Mr. Seamus McCarthy:

The HSE reports that, as of March 2019, there were 127 operational PCCs in Ireland. In simple numeric terms, this is just over one third of the network originally envisaged. A target timeframe for the delivery of the centres has not been set. If delivery continues at the current rate, it is estimated that it will take at least a further 20 years to develop the full network.

We sought information from the HSE on the size of the existing centres, the staff deployed to each, the nature of the services provided, the procurement method and the cost. This type of information was not available centrally, so information relating to the premises and their procurement was compiled manually from multiple sources across the HSE. We could not get a clear picture of the range of services offered.

A key finding that emerged is that there is currently no formal definition of a primary care centre in terms of the core services to be accommodated. The HSE currently defines a PCC in very broad terms which encompass pre-existing and new buildings, stand-alone centres and centres co-located with other services such as community hospitals. The absence of a clear definition of what constitutes a primary care centre hinders meaningful tracking and reporting of progress.

In 2011, the HSE carried out a detailed assessment, which identified 297 potential locations for delivery of PCCs, in addition to the 43 operating at the end of 2010. The HSE ranked all 340 locations in order of priority for delivery or development, based on assessments of local service need, existing infrastructure and the level of deprivation in the catchment area. That ranking has not been revisited by the HSE since 2012, despite significant changes in population and economic conditions.

Some 27 PCCs were brought into operation in 2011 and 2012. Following the HSE’s location ranking exercise, a further 57 centres were delivered between 2013 and March 2019, but the delivery of these centres has not followed the ranked order of priority. As a result, almost half of the 50 locations ranked with highest priority in 2012 were recorded in March 2019 as being at "early planning" stage, or had no indication of progress in the delivery of a centre.

The HSE has used three main models for procurement of the centres delivered since 2013, namely, direct commissioning of a building by the HSE; long-term leasing from local developers and-or investors; and a public private partnership, PPP, to build and make available a bundle of 14 care centres on HSE-owned sites. The various delivery models have very different cost structures, making any comparison of the costs and benefits of each option difficult. Given the volume of delivery over the past five years or so, it would be opportune for the HSE to undertake a formal cost-effectiveness comparison of the different procurement methods.

The original model outlined for primary care delivery envisaged that each PCC would accommodate one or more core primary care teams, supported by a wider network of health and social care professionals, as outlined in figure 15.1 of this chapter of the report. However, as the HSE does not currently have an integrated reporting system, specific information is not available on the number and mix of teams in each operational centre, the numbers of filled and vacant posts, or the types of services being provided by the teams. For the purposes of this examination, the HSE reported that, as of July 2019, there were 421 primary care teams in place, of which only about 56% had direct GP involvement. As shown in figure 15.13, most community healthcare organisation, CHO, areas do not have the planned number of primary care teams. Only Dublin north CHO has the target number of teams with GP involvement.

The report makes four recommendations in regard to the management and monitoring of the development of primary care centres. These recommendations have been accepted by the Department of Health and the HSE, which will be able to provide members with an update on their implementation.