The publication last week of a report on primary healthcare by the Oireachtas Committee on Health and Children is an opportunity to assess progress on a key element of the Health Service Executive’s (HSE) transformation plan for the health service. In 2001, the primary care strategy set out a vision for the development of a network of primary care teams throughout the State. Some 95 per cent of patients’ needs were to be delivered in the community by teams comprising doctors, nurses, pharmacists, therapists and other health professionals.
By the end of 2009, some 222 primary care teams had been established; however, the report notes that many of these do not have a physical base. The HSE’s counting of such “virtual” teams as functioning ones has been a source of frustration for the healthcare professionals involved. It is difficult to provide effective care for patients unless team members have a single location to work from. And while the HSE claims it is on target to have about 540 primary care teams in place by the end of 2011, any measurement of progress must count only those teams providing real integrated services to patients, and not teams that have yet to progress beyond a notional status. Concern has also been expressed about a HSE decision to base team catchment areas on rigid electoral districts.
The report warns of a serious family doctor manpower crisis if GP training places are not increased to a minimum of 150 places a year – “a failure to do this is likely to increase waiting lists and put a greater burden on hospital emergency departments”, it says. With no increase in training places, a shortage of more than 300 GPs by 2021 is predicted, which would leave a significant percentage of the population unable to access basic medical care. An expanded role for nurses and community pharmacists, especially in the area of chronic disease management, is an important element of primary care development. There is also a need for diagnostic services to be developed in the community, enabling people who need X-rays, ultrasounds and blood tests to avoid hospital attendance.
International evidence is clear: countries with the most comprehensive primary care systems tend to have lower costs, lower death rates and have citizens who enjoy a longer life expectancy. Healthcare funding must therefore “follow the patient”, with the transfer of funding to primary care where the patient journey begins.