John Gormley (Dublin South East, Green Party)
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Question 395: To ask the Minister for Health and Children the details of the pilot primary care initiatives that have been implemented as part of the national health strategy 2001, specifically the costs, the difficulties in implementation, the duration of the pilot schemes and the way in which the pilot schemes will be generalised for other parts of the country. [2985/04]

Micheál Martin (Cork South Central, Fianna Fail)
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The strategy "Primary Care: A New Direction" provides for the establishment of a number of primary care teams on the basis of the principal features of the integrated interdisciplinary model described in the strategy. These are not pilot projects and they represent the first phase of implementation. The experience of these implementation projects will allow the model to be rolled out in a manner that draws on experience gained and enables all relevant professional and user stakeholders to participate in shaping its more detailed aspects. The strategy committed to the refinement and development of the model by agreement through the joint learning for which these initial implementation projects will allow.

In October 2002 I gave approval to the establishment of ten primary care implementation projects — one in each health board area. These projects are building on the services and resources already in place in the locations involved so as to develop a primary care team in line with the interdisciplinary model described in the strategy. The spread of locations, ranging from the centre-city urban areas to dispersed rural communities, has been chosen to reflect the variety of circumstances around the country in which primary care services must be delivered and to explore, in a practical way, how primary care teams will operate. Each location has its own intrinsic challenges and each primary care team will have to adapt to the needs of the area and community it serves.

The locations of the ten implementation projects are:

In 2002, initial revenue funding of €877,000 was provided. In 2003, an additional €3.623 million in revenue funding was provided on an ongoing basis. This brought the total annual revenue funding to €4.5 million.

In 2004, I have provided an additional €990,000 to the health boards on an ongoing basis in respect of implementation of the primary care strategy and health boards may, if necessary, use this to meet any additional revenue costs associated with the primary care teams. In 2002 I provided funding of €1 million to support information and communications technology developments for the implementation projects, and a total of €2 million to facilitate minor capital works.

There has been substantial progress to date with the development of primary care teams in the chosen locations. However, it must be recognised that moving to the interdisciplinary model of service delivery poses a range of challenges for both the health professionals involved and for the health boards, who have the responsibility for leading the developments. The range of issues which must be worked through as part of the development process includes: developing the team and agreeing team working processes; enrolling clients with the team; managing direct patient access to team members; appointment of additional staff; ensuring that all team members are providing services to the same population; involving the community in the development process; and addressing information and communications technology needs.

All of these issues need to be worked through in detail and this process must involve those who will be working directly as members of the team. In several cases a number of the additional staff members required to enable the teams to deliver the full range of planned services have been appointed. Health boards must ensure that in appointing additional staff they do not exceed their authorised employment numbers and in a number of instances this has been cited as having delayed the putting in place of the full primary care team.

Projects are at different stages of development, with a number already providing new or enhanced primary care services to their target populations. Even at this early stage, some of the benefits, which were anticipated for both service users and providers, are, I understand, becoming evident in these cases, as new or improved primary care services are developed. Areas which are the focus of early efforts to provide new or enhanced services include physiotherapy, which has traditionally been provided as a hospital out-patient service, shared care arrangements with the general hospitals, and the development of social work services which will focus on general family support needs. I would like to take this opportunity to acknowledge the commitment of the frontline health professionals and the health board administrative staff who have devoted considerable effort to the development of the teams to date.

The primary care strategy acknowledged that the current health board structures are not optimised to support the development and reorganisation necessary to implement the new primary care model on a widespread basis. The new structures being developed under the health service reform programme will ensure that the system is organised and managed to support the development and implementation of the health strategy, including the primary care strategy. The structures will be designed to achieve consistent and comprehensive implementation of national policy and to manage and drive the establishment of primary care teams and networks as the standard model of service delivery. The experience gained in the initial group of implementation projects will provide valuable learning, which can inform the wider implementation to follow.

The primary care strategy also indicated that a significant component of the development of primary care teams, in the short to medium term, would involve the reorientation of existing staff and resources. In 2003 my Department requested the health boards to examine how the existing primary and community care resources can best be reorganised, so as to give effect to the application of the team working concept, as described in the strategy, on a wider basis and to map out the geographical areas to be served by primary care teams in the future. The health boards have also been asked to undertake a high-level needs assessment for primary care, which will help to inform this planning task.

The primary care strategy recognises that the provision of modern, well-equipped, accessible premises will be central to the effective functioning of the primary care team. One of the Government's key objectives is to facilitate and encourage the development, where appropriate, of modern, well-equipped, user-friendly buildings in which the broad range of primary care services, including general practice, can be delivered. The strategy also emphasises the need to gain full benefit from existing buildings and to fully exploit any opportunities for public-private partnerships in implementing the development programme. I am committed to developing policy in such a way as to maximise the opportunities to attract private sector interests into the provision of facilities to support delivery of primary care service in accordance with the new interdisciplinary model.