Primary Care - Priorities for Future

1. Primary Care – Priorities for
Future
PRIMARY CARE CONFERENCE
Brian Murphy
Head of Planning, Performance & Programme
Management
Primary Care
19th November 2014

2. Overall Objective
 A more balanced, Integrated Health Service
 More healthcare in Primary and Community
settings
 Strong on Safety & Quality
 Strong on Access
 Improved Customer service
 Good value for money

3. Overview of Integrated Health
System
Acute Care
Acute Care
Acute Care
Primary Care
Primary, Community
and
Continuing Care
Primary, Community
Continuing Care
Self Self Care
Self Care
No No Care Care Requirement
No Care Requirement
Internal hospital processes are optimised to
support high quality care, reduce patient delay
and maximise use of the bed stock
The nature, capacity and availability of responsive
community based services is configured to avoid
unnecessary admissions to acute care and to
facilitate earlier discharge and a return to
independence
Patients are involved in their own care of minor,
acute and long term conditions –
with professionals providing a supportive,
advisory, educational and skills training role
There is an emphasis on illness prevention, early
detection and early intervention

4. Policy Influencers

5. Some Policy Documents & Papers
 Primary Care – A New Direction
 Community Healthcare Organisations
 Healthy Ireland
 Future Health - A Strategic Framework for Reform of the Health
Service 2012 – 2015
 The Path to Universal Health Care
 E-Health Strategy for Ireland
 The Establishment of Hospital Groups as a transition to
Independent Hospital Trusts
 Primary Health Care - Now More Than Ever – World Health
Organisation
 National Standards for Safer Better Healthcare
 Corporate Plan/ Service Plan/ Operational Plan

6. Primary Care Division
Includes:
 Primary Care Services
 Primary Care Reimbursement Service (PCRS)
 GP Out of Hours
 Social Inclusion Services
 Oral Health
 Medicines Management
 Civil Registration

7. Finance and HR – 2015
Finance
Primary Care Division €3.36b
Contracted providers GPs, Pharmacies, Optometrists etc.
WTE (September 2014)
7,000
9,323

8. Primary Care - Key Priorities for 2015
Primary Care
 Improve access to primary care services and reduce waiting lists and waiting times
 Implement models of care for chronic illness management
 Implement service integration measures to reduce the reliance on acute hospitals and
reduce the number of delayed discharges
 Extend the coverage of community intervention teams and improve access to primary
diagnostics
 Enhance oral health and orthodontics services
 Roll out the community oncology programme
PCRS
 Extend access to GP care without fees to children under 6 years and adults over 70
years
 Introduce service improvements in relation to medical card eligibility assessment and
manage medical card provision and reimbursement
 Develop further medicine management programme
Social Inclusion
 Improve health outcomes for persons with addiction
 Contribute to reductions in levels of homelessness
 Enhance the provision of primary care services to vulnerable and disadvantaged
groups

9. COMMUNITY INTERVENTION
TEAMS
WHAT ARE THEY?
 Nurse led service providing care for the
patient in their home/community
 Service supports early discharge,
admission avoidance & reduces costs
 Standard of care provided must be of
equal, if not higher, quality than usual
standard (often inpatient) care.
8 CITs in Ireland
Dublin South
Dublin North
Carlow/Kilkenny
Limerick
Tipperary
Clare
Cork
Galway

10. Services Provided by CITs that
support Early Discharge
 Intravenous Treatment – OPAT – short & long courses
 Blood & Fluid Management
 Patient care such as acute anticoagulation & urinary related care
 End of Life Care
 Other medical conditions such as COPD & Diabetes

11. CIT Total Referrals & Bed Days
Saved

12. Sample Activity Targets 2015 - Summary
Primary Care
 960,000 Out of Hours GP contacts
 26,000 referrals to Community Intervention Teams
 754,000 Physiotherapy patient contacts
 230,000 Occupational Therapy patient contacts
 22,000 Orthodontic patients in treatment
PCRS
 1.7m medical card holders
 412,000+ GPV card holders
 2.4m DPS claims
 18.6 million prescriptions
 1.4m Dental Treatments (DTSS – complex & routine)
 848,000 Community Ophthalmic Treatments (adults & children)
Social Inclusion
 9,400 Opioid substitute treatments
 1,200 Needle Exchange Packs
 1,440 Hep C Assessment of Needs offered (State infected)

13. Specific Developments 2015
Primary Care
 GP access - children aged 0 - 6 years and over 70s
 Implementation of Community Healthcare Organisations
 Reduce waiting times for assessment and treatment (therapy
services, orthodontics)
 Expand Community Intervention Team activity & OPAT services
 Support discharge of Complex patients/ Special Care Babies
 Review Community Demand-led Schemes
 Chronic Disease Prevention and Management
 Improve Ultrasound access
 Commence implementation of Electronic Patient Management
System & Individual Health Identifier
 Dental and Oral Health Initiatives
 Secure Email Roll out
 Preparation for National Standards for Safer Better Healthcare

14. COMMUNITY HEALTHCARE
ORGANISATIONS
 9 Community Healthcare Organisations
(CHOs)
 90 Primary Care Networks
 100 GPs involved in Business and Clinical
Management

15. Specific Developments 2015
(contd)
Social Inclusion
 National Drugs Strategy – implement actions on early intervention, treatment
and rehabilitation
 Opioid Treatment Protocol – implement recommendations
 Tier 4 Report – implement recommendations
 Pharmacy Needle Exchange
 Implement Clinical Governance Framework for Addiction Services
PCRS
 Implement first phase of universal GP Service – 0-6 year olds and Over 70s.
 Improve the operation of the GMS Scheme on foot of the Report of the
Medical Card Process Review and the Report of the Expert Panel on Medical
Need and Medical Card Eligibility
 Provide newly licensed Hep C drugs
 Medicines Management – Achieve Reference pricing and generic substitution
targets
 Data sharing – Revenue Commissioners and Dept of Social Protection

16. CAPITAL DEVELOPMENTS –
Primary Care Centres
 Exchequer funding
 PPP
 Operational Lease model
 Expressions of interest now being sought to
advance further primary care infrastructure

18. Enablers
 Management and Clinical Governance Structures
 Fit for purpose Contracts
 GP Training and GP Manpower
 Clinical Programmes
 Electronic Patient Management System/ Individual Health
Identifier
 Service Integration / Discharge Planning / CIT
 Health Needs Assessments and Service User Involvement
 Managing Culture and Relationship Building

19. Key Messages
 Safety and Quality
 Prepare for HIQA Standards
 Develop safety and risk structures
 Develop quality indicators
 Implement investigation report recommendations
 Conduct audits of performance
 Access and Patient Centred
 Reduce waiting times
 Improve access
 Improve integration
 Efficiency and Productivity
 Re-engineer work processes and practices
 Introduce Model change
 Productivity ratios
 Technology
 Patient Management System
 Electronic GP referrals
 Health identifier initiative
 Secure email

20. THANK YOU