infrastructure is under construction or at an advanced planning stage.
In general, services provided in PCCs include: Public Health Nursing; Physiotherapy; Occupational Therapy; Speech and Language Therapy; Primary Care Social Work; Primary Care Counselling; Dietetics; and Podiatry. Some centres also provide additional services such as Minor Surgery, Mental Health services, Pharmacy and Dental services.
The Government is committed to widening access to primary care. This includes introducing, on a phased basis, a universal GP service without fees. This process has commenced in respect of all children under 6 years. The objective is to have universal GP care without fees for children under 6 years in place in Quarter 2, 2015, subject to the conclusion of the present discussions with the Irish Medical Organisation and the completion of a fee-setting process.
The Government is also prioritising GP care without fees at the point of access for persons over 70 years to coincide with the introduction of GP care without fees for children under 6. This will be facilitated under the existing GMS contract.
The HSE/Department and the IMO, under the Framework Agreement signed in June 2014, have also commenced talks on a new GP contract, with more substantive engagement scheduled for the coming weeks. A priority of these discussions will be the inclusion of chronic disease management for patients.
The HSE has identified an initial five Integrated Care Programmes for implementation in 2015, including the Integrated Care Programme for the prevention and management of Chronic Disease.
The National Integrated Care Diabetes Programme is being implemented on a phased basis. In 2013, the Government approved funding for the appointment of 17 Integrated Care Diabetes Nurse Specialists to support the phased roll out of the programme. To-date, 16.65 Whole Time Equivalent nurse specialists have been recruited.
Work is also underway in the HSE on an implementation plan for the National Clinical Programme for Asthma’s Model of Care.
The HSE’s 2015 National Service Plan (NSP) commits the HSE to roll out a pilot, to provide GP direct access to ultrasound, at approximately eight primary care sites, across the South and West, from early 2015. The pilot will aim to clear any existing hospital waiting lists for GP referrals to ultrasound.
The NSP also makes a commitment to pilot the provision of additional minor surgery services in agreed primary care settings and sites. This will contribute to a reduction in the waiting lists for minor surgery procedures in hospitals. The intention is to make this pilot service available in all of the HSE's Community Healthcare Organisations, ensuring local access for patients.
I am satisfied that the implementation of the above key measures will play a significant part in the refocusing of health services in line with the Government's health reform programme.
