Naoise Ó Muirí (Dublin Bay North, Fine Gael)
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9. To ask the Minister for Health the status of the chronic disease Mmnagement programme; the number of patients now enrolled; and if she will make a statement on the matter. [34666/25]

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The GP chronic disease management programme commenced in 2020 and has been rolled out on a phased basis over four years to adults with either a medical card or, for GMS patients, a GP visit card. The aim of the programme is to prevent and manage chronic diseases. Since 2020, over 680,000 patients have been registered on the programme, including those who have exited the programme. Some 91% of patients now receive routine care in community settings, reducing their reliance on hospitals. An ICGP study found that for patients enrolled in the treatment programme, there were 30% fewer emergency department attendances, 26% fewer hospital admissions and 33% fewer GP out-of-hours attendances compared with their pre-enrolment rates.

The majority of patients manage their conditions through the GP chronic disease management programme. In addition, the 26 operational community specialist teams for chronic disease management, linking the care pathways between acute and community services, are delivering services from integrated care hubs located in or adjacent to primary care centres. They are fantastic. In 2024, over 354,000 patient contacts were provided by community specialist teams for chronic disease management, about 55% ahead of target, and this year to the end of quarter 1, 108,000 patient contacts had already been provided by these teams, which is about 30% ahead of target.

The conditions covered by the programme are type 2 diabetes; asthma; chronic obstructive pulmonary disease, COPD; and cardiovascular disease. The treatment programme supports patients in managing their chronic conditions. Patients receive two reviews in a 12-month period, with each review including a practice nurse and a GP visit. GMS patients over 45 years of age found to be at high risk of cardiovascular disease or diabetes are enrolled in the prevention programme and receive one annual review. The prevention programme was expanded from 30 November 2023 to include adult GMS patients with hypertension and all women who have had a diagnosis of gestational diabetes or pre-eclampsia since 1 January 2023.

Naoise Ó Muirí (Dublin Bay North, Fine Gael)
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I am looking at this programme and it seems to be a quiet success story for the HSE. We hear very little about it. The Minister mentioned statistics regarding fewer presentations at emergency departments. That is a very good measure of success. The Minister mentioned some additional conditions that will be brought into it. I think she mentioned hypertension. It would be useful to have that list.

I see from the HSE's report that the overall uptake is pretty good but it is probably behind for younger sufferers, mainly because it has not been open to them for as long. Are there plans to promote it or make those patients aware they have this option? It is a very good option for those patients.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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That is right. It impacts early detection as well. As populations age - which ours is doing - the prevalence of chronic conditions, including multimorbidity, rises. Early protection through the chronic disease management programme prevents the need for more intensive hospital-based treatments. Since 2020, 51% of the new chronic disease diagnoses have been made through elements of this programme. It is not just treating more effectively; it is diagnosing more effectively and being able to divert attention to prevention and early intervention.

As regards expansion of the scheme, a further expansion of the programme to include chronic kidney disease is planned for the end of the year, and further expansion would include rigorous clinical assessment and engagement with stakeholders. Not all chronic conditions can be managed in that way and it is important to recognise the capacity of general practice and how we are trying to grow general practice at the same time. I have listed a number of conditions but I also want to flag that, for example, the Benbulbin hub in Sligo treats a range of different illnesses and it is separate from the hospital, and again and again, prevents hospital attendances.