Dr. David Molony MPHC Mallow 13/6/2013

Can Primary Care really make a difference to the Irish health service? Role of Primary Care Can Primary Care really make a difference to the Irish health service?

Role of Primary Care Definition of Primary Care Composition of Primary Care General Practice Activity Patient Pathway Primary Care Strategy 2001- Process of Change Obstacles to Progress Potentials of Primary Care Examples of Change Can Supported Primary Care Deliver?

Primary Care (term from Dawson Report 1920 UK) Primary Care is the first level of medical intervention—ie Pre-hospital care Secondary Care is hospital intervention with potential overnight stay Tertiary Care is Specialist Hospital care

Role of Primary Care Definition of Primary Care Composition of Primary Care General Practice Activity Patient Pathway Primary Care Strategy 2001- Process of Change Obstacles to Progress Potentials of Primary Care Examples of Change Can Supported Primary Care Deliver?

Primary Care 2,600 GPs + 500 other GPs 280 Training Registrars >1,200 Practice Nurses 3-4,000 administration staff HSE pre hospital services- 4,000 PHN, HSE Community Specialists-Physio, OT, S&L, Psychology, Podiatry etc. HSE Administrative staff Private Community Specialists –mirror HSE

Role of Primary Care Definition of Primary Care Composition of Primary Care General Practice Activity Patient Pathway Primary Care Strategy 2001- Process of Change Obstacles to Progress Potentials of Primary Care Examples of Change Can Supported Primary Care Deliver?

General Practice Activity-currently 44% GMS (GP + HSE cover) 56% Private (no HSE cover) 21,000,000+ consultations/yr.-100% pop, >90% satisfaction.24/7, 365, same day presentation, Co-Op contribution, refer 10% hosp (½ for diagnostics), CDM.

Role of Primary Care Definition of Primary Care Composition of Primary Care General Practice Activity Patient Pathway Primary Care Strategy 2001- Process of Change Obstacles to Progress Potentials of Primary Care Examples of Change Can Supported Primary Care Deliver?

Patient Pathway GP Gatekeeper role 21,000,000+ Primary Care 19,000,000 Full treatment Secondary Care 1,000,000 diagnostics Hosp. Stay, OPD, Tertiary Care Specialist services 2,000,000 19,000,000

Role of Primary Care Definition of Primary Care Composition of Primary Care General Practice Activity Patient Pathway Primary Care Strategy 2001- Process of Change Obstacles to Progress Potentials of Primary Care Examples of Change Can Supported Primary Care Deliver?

Primary Care Strategy-2001 Provide 90-95% healthcare needs. Patient centred care, near patient, community emphasis, Flexible hours. Primary Care Teams—7-8,000 patients, co- operation, deliver care eg EARLI Study in MPHC. Ease pressure on hospitals and let them achieve their aims.

Role of Primary Care Definition of Primary Care Composition of Primary Care General Practice Activity Patient Pathway Primary Care Strategy 2001- Process of Change Obstacles to Progress Potentials of Primary Care Examples of Change Can Supported Primary Care Deliver?

Process of Change

Role of Primary Care Definition of Primary Care Composition of Primary Care General Practice Activity Patient Pathway Primary Care Strategy 2001- Process of Change Obstacles to Progress Potentials of Primary Care Examples of Change Can Supported Primary Care Deliver?

Obstacles to Progress 1970 Health Act GMS Contract Private Insurance Silo Mentality Universal Health Identifier Moving Hospital Staff to PC. Health delivery decided by money Responsibility separated Political Will Lack of Competition-protectionism Antagonism to SMEs –Public/Private

Role of Primary Care Definition of Primary Care Composition of Primary Care General Practice Activity Patient Pathway Primary Care Strategy 2001- Process of Change Obstacles to Progress Potentials of Primary Care Examples of Change Can Supported Primary Care Deliver?

Potential of Primary Care Under Utilised resources-staff, sites, Under Utilised skills- Drs/PN/Others Low cost (30-50% cost of same in Hospital – international figures) >90% GP Practices computerised Complete Medical Record in GP 1500 GP+HSE Sites in all communities Primary Care Teams (EARLI) CDM—80% all healthcare Proven delivery system 4-6% budget shift could solve

Role of Primary Care Definition of Primary Care Composition of Primary Care General Practice Activity Patient Pathway Primary Care Strategy 2001- Process of Change Obstacles to Progress Potentials of Primary Care Examples of Change Can Supported Primary Care Deliver?

Examples of Change Proposed National Diabetes programme Audited model delivering Midlands, DiGP Cork Ready to roll out Retinopathy Screening Hosp OPD Optometrist, cost €45. Ultrasound in Primary Care Cost €100 Saves 3 OPD visits, 10-12 week delay-cost €1,100

Examples of Change Review of 35 Punch & Excision Biopsies in Primary Care 2011 ½ Malignant or Pre-malignant—11  Plastics for wider excision = 22 visits to hospital Normally 35  Plastics/Dermatology 3 visits- assess, do & review =105 Saving of 83 Hospital visits, around €40,000.

Examples of Change Warfarin Clinic MPHC Old system-12 steps, Blood to hospital—TTR 51% New Computerised system- 5min appt, near testing & immediate computerised assisted result—TTR 67% Patient pays—90% satisfaction CUH saved 5,000 tests pa but keep the resource

Role of Primary Care Definition of Primary Care Composition of Primary Care General Practice Activity Patient Pathway Primary Care Strategy 2001- Process of Change Obstacles to Progress Potentials of Primary Care Examples of Change Can Supported Primary Care Deliver?

Can Supported Primary Care deliver to the Irish Health Service? YES IT CAN Keep hospital referrals down. Allow hospitals to do what they are designed to do. Immediately bring CDM and it’s benefits. Provide care near to patient, at lower cost and more effectively. Change the system from CRISIS management to HEALTH DELIVERY.