Dr. Marita O'Brien:

In response to Deputy's Michael Harty's questions I would add a further point about capacity in primary care services. The Health Research Board produced an interesting report on the integration of health and social care services. It examined different ways of providing for a more integrated approach, especially in health and social care services. It gave good examples of measures such as capitation. If capitation was provided for local populations in primary care centres, they would have to manage people's health from the cradle to the grave. Therefore, they would be incentivised to take prevention measures into account, intervene earlier rather than wait until crisis point was reached when people would end up having to enter the acute care system.

It is a more locally developed approach at a local area level, a population based health model but with a local based approach to it. There are some examples of that in Australia.

There is reference in the report to the Kaiser Permanente Medical Group, a not-for-profit group in the US, that take this type of approach and it seems to have very good outcomes on evaluation. There are a few different examples given in that report. Taking that approach, it must be based at a community level because, as Mr. Paul Gordon pointed out, different communities have different needs. In a disadvantaged area, the approach would have to be at a community level and account would have to be taken of providing for the particular needs of the population.