Making primary care the primary focus

There is hope at last that our dysfunctional health system might be fixed. I say system, not services, because by and large the services are as good as anywhere in Europe if people can get access to them.

The disconnect, snail’s-pace development of primary care and overreliance on hospital services are the main system problems. Last week, Prof Michael O’Keeffe, an eye specialist in Temple Street Hospital, estimated that more than 4,000 children a year are referred to the hospital unnecessarily because community services are inadequate. “Children are not being treated in the community and are being dumped on to our outpatients [department]”.Waiting lists for eye services are now longer than 12 months.

The decision by Minister for Health Leo Varadkar to concentrate on providing universal GP and primary care services before putting in place a plan for universal health insurance is the right one. As the Minister put it: "We have a health service that's about treating disease and doing so in hospitals, whereas we should be trying to move towards a health service that's about keeping people well and treating them by and large in the community."

I couldn't agree more. Universal access to primary care will solve most of the problems that beset the health sector in one fell swoop.The language used by the Minister is new because he wants universal access to a wide range of primary care services, not just GP, including: optical and dental services; minor surgery; physiotherapy; public health nursing and treatment of chronic disease. According to the Minister: "If we don't get a handle on those things [diabetes, obesity, chronic heart and lung disease, and asthma] not only will it overwhelm our health service and our own health as people, it will overwhelm our economy as well."


Primary care services Every m

inister for health and every strategy document over the past 40 years has called for the development of comprehensive primary care services. In 2001, the Health Strategy: Quality and Fairness – A Health System for You said: "Primary care services will undergo major development to deliver an integrated community-based service, accessible to all on a round-the-clock basis".

This did not happen. During every one of the almost 38 years I worked in the health sector, acute hospitals overspent and used up funding earmarked for developments in primary and community care. The HSE 2014 National Service Plan shows that less than a quarter of the overall health budget is allocated to primary care, and most of that is spent on drugs. A staggering 66 million prescription items are expected to be dispensed to medical-card patients alone in 2014.

There is hope now that comprehensive primary care services will finally be put in place. The main challenge will be persuading the public that these services have more than enough expertise to meet their needs. Most people believe hospital services must be better and feel short-changed if they are not referred to a consultant. Citizens are loyal to their local hospitals which, to them, represent safety and security. They do not see primary care in the same way and a majority of people see primary care as the GP.

Other services are something called “community care”, available to some older people and people with disabilities. Primary care is thought of as the place to go for a prescription, not an experience capable of promoting health, preventing disease and dealing with 80 per cent of chronic health problems. If the public are expected to believe in and pay for primary care in the same way they believe in and pay for hospitals, then primary care needs to be repackaged and rebranded.

Varadkar was minister for transport, tourism and sport when Fáilte Ireland repackaged and rebranded the west coast of Ireland as the Wild Atlantic Way. Everything was there already: scenery, walks and so on. All that was needed was to pull it together and offer a joined-up experience. The signs for the Atlantic way are great. Can primary care be repackaged and rebranded in a similar fashion? Like the Atlantic way, almost everything is there already. Just think of the signs used by the health sector; often incomprehensible, sometimes no more than a sheet of paper sellotaped to a door, or nameplates for standalone services. All primary care services need the same sign. Signs will not produce more services but will at least start people thinking about primary care as a coherent whole.

Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council.