I propose to take Questions Nos. 217 to 219, inclusive, together.
It has been policy of successive Governments that primary care should be the central focus of the delivery of health and personal social services and this remains the direction of travel. In order to achieve a more balanced health service the vast majority of patients and clients who require urgent or planned care should be managed within primary and community-based settings. This must be achieved while ensuring that services are cost-effective, safe and of the highest quality, and also well-integrated and aligned with relevant specialist services. Significant steps have already been taken to extend the range of services provided in the primary care setting as well as, in the current year, extending universal access to GP care without fees to all children aged up to five years of age and all adults aged 70 or over.
Primary care teams and networks located on the same site in a Primary Care Centre or in very close proximity in convenient, accessible, locations offer individuals and families the opportunity to avail of ‘one stop shop’ primary care services and a greater range of health and social services in one location. They also afford team and network members increased access to colleagues and the opportunity to work in a more integrated way. The HSE is continuing the delivery of Primary Care Centres (PCCs). To date, there are 90 Primary Care Centres in operation, 47 of which have opened since 2011. These Primary Care Centres complement the existing network of smaller Health Centres around the country and a variety of privately-owned GP and primary care premises which are used to facilitate delivery of publicly-funded care to patients. The next phase of the programme is to deliver an additional 52 Centres over the next three years as follows:
- Under the Public Private Partnership method, the contract for the provision of 14 PCCs has been awarded and it is expected that construction work will commence before the end of 2015, with the centres expected to be completed in 2017.
- Under the Operational Lease method, in November 2014, the HSE advertised an additional 73 locations for delivery of Primary Care Centres by Operational Lease. The HSE is at an advanced stage of negotiation with developers in 24 new locations where Agreements for Lease have been entered into.
- Through the Exchequer Funded/Direct Build method, there are currently 14 additional locations where construction is underway or the centres are at advanced planning stage.
The range of services provided through primary care centres varies according to local circumstances, which include the needs of the community served. Amongst the core services concerned are primary care team services such as those of general practitioners and their practice staff, general nursing, public health nursing, physiotherapy, occupational therapy and social work. A wide range of other services are provided in these settings and may include child health developmental clinics, dental care, dietetics, community ophthalmology, podiatry, psychology, maternity/paediatric outreach services, adult and child/adolescent mental health services, psychiatry of old age services and counselling and addiction services. Primary care centres can also support other public services and communities generally by having meeting facilities that facilitate cross-sectoral working and support to a range of community-based organisations.
Enhancements of service which are being implemented and which already enable patients to receive specific elements of care in the primary care rather than the hospital setting include:
- the appointment of Integrated Diabetes Nurse Specialists who support diabetics in the management of their condition;
- the recent commencement of a diabetic Cycle of Care for GMS patients whose doctor deems them suitable for this service;
- the provision, for children aged under six and who are diagnosed with asthma, of periodic checks to assist in the management of the condition;
- the provision of diagnostic radiological services in some PCCs, with access being further enhanced in 2015 with the provision of prioritised access to diagnostic ultrasound services via an external provider at six locations nationally, providing in excess of 16,000 scans per annum;
- the commencement in 2015 of new minor surgery services in 20 primary care locations. In a full year it is estimated that 10,000 procedures can be provided in the primary care rather than hospital setting.
There is potential for further expansion of the range of care provided on a multidisciplinary basis in primary care and the current negotiations on a review of the GMS GP contract will include consideration of such matters.
There are now ten primary care-led community intervention teams, CITs, in operation. These focus on both hospital and admission avoidance and also in facilitating early discharge of patients from hospital. Areas currently served are Dublin North, Dublin South, Kildare, Louth, Meath, Wicklow, Carlow/Kilkenny, Midwest (Limerick, North Tipperary, Clare), Cork and Galway. A new CIT service will be commence in Waterford in the coming weeks. Many of the CITs operate from PCCs and liaise closely with health professionals based at these centres. At any one time, there are over 200 patients in receipt of CIT services in the community who would ordinarily have been in hospital.
There is no doubt but that the developments in primary care which I have outlined above are strengthening the capacity of this sector to meet the healthcare needs of our growing and ageing population. It is of course important to view these advances as merited in their own right and not primarily a response to or a solution to the pressures experienced in the acute hospital services.
