Wednesday, 26 April 2006
Departmental Strategy Statements.
Question 51: To ask the Tánaiste and Minister for Health and Children if actions 4 and 5 of table 3 of the primary health care strategy remain her policy; the progress to date on achieving these actions; and if she will make a statement on the matter. [15608/06]
The Government is fully committed to the implementation of the principles contained in the primary care strategy and this includes the development of primary care teams and networks. The implementation process at operational level is a function of the HSE, whose chief executive officer has identified as a priority the development of multidisciplinary primary care teams. The 2006 Estimate for the HSE includes an additional €10 million in revenue funding to enable the establishment of up to 100 new primary care teams. This will enable the provision of 300 additional front-line personnel to work alongside GPs to provide integrated and accessible services in the community. Work by the HSE to establish these teams is under way. In planning for the establishment of these teams, the executive intends to focus where possible on areas of disadvantage and with significant health inequalities.
I am encouraged to learn that in excess of 1,000 general practitioners have responded positively to an invitation from the HSE seeking expressions of interest. Following the identification by the executive of the GPs to be involved in the development of the teams, work will be required to realign HSE services to give best efficiencies for teamwork and to determine ideal team compositions to meet the needs of identified areas.
Ongoing implementation of the primary care strategy will focus on the reorganisation of the resources already available. This whole-system approach to implementation means change will be required in many sectors in the health service and not solely within primary care.
It is difficult to know where to start regarding this report. Much of this stems from what Mr. Derek Davis said at the IMO conference and the Tánaiste's comments afterwards criticising GPs. Again she was acting as if she was an outsider and not involved. As legislators we have responsibility for patients with medical cards and a moral responsibility for private patients. What will the Tánaiste do to ensure the country has a GP service in five years' time? This is the next crisis brewing after that in accident and emergency services. Medical card patients have difficulty in accessing GPs in some areas, which usually indicates the start of a developing crisis. It will soon start to affect private patients.
Where does the Tánaiste stand regarding the primary care strategy? We seem to be back at square one. When the former Minister for Health and Children, Deputy Martin, announced the primary care strategy in 2001, he said that 60 primary care teams would be established within five years. The Tánaiste is now making the same promise to establish 75 primary care teams five years later. When the primary care strategy was published it was a ten-year plan. Is it Government policy that it is now a 15-year plan because nothing has been done in the past five years?
The Tánaiste needs to be honest in admitting that there is a major problem in general practice and in primary care. The Tánaiste has said that GPs are not available outside of office hours and are not on call. However, Members of this House have a responsibility for one third of the population with medical cards. It is not good enough simply to pass the buck on the matter. We must determine what the Government has or has not done in this case and what it will do to correct this problem. There is no point in us coming back to the House in three years' time with the same crisis in general practice as exists in the accident and emergency service now. Accident and emergency units only cater for 3,000 patients per day whereas general practice deals with 20,000. We cannot blame the people working in the area. As the Tánaiste indicated, 1,000 GPs applied for these new posts.
I will tell the Deputy what we are doing. This year current expenditure on health care will be €12 billion, €7 billion of which will be on primary continuing community care. Of the €7 billion, primary care and community health services get approximately €3.2 billion, which is a considerable amount of money. We are trying to strengthen the personnel and expertise available to general practitioners. As the Deputy will be aware, we made provision this year for 300 people, including physiotherapists and other therapists to be made available to primary care teams.
We also need to improve the organisation of services on the ground. At the moment, when leaving a hospital a patient's case will be reviewed by a hospital's occupational therapist. However, the occupational therapist in the community needs to go to the patient's house and those people rarely meet or talk to each other. The HSE is seeking to bring many people together. Let us consider the recently opened Ballymun health centre. Instead of people operating in many different offices in the area, they are now together. The same number of people can now provide a much better service. I understand one of the public health nurses has said that since moving to the new centre, she now spends approximately 10% of her time on the phone as opposed to the 25% she used to spend trying to talk to other colleagues. Much of what needs to be done involves bringing together the existing people on the ground. We are also increasing the number of university places for medical students and the number of training places for general practitioners. We intend to introduce graduate entry into medical school from the 2007 academic year. We are reducing the number of points required to 450, although we are still talking about the top group because the top 16% of students who do the leaving certificate get 450 points or more. We are investing in more clinical placements with a view to increasing the number of people who intend to pursue medicine as a career. It is obvious that a new contract of employment is being negotiated with the Irish Medical Organisation, which is working on behalf of general practitioners. I am a strong fan of trying to empower general practitioners to have a greater role, particularly in respect of things like chronic illness and smear testing which are more appropriate for primary care. It is clear that we have to put in place a contract of employment that incentivises that happening at that level.
I am also a great fan of things being done at primary care level, but we do not have the personnel. I am sure the Tánaiste is aware that a small percentage of patients are having difficulty in accessing general practice. This is the beginning of the problem. It takes four or five years to train a general practitioner. If we wait that long, it will not be good enough. I would like the Government to propose how we can correct the manpower problem that is starting to lead to problems in accessing services.
We need to ensure we do not limit the number of people who can access general medical service contracts, which is something we have done. I regularly meet doctors who would love to have general medical service practices, but are prohibited from doing so under the current rules which were agreed with the IMO. I met two such doctors last week. We have to use our existing capacity as best we can. I share the view that was expressed by the Deputy. It is clear there will be a focus on primary care in the future. I understand there are approximately 18 million contacts between doctors and patients under the general medical service each year. When one considers that approximately 1.1 million people have medical cards, it is clear that each of them makes an average of almost 18 visits each year. There is a huge level of contact between doctors and patients at that level. It is clear we have to resource the general medical service, in which the greatest amount of activity takes place, in a better manner.